Cases, severity of youth-onset type 2 diabetes up during COVID-19
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Increased burden of youth-onset type 2 diabetes during the COVID-19 pandemic led to increased strain on pediatric diabetes health care providers, children and families, according to findings published in The Journal of Pediatrics.
“The pandemic environment had a strong impact on presentation of youth-onset type 2 diabetes, both with an increase in frequency of diagnosed cases and in severity of presentation,” Megan Moriarty Kelsey, MD, MS, associate professor of pediatric endocrinology and medical director of lifestyle medicine and metabolic and bariatric surgery at the Children’s Hospital Colorado at the University of Colorado School of Medicine, told Healio. “We had all anecdotally noticed an increase in youth-onset type 2 diabetes cases. However, because the background incidence of youth-onset type 2 diabetes was already increasing, and because type 2 diabetes is still relatively rare compared to type 1 [diabetes] in children, it was difficult to know the significance of this increase.”
For this multicenter, hospital-based, retrospective chart review, researchers assessed 3,113 youths (mean age, 14.4 years; 50.5% girls and women) aged 21 years or younger with newly diagnosed type 2 diabetes from 24 centers between March 2018 and February 2021. Researchers also collected data on BMI in the 85th or higher percentile and negative pancreatic autoantibodies.
In the first year of the pandemic, researchers observed that new type 2 diabetes cases increased 77.2%, or 1,463 cases, compared with a mean of 886 cases in 2019 and a mean of 765 cases in 2018.
“The most surprising finding was sex reversal in frequency of onset. Typically, youth-onset type 2 diabetes is twice as common in girls as in boys, a sex difference that is not present in adult-onset diabetes. However, during the first year of the pandemic, new diagnoses were more common in boys, who represented 55% of new cases in our study,” Kelsey said. “We also found that the increase in rates disproportionately affected youth who identified as Black. This is perhaps less surprising, because it was already happening prior to the pandemic, but is nonetheless an important finding and is critical to address.”
In addition, researchers also observed a significant increase in the likelihood of presenting with metabolic decompensation and severe diabetic ketoacidosis in 2020 compared with 2018 and 2019 (21% vs. 9.4% and 9%, respectively; P < .001).
“We need to know whether and how long this increase in frequency and severity of presentation has persisted. Data from our own site suggest that the increase tailed off by the end of 2021, and new case rates may have even fallen behind pre-pandemic rates,” Kelsey said. “This could suggest that the pandemic accelerated the diagnosis of type 2 diabetes in those already at high risk. However, we need to see if this finding holds up in a larger, nationally representative sample.”
For more information:
Megan Moriarty Kelsey, MD, MS, can be reached at megan.kelsey@childrenscolorado.org.
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