Increase in newly diagnosed type 1 diabetes in youth during the COVID ‐19 pandemic in the United States : A multi‐center analysis

Abstract

Background An increase in newly diagnosed type 1 diabetes (T1D) has been posited during the COVID‐19 pandemic, but data are conflicting. We aimed to determine trends in newly diagnosed T1D and severity of presentation at diagnosis for pediatric and adolescent patients during COVID‐19 (2020) as compared to the previous year (2019) in a multi‐center analysis across the United States. Methods This retrospective study from seven centers in the T1D Exchange Quality Improvement Collaborative (T1DX‐QI) included data on new onset T1D diagnosis and proportion in DKA at diagnosis from January 1 to December 31, 2020, compared to the prior year. Chi‐square tests were used to compare differences in patient characteristics during the pandemic period compared to the prior year. Results Across seven sites, there were 1399 newly diagnosed T1D patients in 2020, compared to 1277 in 2019 ( p = 0.007). A greater proportion of newly diagnosed patients presented in DKA in 2020 compared to 2019 (599/1399(42.8%) vs. 493/1277(38.6%), p = 0.02), with a higher proportion presenting with severe DKA ( p = 0.01) as characterized by a pH <7.1 and/or bicarbonate of <5 mmol/L. Monthly data trends demonstrated a higher number of new T1D diagnoses over the spring and summer months (March to September) of 2020 compared to 2019 ( p < 0.001). Conclusions We found an increase in newly diagnosed T1D and a greater proportion presenting in DKA at diagnosis during the COVID‐19 pandemic compared to the prior year. Future longitudinal studies are needed to confirm these findings with population level data and determine the long‐term impact of COVID‐19 on diabetes trends.

An exploratory analysis of the impact of the COVID-19 pandemic on pediatric type 1 diabetes mellitus patient outcomes: A single-center study

“…In contrast, fewer patients with established T1DM diagnosis had DKA during the pandemic phase. While the reported number of cases for these outcomes were relatively small, the data are consistent with current evidence reporting an increase in DKA and its severity at diagnosis (21,(26)(27)(28)(29)(56)(57)(58). These findings are likely related to delays in seeking care due to concerns about the increased risk in contracting the COVID-19 virus in healthcare facilities, and caregivers abiding by health systems messaging to divert care away from hospitals to prioritize resource utilization for COVID-19 activities (26).…”

“…Emerging evidence suggests that there may be a rise in the number of children newly diagnosed with T1DM during the pandemic compared to the pre-pandemic phase, although this association has not been universal (27)(28)(29)(30)(31)(32)(33). The data so far also suggest an increase in the number of children presenting in diabetic ketoacidosis (DKA) (26,(34)(35)(36).…”

Impact of the COVID-19 pandemic on long-term trends in the prevalence of diabetic ketoacidosis at diagnosis of paediatric type 1 diabetes: an international multicentre study based on data from 13 national diabetes registries

“…This observation contrasts with other reports from the USA, where an increased prevalence of diabetic ketoacidosis during the COVID-19 pandemic has been reported. 21 , 26 Besides the fact that different regions were studied, this discrepancy might also be due to methodological reasons. For example, we did not simply compare the prevalence of diabetic ketoacidosis during the pandemic years with the average prevalence in previous years, as other studies have done.…”

Diabetes Population Health Innovations in the Age of COVID-19: Insights From the T1D Exchange Quality Improvement Collaborative

“…The existing health collaborative served as a springboard for robust surveillance study, documenting numerous works on the effects of COVID-19. 3,4,[20][21][22][23][24][25][26][27][28] Other investigators also embraced the power of real-world surveillance and real-world data. 29,30 Big Data, Machine Learning, and Artificial Intelligence…”