Comparison of BMI and HbA1c in pediatric patients with established type 1 and type 2 diabetes and those at risk for type 2 diabetes, before and after the COVID-19 pandemic

ABSTRACT

Introduction: We know that nutritional education and goal BMI are important to all diabetes management. Objective(s) Aim was to see how HbA1c and BMI were affected pre- and post- COVID-19 pandemic in youth with established type 1 (T1D), type 2 (T2D) and those followed in youth diabetes prevention clinic (YDPC). Method(s) Retrospective chart review. Youth included if diagnosed with diabetes prior to 4/2/2019, seen the year pre-COVID (between 4/2/2019-3/22/2020) (or for YDPC clinic just seen in that year prior), who also had 1 follow-up (f/u) visit after the start of the pandemic (3/23/2020-12/31/2020). The second f/u interval was 8/1/2021- 12/31/2021. The statistical analysis was conducted using GraphPad Prism Version 8. For continuous variables, the D'Agostino and Pearson test was used to determine normality, and data were compared using a paired t-test or a Wilcoxon matched-pairs signed-rank test depending on variable type. Result(s) There was no change in HbA1c or BMI z-score pre-COVID pandemic versus first f/u visit in the YDPC or T1D group (see Table). However, in the T2D group, there was a statistical increase in HbA1c at first f/u (p = 0.003), with no change in BMI z-score. In the second f/u interval (n = 166/277 T1D group, n = 15/34 T2D group), there was no change in HbA1C, but there was a statistical decrease in BMI z-score (p-value of 0.03) in the T1D group. Conclusion(s) Of our 3 cohorts, it appears that the youth with established T2D had a significant increase in HbA1c at first follow-up after the COVID-19 pandemic, with no significant change in BMI z-score. Thus, this change in HbA1c appears related to other factors. Youth with established T1D did not have a change in HbA1c or BMI z-score. However, in the subset of patients that were seen during the second f/u interval, their BMI z-score did seem to increase. This potentially reflects the national trend of increased obesity in healthy children. Even in those with T1D, these trends in BMI are important to help guide improved outcomes.