New-onset pediatric sort 2 diabetes circumstances enhance 182% throughout first yr of COVID-19

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

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

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The number of new-onset type 2 diabetes cases in children rose significantly in the first 9 months of the COVID-19 pandemic, particularly among boys and black teens, a spokesman said.

In the first year of the COVID-19 pandemic, new cases of type 2 diabetes rose 182% year over year, and there was also a sharp increase in diabetic ketoacidosis, according to a retrospective analysis of data from Children’s National Hospital in Washington, DC and hyperosmolar DKA.

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

“These changes in the number of cases and the severity of presentation disproportionately affected non-Hispanic Black youth, highlighting the potential of the pandemic to exacerbate pre-existing health inequalities.” Brynn E. Marks, MD, MSHPEd, Assistant professor of pediatrics at the George Washington University School of Medicine and Health Sciences, attending physician in the department of endocrinology and assistant director of the pediatric endocrinology fellowship program at Children’s National Hospital, told Healio.

Brynn E. Marks

From March 11, 2020 to March 10, 2021, Marks and colleagues conducted a retrospective, cross-sectional exam of adolescents aged 21 or younger who were diagnosed with newly emerged type 2 diabetes during the COVID-19 pandemic at Children’s National Hospital has been. These data have been compared with those from the year before the pandemic, from March 11, 2019 to March 10, 2020. Adolescents were classified as type 2 diabetes if all pancreatic autoantibodies were negative, the BMI z value was 1.64 or higher and the patient did not present to the DKA at diagnosis. The diagnosis was confirmed in adolescents who met these criteria and the type of diabetes was determined in those who did not meet these criteria.

The results were presented at the American Diabetes Association’s virtual scientific sessions.

Diabetes diagnoses are increasing among boys and black adolescents

The number of 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 <0.001). Although 58% of new pre-pandemic type 2 diabetes cases occurred in girls, that percentage fell to 41.1% (P = .048) during the pandemic. In an analysis of cases by race, non-Hispanic black teens had the largest increase, from 29 cases in the year before the pandemic to 108 during COVID-19. Prior to the pandemic, 58% of all new cases of type 2 diabetes were among black teenagers. That percentage rose to 76.7% during the pandemic.

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

More DKA during COVID-19

The proportion of adolescents with newly onset type 2 diabetes who presented with DKA increased from 4% before the pandemic to 23.4% during the pandemic (P = 0.001). Of the 33 DKA cases recorded during the pandemic, 31 were black teenagers. There were also 13 cases of hyperosmolar DKA during the pandemic compared to none before the pandemic (P = 0.022), with 12 of the 13 cases found in black adolescents.

Of the patients screened with newly onset type 2 diabetes, 3.5% tested positive for COVID-19 at the time of diagnosis. Over the same period, 3.3% of adolescents with newly onset type 1 diabetes tested positive for COVID-19. Given that cases of type 1 diabetes increased 15% during the pandemic, compared to the 182% increase in type 2 diabetes, Marks said this questions whether the virus is a direct one Influence on the increase in type 2 diabetes cases or whether indirect effects such as social distancing measures or restricted mobility had a greater influence.

“Although we could not assess the frequency of primary care visits in our population, fewer teenagers were seen for checkups during the pandemic and there is concern that many people delayed access to hospital care during the pandemic,” said Marks. “This underscores the importance of primary care screenings to detect type 2 diabetes and avoid severe presentations at DKA and hyperosmolar DKA. Heavier presentations among black youth also highlight the need to develop strategies to promote equity in health care and address the undue burden of the COVID-19 pandemic on underserved communities in order to avoid exacerbating inequalities and long-term health outcomes.

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Scientific meetings of the American Diabetes Association

Scientific meetings of the American Diabetes Association