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

Context: The effects of the coronavirus disease 2019 (COVID-19) pandemic on the incident cases of pediatric type 1 diabetes (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 laboratory results from patients ages 0 through 21 years 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 2 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 = 0.009). Patients with T2D were more likely to present in diabetic ketoacidosis (DKA), though this was not statistically significant (P = 0.093). Severe DKA was higher compared with moderate DKA (P = 0.036) in incident cases of pediatric T2D. During the pandemic, for the first time, incident cases of T2D accounted for more than one-half of 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.

COVID-19, Rural Communities, and Implications of Telebehavioral Health Services: Addressing the Benefits and Challenges of Behavioral Health Services via Telehealth in Nebraska

Telehealth has been in use, in various forms, for over a century and is growing increasingly more popular. The current research sought to examine the prevalence, benefits, and challenges of telehealth for behavioral and mental health services in the state of Nebraska with a particular focus on rural communities. The COVID-19 pandemic coincided with the research endeavors and impacted the questions that were asked related to the use of telebehavioral health. Specifically, the research included an investigation of the rates of use of telebehavioral health across agencies and whether/how the pandemic impacted the use of telehealth services. The research included an initial examination of more than 50 behavioral health agencies to assess overall utilization of telehealth. Researchers then conducted interviews with 15 practitioners to discuss the challenges and benefits associated with telehealth services. Key results suggest that implementation of telehealth in Nebraska has resulted in increased access to services among rural residents and has deeply impacted clinical practice. Additionally, clinicians identified specific benefits and challenges of telebehavioral health. It was also noted that the majority of clinicians plan to continue providing services via telehealth if the policies and regulations remain as they are post-COVID-19. Implications of this research highlight the efficiency and effectiveness of using telehealth to increase access.