Incidence and Characteristics of Type 1 and Type 2 Diabetes among Youths in the COVID-19 Pandemic

ABSTRACT

Background: The impact of SARS-COV-2 on islet cell function and immune dysregulation is unclear. Though adults with diabetes suffer higher rates of morbidity and mortality from COVID-19, pediatric data is limited. We aimed to study the number and characteristics of new onset type 1 (T1D) and type 2 (T2D) diabetes pre- and during the pandemic. Method: This was a retrospective study using inpatient data at UCSF Benioff Children's Hospital Oakland. We examined newly diagnosed T1D and T2D, aged < 18 years old, from May 2019 to Jan 2021. COVID-19 pandemic was defined from Mar 2020 onward. Results: Respectively, there were 59 and 64 new T1D, and 25 and 34 new T2D pre- and during COVID-19 pandemic. No difference was observed in time-adjusted incidence rate in T1D, but a rising trend in T2D was seen. A higher infection rate (PCR or IgG) was shown in T2D than T1D (11.8% vs. 3.1%, p = 0.05). During COVID-19, individuals with T1D had higher BMI z-scores (0.4 vs. -0.2, p = 0.03) and c-peptide levels (0.8 ng/ml vs. 0.5 ng/ml, p <0.01), and more Hispanics were diagnosed (46.9% vs. 27.1%, p = 0.02). Individuals with T2D were younger (mean age 12.8 yr vs. 14.5 yr, p = 0.02) and had more DKA on presentation (35.3% vs. 12.0%, p = 0.04) during the pandemic. Insurance and income were not associated with T1D nor T2D. No differences in patient demographics were observed in relation to COVID-19. Conclusion: We observed a rising trend of new onset T2D in the pediatric population during COVID-19, who were younger and sicker at presentation, and had a higher COVID-19 positivity rate than T1D. T1D incidence was similar, but individuals were more obese, had greater beta cell reserve at presentation, and a higher proportion were Hispanic compared to pre-pandemic. The roles of COVID-19, stress, and/or lifestyle changes associated with shelter-in-place orders, contributing to increased BMI and c-peptide levels in T1D, or increasing the risk for new onset diabetes and DKA in youths with T2D needs to be elucidated further and studied.