Initial Presentation of Children with Type 2 Diabetes during the COVID-19 Pandemic

ABSTRACT

Stay at home orders due to the COVID-19 pandemic have exacerbated risk factors for type 2 diabetes. These orders have limited opportunities for daily physical activity, encouraged more screen time and sedentary behaviors, led to disturbed sleep, and promoted consumption of ultra-processed foods. Even modest weight gain over a short period of time can increase the risk for long-term consequences such as type 2 diabetes and cardiovascular disease. During the COVID-19 pandemic, there has been little data on the incidence or severity of new-onset type 2 diabetes in the pediatric population. We conducted a retrospective chart review of admissions for new onset type 2 diabetes from March to December 2019 and for the same period in 2020 at a tertiary care children's hospital. Eligible patients were identified using ICD-10 codes for type 2 diabetes (E11.*);hyperglycemia (E72.51, E11.65, R73.9, R73.09);and hyperosmolar hyperglycemic syndrome (E13.*, E11.01). Each admission was carefully reviewed, and those with type 1 diabetes or hyperglycemia unrelated to diabetes were excluded. In 2019 the hospitalization rate for new onset type 2 diabetes was 0.27% (8 cases out of 2964 hospitalizations) compared to 0.62% (17 out of 2729) in 2020, p<0.048. In total 23 of 25 children were African American and 19 children were male. Three children in 2019 versus 8 children in 2020 met criteria for DKA while 2 children met criteria for HHS in 2020. The mean admission HbA1c was 12.4% in 2019 vs. 13.1% in 2020;while the mean admission glucose was 441 mg/dL in 2019 vs. 669 mg/dL in 2020. Furthermore, the admission serum osmolality was 314 mmol/kg in 2019 compared to 335 mmol/kg in 2020. Our study found that the incidence of hospitalization for new onset type 2 diabetes was higher in 2020 during the COVID-19 pandemic compared to the same period in 2019. While the labs presented were not statistically different due to the limited number of participants, further studies are warranted to better understand the clinical implications of these findings.