Type 1 diabetes diagnoses, DKA increase during COVID-19 pandemic
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More children were diagnosed with type 1 diabetes, and experienced diabetic ketoacidosis at presentation, in the first year of the COVID-19 pandemic than in the previous 5 years, according to data published in JAMA Pediatrics.
“[My colleagues] and I are pediatric endocrinologists at Rady Children’s Hospital-San Diego, which is the only children’s hospital in the greater San Diego area,” Jane Kim, MD, clinical professor of pediatrics at UC San Diego Health, told Healio. “[We] had noticed an apparent increase in the number of children admitted to the hospital with newly diagnosed type 1 diabetes following the onset of the COVID-19 pandemic.”
Kim and colleagues conducted a retrospective review of electronic medical records at Rady Children’s Hospital from March 19, 2015, to March 18, 2021, to assess whether the perceived increase was statistically significant.
In the cross-sectional study, the researchers analyzed data on age, sex, HbA1c, BMI z score, COVID-19 infection results, DKA (as evidenced by use of insulin infusion) and admission to the pediatric ICU for all patients younger than 19 years with at least one positive type 1 diabetes antibody titer. The COVID-19 year was defined as the period from March 19, 2020, to March 18, 2021, and data from March 2015 to March 2020 were analyzed to ensure that the increase in new-onset type 1 diabetes diagnoses could not be attributed to previous annual rates of increase.
Researchers found a 57% increase in the number of children (mean age, 9.6 years; 106 girls; four with COVID-19 on admission) admitted with new-onset type 1 diabetes during the COVID-19 year vs. previous years (187 children vs. 119 children). In July 2020, the 15 new diagnoses were more than the anticipated 10 cases predicted by a quarterly moving average of the previous 5 years (95% CI, 6.79-13.89), and in February 2021, the 21 new diagnoses were greater than the predicted 10 diagnoses (95% CI, 6.88-13.54).
A significant increase was observed in the frequency of DKA at the time of diabetes diagnosis, with 49.7% of patients requiring an insulin infusion during the COVID-19 year compared with 40.7% in the prior 5 years (an increase of 22%), according to the researchers. No differences were observed for mean age at presentation, BMI z score, HbA1c or percentage of patients requiring pediatric ICU admission.
The increase in new diabetes diagnoses was not attributable to changes in inpatient admissions during the study period, according to the researchers, as the number of inpatient admissions decreased by 19% from 2019 to 2020, whereas the number of children seen in the pediatric endocrine clinic did not change substantially.
“Some reports early in the pandemic from Italy and Germany did not see higher rates of type 1 diabetes. Our study examined a longer timeframe and showed a significant increase in type 1 diabetes incidence, a finding that was certainly in contrast to those prior reports,” Kim said.
"We don’t yet know why we are seeing these increased rates of diabetes, so it’s important to keep investigating the direct and indirect effects of the pandemic on childhood health to better understand and prevent disease.”
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