ABSTRACT
Background. The COVID-19 pandemic continues to impact healthcare overall particularly in relation to diabetes. Initial studies showed delays in emergent healthcare utilization, decreased preventative care visits, and more severe presentations of new onset diabetes. However, the pathophysiologic relationship between COVID-19 and type 1 diabetes is not yet well understood. Objective(s): Our primary objective was to compare the annual rates of new type 1 diabetes diagnoses between the pre-pandemic (1/2015-12/2019) and pandemic (1/2020-12/2021) periods. We hypothesized that the number of new-onset pediatric cases of type 1 diabetes increased during the COVID-19 pandemic compared to the preceding 5-year period. Method(s): We performed a retrospective review of EMR data from one pediatric tertiary care center from 1/1/2015 to 12/31/2021. Initial data were extracted based on ICD-10 codes (E08, E09, E10, E11, E13). Data were validated and excluded according to the following criteria: age >21 years at diagnosis, diagnosis date outside of study period, confirmed other form of diabetes, complex disease without confirmed auto-antibodies, and inadequate data at time of diagnosis. Result(s): Ultimately 1,057 patients met inclusion criteria. In the pre-pandemic period annual new onset cases ranged from 120-147 cases/year with a mean of 135.4 (Table 1). During the COVID-19 pandemic a mean of 182.5 cases/year were diagnosed (168 in 2020 and 197 in 2021). Cases increased 16% from 2019 to 2020 and further increased 17% from 2020 to 2021. Overall, cases increased 35% during the pandemic period (2020-2021) compared to the pre-pandemic period. Prior to the sharp rise in cases, new diagnoses declined in February-May 2020 (4 cases/ month in May 2020 compared to pre-pandemic average of 11.6 cases/month). Discussion(s): Quantifying the increase in new diagnoses of type 1 diabetes during the COVID-19 pandemic is important to understand the true impact of the global health crisis on this population. The increase in cases during the pandemic is likely multifactorial and continuing to understand this relationship may have important implications for public health policy and understanding type 1 diabetes pathophysiology in the future.
ABSTRACT
Introduction: Initial studies of pediatric diabetes and COVID-19 focused on type 1 diabetes with some initial reports showing an increase in youth onset type 2 diabetes (T2D). We aim to expand on this initial evidence in a larger population over a longer period. Objectives: The purpose of our study was to describe the amount, the severity, and the demographics of youth onset T2D diagnoses during the COVID-19 pandemic compared to the five years prior. Methods: We performed a retrospective cross-sectional review of youth (age≤21) diagnosed with T2D during the COVID-19 pandemic (5/1/2020 to 4/30/2021) and the five years prior (5/1/2015- 4/30/2020) at a pediatric tertiary care center. Children were identified by ICD codes (ICD9 250.00, ICD10 E13.9 or E11.9). Charts were reviewed to confirm diagnosis and exclude those with medication induced diabetes, MODY, >1 positive autoantibody, or BMI<85%. Chi-squared, t-tests, and fisher's exact tests were used for analyses. Results: In the pre-pandemic era annual diagnoses of T2D ranged from 39-66 (mean=52). During the pandemic 155 children were diagnosed with T2D, an increase of 298% from the pre-pandemic mean. New diagnoses increased 455% in Black patients and 248% in Hispanic patients. The average A1C at presentation was higher during the pandemic (9.47%±2.57) than prior (8.69% ±2.09) (p=0.001). Rates of acidosis (pH<7.3) were similar before (7.3%) and during (6.4%) the pandemic (p=0.741). Rates of hyperosmolarity (serum osm ≥330 and glucose >600) were also similar, 1.9% vs 0.6% respectively (p=0.418). Of those diagnosed during the pandemic, 56% were tested for COVID-19 and three tested positive. Conclusions: New diagnoses of T2D increased during the COVID-19 pandemic particularly among Black youth. A1C values at diagnosis increased, but rates of acidosis and hyperosmolarity did not. Clinical COVID infection was very uncommon. The findings display the significant effect of the COVID-19 pandemic on youth, specifically Black youth. Given the lack of COVID-19 positivity, the increase may be tied to social-distancing practices and behavioral changes. (Figure Presented).