New-onset pediatric type 2 diabetes cases increase 182% during first year of COVID-19
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There was a significant increase in the number of cases of new-onset type 2 diabetes among children during the first 9 months of the COVID-19 pandemic, especially among boys and Black youths, according to a speaker.
According to a retrospective analysis of data from the Children’s National Hospital in Washington, D.C., new cases of type 2 diabetes increased 182% in the first year of the COVID-19 pandemic compared with the year prior, and there was also a large increase in diabetic ketoacidosis and hyperosmolar DKA.
“These changes in the number of cases and severity of presentation disproportionately impacted non-Hispanic Black youth, calling attention to the potential for the pandemic to worsen preexisting health disparities,” Brynn E. Marks, MD, MSHPEd, assistant professor of pediatrics at the George Washington University School of Medicine and Health Sciences, attending physician in the division of endocrinology, and assistant director of the pediatric endocrinology fellowship program at Children’s National Hospital, told Healio.
Marks and colleagues conducted a retrospective cross-sectional review of youths aged 21 years or younger diagnosed with new-onset type 2 diabetes during the COVID-19 pandemic from March 11, 2020, to March 10, 2021, at Children’s National Hospital. These data were compared with those from the year before the pandemic from March 11, 2019, to March 10, 2020. Youths were classified as having type 2 diabetes if all pancreatic autoantibodies were negative, the BMI z score was 1.64 or greater, and the patient did not present in DKA at diagnosis. Chart review was conducted to confirm the diagnosis for youths meeting these criteria and to determine the type of diabetes for those not meeting these criteria.
The findings were presented at the virtual American Diabetes Association Scientific Sessions.
Diabetes diagnoses increase for boys, Black youths
New cases of type 2 diabetes increased from 50 in the year before the pandemic to 141 during the first year of the pandemic (P < .001). Although 58% of new type 2 diabetes cases were in girls before the pandemic, that percentage dropped to 41.1% during the pandemic (P = .048). In an analysis of cases by race, non-Hispanic Black youths had the largest increase, from 29 cases in the year before the pandemic to 108 during COVID-19. Pre-pandemic, 58% of all new-onset type 2 diabetes cases were in Black youths. That percentage increased to 76.7% during the pandemic.
Those with new-onset type 2 diabetes during the pandemic had a higher HbA1c compared with those who were diagnosed before the pandemic (10% vs. 9.3%; P = .077). Of those diagnosed during the pandemic, 60.3% required inpatient diabetes management, due to severe hyperglycemia or ketosis, compared with 36% of those diagnosed before the pandemic (P = .005).
More DKA during COVID-19
The percentage of youths with new-onset type 2 diabetes presenting with DKA increased from 4% pre-pandemic to 23.4% during the pandemic (P = .001). Of the 33 DKA cases recorded during the pandemic, 31 were in Black youths. There were also 13 cases of hyperosmolar DKA during the pandemic compared with none before the pandemic (P = .022), with 12 of the 13 cases found in Black youths.
Of those diagnosed with new-onset type 2 diabetes who were screened, 3.5% tested positive for COVID-19 at the time of diagnosis. During the same time period, 3.3% of youths with new onset type 1 diabetes tested positive for COVID-19. Given that cases of type 1 diabetes increased by 15% during the pandemic, as compared with the 182% increase in type 2 diabetes, Marks said this calls into question whether the virus had a direct effect on the increase in type 2 diabetes cases or if indirect effects, such as social distancing measures or decreases in exercise, had a greater influence.
“Although we were unable to assess the frequency of primary care visits in our population, fewer youth were seen for preventive care during the pandemic, and there is concern that many individuals delayed accessing hospital-based care during the pandemic,” Marks said. “This highlights the importance of primary care-based screenings to detect type 2 diabetes and to avoid severe presentations in DKA and hyperosmolar DKA. More severe presentations among Black youths also highlight the need to develop strategies to promote health equity and address the undue burden of the COVID-19 pandemic on underserved communities to avoid worsening disparities and long-term health outcomes.”
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Marks B. 15-OR. Presented at: American Diabetes Association Scientific Sessions; June 25-29, 2021 (virtual meeting).
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