Pediatric Diabetes on the Rise: Trends in Incident Diabetes During the COVID-19 Pandemic

Abstract

Context The effects of the COVID-19 pandemic on the incident cases of pediatric Type 1 (T1D) and Type 2 diabetes (T2D) are not clear. Objective To identify trends in incidence and presentation of pediatric new-onset T1D and T2D during the COVID-19 pandemic. Methods A retrospective chart review was conducted. Demographics, anthropometrics, and initial labs from patients ages 0-21 who presented with new-onset diabetes to a pediatric tertiary care center were recorded. Results During the pandemic incident cases of pediatric T1D increased from 31 in each of the prior two years to 46; an increase of 48%. Incident cases of pediatric T2D increased by 231% from 2019 to 2020. The number of incident cases of pediatric T2D increased significantly more than the number of incident cases of pediatric T1D (p-value = 0.009). Patients with T2D were more likely to present in DKA, though this was not statistically significant (p-value=0.093). Severe DKA was higher compared to moderate DKA (p-value = 0.036) in incident cases of pediatric T2D. During the pandemic, for the first time, incident cases of T2D accounted for more than half of the all newly diagnosed pediatric diabetes cases (53%). Conclusions There were more incident pediatric T1D and T2D cases as well as an increase in DKA severity in T2D at presentation during the COVID-19 pandemic. More importantly, incident T2D cases were higher than the incident T1D during the pandemic. This clearly suggests a disruption and change in the pediatric diabetes trends with profound individual and community health consequences.

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

“… 12 , 14 , 18 , 20 , 30 , 32 , 37 , 38 , 40 , 46 The number of COVID‐19‐positive cases in 16 remaining studies was as follows: one case in three studies, 33 , 35 , 42 two cases in two studies, 29 , 36 four cases in two studies, 17 , 45 eight cases in four studies, 13 , 19 , 31 , 41 and no case in five studies. 16 , 34 , 39 , 43 , 44 The worldwide incidence rate of diagnosis of T1D in the 2019 period was 19.73 per 100 000 children (18 years and younger) and 32.39 per 100 000 in the 2020 period. Compare with pre‐COVID‐19 pandemic, the number of worldwide pediatric new‐onset T1D, DKA, and severe DKA during the first year of COVID‐19 pandemic increased by 9.5%, 25%, and 19.5%, respectively.…”

“…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 ).…”

“…In total, six studies 19 , 32 , 34 , 39 , 40 , 43 included within this meta‐analysis, which reported blood glucose and HbA1c levels in children who were newly diagnosed with T1D in 2019 and 2020. There were statistically significant associations between COVID‐19 pandemic with elevation in blood glucose and HbA1c levels in pediatric newly diagnosed T1D compared with pre‐COVID‐19 period (SMD = 0.336, 95% CI 0.074–0.598, p = 0.012, and SMD = 0.173, 95% CI 0.022–0.323, p = 0.024, respectively; Figure 4 ).…”

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

“…Multicenter and/or population-based studies in the US and Europe suggest that the proportion of youth with T1D presenting in diabetic ketoacidosis (DKA) rose early in the pandemic, but the impact on the overall incidence of T1D is still unclear[6][7][8][9][10] . Several U.S. individual institutions showed an increase in both rates and severity of presentation of youth-onset type 2 diabetes during the pandemic[11][12][13][14][15] . However, multicenter/population-based data regarding effects of the COVID-19 pandemic on youth-onset type 2 diabetes have not yet been published.This study was designed to compile retrospective data from electronic medical records (EMRs) from institutions across the U.S. to assess the national impact of the COVID-19 pandemic on rates of youth-onset type 2 diabetes.…”

Longitudinal analysis reveals elevation then sustained higher expression of autoantibodies for six months after SARS-CoV-2 infection

“…New onset inflammatory diseases with putative autoimmune or inflammatory drivers have been diagnosed after SARS-CoV-2 infection, such as pediatric inflammatory multisystemic syndrome (PIMS) or multisystem inflammatory syndrome in children (MIS-C), as well as the autoimmune conditions such as Guillain-Barre syndrome, Immune Thrombocytopenic Purpura, and autoimmune hemolytic anemia [6][7][8][9][10][11]. Pediatric Type I and Type 2 diabetes cases are rising since the start of the pandemic [12,13]; also, unusually high cases of new onset diabetes in children and adults are reported months after infection with SARS-CoV-2 [14,15]. These new disease diagnoses contribute to the growing literature illuminating the frequencies and morbidities of individuals afflicted with post-acute sequalae of SARS-CoV-2 (PASC) [16].…”