Increased Rates of Hospitalized Children with Type 1 and Type 2 Diabetes Mellitus in NYC Hospital During COVID19 Pandemic

Objectives There have been reports of increased new onset diabetes and severity of DKA for children with diabetes following COVID19 infection and during the pandemic worldwide. Our objective is to study whether there is a change in admission rates and severity of presentation for type 1 (T1DM) and type 2 diabetes mellitus (T2DM) in our center from 2018 to 2020. Methods This is an IRB approved retrospective chart review of children admitted to our two hospitals from 1/1/18 to 12/31/20. We included ICD9 and ICD10 codes for diabetic ketoacidosis (DKA), hyperglycemic hyperosmolar syndrome (HHS) and hyperglycemia for those with diabetes. SAS 9.4 was used for ANOVA, T-test, Poisson regression. Results We included 132 patients with 214 hospitalizations: 158 T1DM, 40 T2DM and 16 other (14 steroid induced, 2 MODY). Overall admissions increased from 3.4% in 2018, to 4.6% in 2019, and 6.4% in 2020 (p = 0.05). Overall T1DM admissions were similar across all 3 years, however T2DM rates increased from 0.4% to 0.8% to 2% (p=0.0064). Newly diagnosed T1DM rates increased from 0.4% to 0.3% to 1.7% (p=0.002), and new-onset T2DM rates also increased from 0.2% to 0.7% to 1.1% (p=0.0026). DKA increased from 2.5% to 3.5% to 4% (p=0.028). HHS increased from 0.1% to 0.2% to 0.6% (p=0.047). There was no difference in average A1c. Severity of DKA in newly diagnosed diabetes was unaffected (p=0.833). Only 3 patients tested positive for COVID 19 while everyone else was negative by COVID 19 PCR. Conclusions Our urban academic medical center is located in central Brooklyn and serves a majority who are Black (87%). As far as we know, this is the first study investigating pediatric diabetes cases admitted in central Brooklyn during the height of the pandemic. Overall, hospitalization rates in children with T2DM and in new onset T1DM and T2DM increased, despite overall admissions declining in 2020. Whether the shutdown affected patient's perception of their symptoms or another reason leading to delayed care, or change in access to care remains to be seen. Active COVID19 infection did not appear to affect patients who had been admitted for diabetes. More studies are needed to elucidate the reason for this observed increase hospitalization rates.

Changes in Adiposity as Measured by Modified BMI Z-scores Associated with the COVID-19 Pandemic Among Well Children and Adolescents Within a Large Urban Health System

Background: To control the spread of COVID-19 in NYC, a stay-at-home order was issued for March 22, 2020-June 13, 2020 followed by ongoing restrictions and only partial school reopening. The health impacts of these unprecedented restrictions on children are not yet known. Our objective was to examine whether BMI change during the COVID-19 period differed from the prior year among healthy children. Methods: This is a multicenter retrospective observational study of children aged five to eighteen years who received care within the NYC public hospital system between 2018 and 2020 encompassing all the five boroughs of the city. Using the system's electronic medical records, we identified patients who had a well-child visit between June 13, 2020 and December 31, 2020. Patients were included if they had annual well-child visits in the two previous years with anthropometric data recorded at all three visits. Patients with diagnoses that may affect adiposity (e.g. hypothyroidism) were excluded. We collected sociodemographic and anthropometric data for each year and calculated a modified body mass index z-score (mBMIz), which is a measure of relative BMI adjusted for age and sex. We compared change in mBMIz/month between the 2019 and 2020 visits (which included the pandemic) with the change in mBMIz/month between the 2018 and 2019 visits using generalized estimating equations (GEE). We examined whether the mBMIz/month change differed between the two periods and whether 2018 BMI category (underweight (5%), normal (5-85%), overweight (85-95%), obese (95-99%), extremely obese(>99%))modified this effect. Analyses were conducted using STATA software. Results: Of 23,458 patients seen between June 13, 2020 and December 31, 2020, 7,575 (32.3%) met our inclusion and exclusion criteria. The mean mBMIz was 0.68 in 2018, 0.69 in 2019 and 0.90 in 2020. (Table 1). In GEE analysis, the change in mBMIz/month was statistically significantly higher in 2019-2020 than in 2018-2019 (mean difference in mBMIz/month change=0.0152, p < 0.0001). While the change in mBMIz/month in 2019-2020 was lowest in patients in the extremely obese category, the difference in mBMIz/month between the two periods was greatest in this group (interaction effect of period and 2018 baseline category p < 0.0001). (Table 2). Conclusion: Our study suggests that the activity restrictions due to the COVID-19 outbreak are associated with greater excess weight gain in a diverse NYC population of healthy children as measured by mBMIz relative to the year prior to the outbreak. These findings correspond to the mean BMI percentile of our population changing from approximately 75th to the 82nd. These findings require further monitoring to better understand the specific reasons for the observed patterns across children in different BMI categories, assessment of longer-term health impact on this population and interventions to modify or reverse these worrisome trends. (Table Presented).