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We described the development of T1D incidence from 2012 to 2021 and compared the incidence of the pre-pandemic period (2012\u20132019) with the pandemic period (2020\u20132021) in Bavaria, Germany. Routinely collected health claims from the Bavarian Association of Statutory Health Insurance Physicians (KVB), covering a population of 2\u00a0million children and adolescents (aged\u2009\u2264\u200919 years), were used. All cases of newly diagnosed T1D (ICD-10-GM E10) were included. Sex-specific annual and quarterly crude incidence rates (CIR) and age-standardized incidence rates (ASIR) were calculated. Sex-specific CIRs were calculated by 5-year age groups. Interrupted time series analysis was used to analyze trend changes in the pandemic versus the pre-pandemic period. From 2012 to 2021, 5,762 incident cases were identified in Bavaria. Overall, an increasing incidence was observed with an average annual increase of 3.7% in females (from 23.5 in 2012 to 32.5 per 100,000 person-years (py) in 2021) and 5.0% in males (from 25.2 to 38.9 per 100,000 py). The increase was highest in age groups 0\u20134 (12.4%) in males and 15\u201319 (8.5%) in females. Regression analysis showed no clear level or slope change in T1D incidence for both sexes during the pandemic period. When accounting for non-linear trends, a statistically significant level change was observed for females during the pandemic period (\u00df=7.66, 95% CI 0.23, 15.09), suggesting a potential association for females. The increasing T1D incidence in Bavarian youth from 2012 to 2021 highlights the importance of incidence surveillance.<\/jats:p>","DOI":"10.1007\/s10654-026-01417-y","type":"journal-article","created":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T09:21:17Z","timestamp":1780392077000},"page":"881-892","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Increasing incidence of type 1 diabetes in children and adolescents from 2012 to 2021 in Germany: trends before and during the COVID-19 pandemic"],"prefix":"10.1007","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-5628-6631","authenticated-orcid":false,"given":"Carolin T.","family":"Lehner","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3671-725X","authenticated-orcid":false,"given":"Ivona","family":"Anastasova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0392-1580","authenticated-orcid":false,"given":"Gunther","family":"Schauberger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6584-3197","authenticated-orcid":false,"given":"Marian","family":"Eberl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5222-2348","authenticated-orcid":false,"given":"Florian","family":"Schederecker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Tauscher","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roman","family":"Gerlach","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3523-1362","authenticated-orcid":false,"given":"Stefanie J.","family":"Klug","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,6,2]]},"reference":[{"issue":"10138","key":"1417_CR1","doi-asserted-by":"publisher","first-page":"2449","DOI":"10.1016\/s0140-6736(18)31320-5","volume":"391","author":"LA DiMeglio","year":"2018","unstructured":"DiMeglio LA, Evans-Molina C, Oram RA. 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