Increase in the Number of Pediatric New-Onset Diabetes and Diabetic Ketoacidosis Cases During the COVID-19 Pandemic

COVID-19 and diabetes in children

“…In particular, the relative frequency of T2D increased significantly in the cohort of children with DKA, and the percentage of moderate DKA was higher among children with T2D than in T1D. 38) Comparable results about T2D and DKA were observed at Children's Hospital, Los Angeles, where the prevalence of DKA increased significantly from <10% to 20% from 2018-2019 to 2020. 89) Other retrospective studies reported an increased incidence of T2D compared to pre-pandemic years mostly as an indirect effect of the pandemic.…”

“…29) In addition to the increase of DKA at T1D diagnosis, COVID-19 indirectly raised T2D risk in children and adolescents through increases in body weight and BMI that can be traced back to the effects of the pandemic and mandatory home confinement. 38,88,90) In patients with documented SARS-CoV-2 infection, associations between COVID-19 and diabetes were found not only for adults, but also for children. COVID-19 might lead to diabetes through direct attack of pancreatic β cells and, indirectly, through cytokine storm.…”

“…37) In another study of 615 children admitted with new-onset diabetes in a tertiary care children' s hospital between March 2018 and December 2020, children admitted to the hospital with new-onset diabetes in the pandemic and post-pandemic period were more likely to present with DKA compared to those in the pre-pandemic period. 38) Interestingly, American studies highlight a significant association between ethnicity and DKA proportion, with more DKA diagnoses in nonwhite children (Black, American Indian and Alaskan Native patients). 37,38) Increase in DKA severity in T2D was also described during the pandemic among nonwhite children (Black or African America, Hispanic, Latino).…”

“…38) Interestingly, American studies highlight a significant association between ethnicity and DKA proportion, with more DKA diagnoses in nonwhite children (Black, American Indian and Alaskan Native patients). 37,38) Increase in DKA severity in T2D was also described during the pandemic among nonwhite children (Black or African America, Hispanic, Latino). These adolescents had worse glycemic and metabolic control overall even before the pandemic, mostly as a consequence of socioeconomic status factors and higher BMI.…”

“…11) On the other hand, some studies were conducted without including homogeneous information about SARS-CoV-2 testing status or about the presence or absence of serum antibodies. 33,38,46) This is clearly a source of bias that may lead to inaccurate classification of some patients and result in underestimations of disease effects.…”