Increase in the Diagnosis and Severity of Presentation of Pediatric Type 1 and Type 2 Diabetes during the COVID-19 Pandemic

Abstract

Introduction:The impact of the COVID-19 pandemic on the incidence of pediatric type 1 (T1D) and type 2 diabetes (T2D) and severity of presentation at diagnosis is unclear. Methods: A retrospective comparison of 737 youth diagnosed with T1D and T2D during the initial 12 months of the CO-VID-19 pandemic and in the preceding 2 years was conducted at a pediatric tertiary care center. Results: Incident cases of T1D rose from 152 to 158 in the 2 years before the pandemic (3.9% increase) to 182 cases during the pandemic (15.2% increase). The prevalence of diabetic ketoacidosis (DKA) at T1D diagnosis increased over 3 years (41.4%, 51.9%, and 57.7%, p = 0.003); severe DKA increased during the pandemic as compared to the 2 years before (16.8% vs. 28%, p = 0.004). Although there was no difference in the mean hemoglobin A1c (HbA1c) between racial and ethnic groups at T1D diagnosis in the 2-years pre-pandemic (p = 0.31), during the pandemic HbA1c at T1D diagnosis was higher in non-Hispanic Black (NHB) youth (11.3 ± 1.4%, non-Hispanic White 10.5 ± 1.6%, Latinx 10.8 ± 1.5%, p = 0.01). Incident cases of T2D decreased from 54 to 50 cases (7.4% decrease) over the 2-years pre-pandemic and increased 182% during the pandemic (n = 141, 1.45 cases/month, p < 0.001). As compared to the 2-years pre-pandemic, cases increased most among NHB youth (56.7% vs. 76.6%, p = 0.001) and males (40.4% vs. 58.9%, p = 0.005). Cases of DKA (5.8% vs. 23.4%, p < 0.001) and hyperosmolar DKA (0 vs. 9.2%, p = 0.001) increased among youth with T2D during the pandemic. Conclusions: During the pandemic, the incidence and severity of presentation of T1D increased modestly, while incident cases of T2D increased 182%, with a nearly 6-fold increase in DKA and nearly a 10% incidence of hyperosmolar DKA. NHB youth were disproportionately impacted, raising concern about worsening of pre-existing health disparities during and after the pandemic.

The Coronavirus Disease 2019 Pandemic is Associated with a Substantial Rise in Frequency and Severity of Presentation of Youth-Onset Type 2 Diabetes

“…Moreover, severity of initial presentation rose, based on proportion presenting with metabolic decompensation, which more than doubled, and median HbA1c at diagnosis. This confirms the findings of three single-center studies, all of which contributed data to this analysis, suggesting that rates of type 2 diabetes and presentation in DKA rose during the COVID-19 pandemic 11 , 14 , 15 .…”

The global impact of COVID‐19 pandemic on the incidence of pediatric new‐onset type 1 diabetes and ketoacidosis: A systematic review and meta‐analysis

“…Twenty‐four studies 12 , 13 , 14 , 16 , 17 , 18 , 19 , 20 , 29 , 30 , 31 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 involving 5671 new T1D patients (2706 new T1D patients in 2019 and 2965 new T1D patients in 2020) reported numbers of pediatric new‐onset T1D before and after the COVID‐19 pandemic. Overall, the COVID‐19 pandemic was significantly associated with an increase in the number of worldwide pediatric newly diagnosed T1D (logit ER = 0.080, 95% confidence interval [CI] 0.028–0.133, p = 0.003; Figure 2A ).…”

“…Twenty‐one studies 12 , 13 , 14 , 16 , 18 , 19 , 20 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 involving 2648 new T1D patients with DKA and 979 new T1D patients with severe DKA (DKA: 1177 new cases in 2019 and 1471 new cases in 2020; severe DKA: 446 new cases in 2019 and 533 new cases in 2020) were included. The random‐effect model showed that COVID‐19 pandemic was associated with an elevation in the risk incidence of worldwide pediatric DKA and severe DKA compared with pre‐COVID‐19 period (RR = 0.064, 95% CI 0.043– 0.084, p = 0.0001, and RR, 0.049 (95% CI: 0.029–0.066; p = 0.0001, respectively; Figure 3 ).…”

“… 15 Although, they did not perform any analysis on the number and rate of newly diagnosed children with T1D and the levels of glucose and HbA1c before and after the COVID‐19 pandemic. Additionally, they did not identify all relevant studies in their search strategy and five relevant reports 16 , 17 , 18 , 19 , 20 were missed in their analyses. Moreover, they included a study by Danne et al which does not report the risk of DKA and severe DKA among newly diagnosed patients.…”

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

“…[10][11][12] An increase in newly diagnosed T1D has been posited during the COVID-19 pandemic. However, published reports have shown conflicting findings, with some reports suggesting an increase in newly diagnosed T1D in children and adolescents, [13][14][15] and others showing no change in expected or actual numbers of newly diagnosed T1D. 16,17 Our objective for this study was to describe trends in newly diagnosed T1D, as well as the severity of presentation at diagnosis during COVID-19 compared to the prior year using data from seven large U.S. clinical centers.…”