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Increase in the Diagnosis and Severity of Presentation of Pediatric Type 1 and Type 2 Diabetes during the COVID-19 Pandemic.
Marks, Brynn E; Khilnani, Aneka; Meyers, Abby; Flokas, Myrto E; Gai, Jiaxiang; Monaghan, Maureen; Streisand, Randi; Estrada, Elizabeth.
  • Marks BE; Division of Endocrinology, Children's National Hospital, Washington, District of Columbia, USA.
  • Khilnani A; George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
  • Meyers A; George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
  • Flokas ME; Division of Endocrinology, Children's National Hospital, Washington, District of Columbia, USA.
  • Gai J; George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
  • Monaghan M; Division of Endocrinology, Children's National Hospital, Washington, District of Columbia, USA.
  • Streisand R; Division of Biostatistics, Children's National Hospital, Washington, District of Columbia, USA.
  • Estrada E; George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
Horm Res Paediatr ; 94(7-8): 275-284, 2021.
Article in English | MEDLINE | ID: covidwho-1438156
ABSTRACT

INTRODUCTION:

The impact of the COVID-19 pandemic on the incidence of pediatric type 1 (T1D) and type 2 diabetes (T2D) and severity of presentation at diagnosis is unclear.

METHODS:

A retrospective comparison of 737 youth diagnosed with T1D and T2D during the initial 12 months of the COVID-19 pandemic and in the preceding 2 years was conducted at a pediatric tertiary care center.

RESULTS:

Incident cases of T1D rose from 152 to 158 in the 2 years before the pandemic (3.9% increase) to 182 cases during the pandemic (15.2% increase). The prevalence of diabetic ketoacidosis (DKA) at T1D diagnosis increased over 3 years (41.4%, 51.9%, and 57.7%, p = 0.003); severe DKA increased during the pandemic as compared to the 2 years before (16.8% vs. 28%, p = 0.004). Although there was no difference in the mean hemoglobin A1c (HbA1c) between racial and ethnic groups at T1D diagnosis in the 2-years pre-pandemic (p = 0.31), during the pandemic HbA1c at T1D diagnosis was higher in non-Hispanic Black (NHB) youth (11.3 ± 1.4%, non-Hispanic White 10.5 ± 1.6%, Latinx 10.8 ± 1.5%, p = 0.01). Incident cases of T2D decreased from 54 to 50 cases (7.4% decrease) over the 2-years pre-pandemic and increased 182% during the pandemic (n = 141, 1.45 cases/month, p < 0.001). As compared to the 2-years pre-pandemic, cases increased most among NHB youth (56.7% vs. 76.6%, p = 0.001) and males (40.4% vs. 58.9%, p = 0.005). Cases of DKA (5.8% vs. 23.4%, p < 0.001) and hyperosmolar DKA (0 vs. 9.2%, p = 0.001) increased among youth with T2D during the pandemic.

CONCLUSIONS:

During the pandemic, the incidence and severity of presentation of T1D increased modestly, while incident cases of T2D increased 182%, with a nearly 6-fold increase in DKA and nearly a 10% incidence of hyperosmolar DKA. NHB youth were disproportionately impacted, raising concern about worsening of pre-existing health disparities during and after the pandemic.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Diabetic Ketoacidosis / Diabetes Mellitus, Type 1 / Diabetes Mellitus, Type 2 / COVID-19 Type of study: Diagnostic study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Adolescent / Child / Child, preschool / Female / Humans / Male Language: English Journal: Horm Res Paediatr Journal subject: Endocrinology / Pediatrics Year: 2021 Document Type: Article Affiliation country: 000519797

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Diabetic Ketoacidosis / Diabetes Mellitus, Type 1 / Diabetes Mellitus, Type 2 / COVID-19 Type of study: Diagnostic study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Adolescent / Child / Child, preschool / Female / Humans / Male Language: English Journal: Horm Res Paediatr Journal subject: Endocrinology / Pediatrics Year: 2021 Document Type: Article Affiliation country: 000519797