New-onset pediatric type 2 diabetes cases increase 182% during first year of COVID-19

Source/Disclosures Published by:

Source:

Marks B. 15-OR. Presented at: American Diabetes Association Scientific Sessions; June 25-29, 2021 (virtual meeting).

disclosures:
Marks reports that she has received funding from Tandem Diabetes Care and supplies from Dexcom.

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According to a speaker, during the first 9 months of the COVID-19 pandemic, there was a significant increase in the number of new-onset type 2 diabetes in children, especially among boys and black youth.

According to a retrospective analysis of data from the Children’s National Hospital in Washington, DC, new cases of type 2 diabetes increased by 182% in the first year of the COVID-19 pandemic compared to the year before, and there was also a large increase in diabetic ketoacidosis and hyperosmolar DKA.

Cases of new-onset type 2 diabetes in children more than doubled during the first 9 months of COVID-19 compared to the year before, and DKA rates rose from 4% to 23.4%. Data is derived from Marks B. 15-OR. Presented at: American Diabetes Association Scientific Sessions; June 25-29, 2021 (virtual meeting).

“These changes in the number of cases and severity of presentation disproportionately impacted non-Hispanic black youth, drawing attention to the potential that the pandemic could exacerbate pre-existing health disparities,” Brynn E. Marks, MD, MSHPed, assistant professor of pediatrics at George Washington University School of Medicine and Health Sciences, attending physician in the division of endocrinology, and assistant director of the pediatric endocrinology fellowship program at Children’s National Hospital, at Healio.

Brynn E. Marks

Marks and colleagues conducted a retrospective cross-sectional assessment of youth 21 or younger diagnosed with type 2 diabetes during the COVID-19 pandemic from March 11, 2020 to March 10, 2021 at Children’s National Hospital. These data were compared with those from the year before the pandemic from March 11, 2019 to March 10, 2020. Young people were classified as type 2 diabetes if all pancreatic autoantibodies were negative, the BMI z-score was 1.64 or higher and the patient did not present in DKA at diagnosis. A graph assessment was performed to confirm the diagnosis for youth who met these criteria and to determine the type of diabetes for those who did not meet these criteria.

The findings were presented at the virtual American Diabetes Association Scientific Sessions.

Diabetes diagnoses on the rise for boys, black youth

New cases of type 2 diabetes increased from 50 in the year before the pandemic to 141 in the first year of the pandemic (P < .001). While 58% of new type 2 diabetes cases were in girls before the pandemic, that percentage dropped to 41.1% during the pandemic (P = .048). In an analysis of cases by race, non-Hispanic black youth had the largest increase, from 29 cases in the year before the pandemic to 108 during COVID-19. Pre-pandemic, 58% of all new-onset type 2 diabetes cases were in black youth. That percentage rose to 76.7% during the pandemic.

Those with type 2 diabetes during the pandemic had higher HbA1c compared to those diagnosed before the pandemic (10% vs. 9.3%; P = 0.077). Of those diagnosed during the pandemic, 60.3% required diabetes treatment because of severe hyperglycemia or ketosis, compared with 36% of those diagnosed before the pandemic (P = 0.005).

More DKA during COVID-19

The percentage of young people with new-onset type 2 diabetes with DKA increased from 4% pre-pandemic to 23.4% during the pandemic (P = .001). Of the 33 DKA cases recorded during the pandemic, 31 were in black youth. There were also 13 cases of hyperosmolar DKA during the pandemic compared to none before the pandemic (P = .022), with 12 of the 13 cases found in black youth.

Of those diagnosed with type 2 diabetes who were screened, 3.5% tested positive for COVID-19 at the time of diagnosis. In the same period, 3.3% of young people with new type 1 diabetes tested positive for COVID-19. Given that the number of type 1 diabetes cases has increased by 15% during the pandemic, compared to the 182% increase in type 2 diabetes, Marks argues that this raises the question of whether the virus had a direct effect on the increase in the number of diabetes. number of cases of type 2 diabetes or that indirect effects, such as social distancing measures or less exercise, had a greater influence.

“While we were unable to assess the frequency of primary care visits in our population, fewer young people were seen for preventive care during the pandemic, and there is concern that many individuals have delayed access to hospital care during the pandemic,” said Marks. “This highlights the importance of primary care-based screenings to detect type 2 diabetes and prevent severe presentations in DKA and hyperosmolar DKA. More severe presentations among black youth also emphasize the need to develop strategies to promote health equity and reduce the undue burden.” of the COVID-19 pandemic for disadvantaged communities to prevent long-term worsening inequalities and health outcomes.

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