The incidence of type 2 diabetes in children appears to have doubled during the COVID-19 pandemic, data from two new US studies show. . and the increase in the severity of the presentation. “
The results of the two separate retrospective chart reviews – one in Washington, DC and the other in Baton Rouge, Louisiana – were presented on June 25 at the American Diabetes Association’s (ADA) 81st virtual scientific meeting.
Although the two studies differed somewhat in the clinical parameters examined, both showed a similar doubling in adolescent type 2 diabetes hospitalization rates in 2020 compared to the same period in 2019, as well as greater severity of metabolic disorders.
And as already described for type 2 diabetes in adolescents, African-American ethnicity dominated in both cohorts.
“Although our data did not allow us to assess the cause of the rise in type 2 diabetes, these differences suggest that indirect effects of social distancing measures, including school closings and unemployment, place undue stress on underserved communities and anxiety during Pandemic medical assistance may also have contributed, “lead investigator of one of the studies, pediatric endocrinologist Brynn E. Marks, MD, Children’s National Hospital, Washington, DC, told Medscape Medical News.
More hospital stays, racial differences exacerbated by COVID-19
The lead author of the other study, Daniel S. Hsia, MD, Pennington Biomedical Research Center, Baton Rouge, Louisiana, told Medscape Medical News, “Since the pandemic, our data suggests that more children are diagnosed with type 2 diabetes and this may require hospitalization if they are diagnosed. Looking at both sets of data, there appears to be a racial disparity in type 2 diabetes diagnoses that was only exacerbated by the COVID-19 pandemic.
Worryingly, Hsia said, “The incidence rate of type 2 diabetes in children had risen before the pandemic. Although there may be a brief flattening now with children receiving regular medical care and back to school, I believe “these rates will continue to rise, especially given the fact that childhood obesity rates are not improving.”
All adolescents newly diagnosed with type 2 diabetes in the children’s hospital
Marks’ data set recorded all adolescents newly diagnosed with type 2 diabetes from March 11, 2020 to March 10, 2021 in the first full year of the COVID-19 pandemic, and compared these data to the March 11 period 2019 to March 10, 2020.
During the pandemic, the number of type 2 diabetes cases rose 182% from 50 in 2019 to 141 in 2020. The average age at diagnosis was around 14 years in both periods.
In the pre-pandemic period, 18 (36%) had to be diagnosed with type 2 diabetes, compared with 85 (60.3%) during the pandemic. At Children’s National, teens with suspected emerging type 2 diabetes are typically not hospitalized unless they have severe hyperglycemia, ketosis, or are unable to schedule urgent outpatient follow-up, Marks noted.
The proportion of adolescents with newly onset type 2 diabetes who presented with diabetic ketoacidosis (DKA) increased from 2 (4%) before the pandemic to 33 (23.4%) during the pandemic. The presentation with hyperosmolar DKA increased from 0 to 13 (9.2%).
During the pandemic, however, of 90 adolescents tested, only five were actively infected with SARS-CoV-2 at the time of diagnosis of type 2 diabetes.
Marks said, “We believe the increase in inpatient admissions was due to heavier presentations during the pandemic … We were surprised by the amazing increase in type 2 diabetes cases … and the increase in the severity of presentations . “
Diagnosis shift to type 2 diabetes
The pandemic also appears to have shifted the proportion of adolescents with type 2 diabetes compared to type 1 diabetes. While 24% of adolescents with emerging diabetes before the pandemic had type 2 diabetes and the remainder had type 1 diabetes, the proportion with type 2 diabetes rose to 44% during the pandemic.
“The rate of type 2 diabetes rose steadily at a rate of 1.45 cases per month as the pandemic progressed, suggesting a cumulative effect of the indirect effects of social distancing measures,” said Marks.
In addition, she added, while 60% of teenagers diagnosed with type 2 diabetes before the pandemic were female, the rate fell to 40% during the pandemic. This trend could be due to activity levels, as adolescents males tend to be more active, but exercise rates decreased in both sexes during the pandemic, but decreased more in men, so activity levels became the same between the sexes.
Although type 2 diabetes is becoming increasingly common among ethnic minority adolescents, the pandemic appears to have exacerbated these differences.
While 58% of teenagers diagnosed with type 2 diabetes prior to the pandemic identified themselves as non-Hispanic Blacks, that percentage rose to 76.7% during the pandemic. Among black adolescents with newly onset type 2 diabetes, 31 out of 33 in DKA and 12 out of 13 who presented in hyperosmolar DKA during the pandemic were black.
“Strategies to promote equity in health care and address the undue stress on underserved communities from the COVID-19 pandemic need to be developed to avoid worsening inequalities and long-term health outcomes,” said Marks.
“A microcosm”: Similar findings in a smaller population
Hsia and colleagues studied a smaller number of patients over a shorter period of time. From March to December 2019, the hospitalization rate for emerging type 2 diabetes was 0.27% (eight of 2964 hospitalizations) compared to 0.62% (17 of 2729 hospitalizations) for the same period in 2020 (P <0.048) - also more than doubling. Age at admission, gender and body mass index did not differ between the two groups.
The criteria for DKA were met by three children in 2019 versus eight in 2020 and hyperosmolar hyperglycemic syndrome zero versus two and two, respectively. The mean A1c value at admission was 12.4% in 2019 versus 13.1% in 2020 (p = 0.59) and the mean serum glucose value was 441 mg / dL versus 669 mg / dL (p = 0.14 ). Serum osmolality at admission was 314 mmol / kg in 2019 compared to 335 mmol / kg in 2020 (P = 0.19).
“Clinically, the differences in the lab results were significant, but we didn’t have enough numbers … to see a statistically significant difference. I think if you look at more centers, our website probably represents a microcosm of what’s happening across the country happens.” “Said Hsia.
In 2019, seven of the eight children were African American, in 2020 there were 16 of the 17 children. The other single child in each group was white.
Hsia said, “To confirm our initial results, larger studies with more patients are needed. More research is needed to understand why this increasing trend in diagnosing type 2 diabetes is occurring in children. ” [and] to better understand how staying home orders and other restrictions due to COVID-19 have exacerbated risk factors for type 2 diabetes. “
“These include decreased physical activity, more screen time, difficulty sleeping, and increased intake of processed foods, all of which can lead to weight gain,” he concluded.
Marks reported that he has received research support from Tandem, Dexcom, and the Cystic Fibrosis Foundation. Hsia has not reported any relevant financial relationships.
ADA 2021. Presented June 25, 2021. Abstract 15-OR.
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