Increased Incidence of Pediatric Type 2 Diabetes Diagnoses during the COVID-19 Pandemic

ABSTRACT

Objectives The incidence of type 2 diabetes mellitus (T2DM) in children and adolescents is increasing worldwide. During the COVID-19 pandemic, most children in the United States attended school remotely for at least several months to control community spread. However, the broader impacts of lockdowns and reduced attendance at school may have exacerbated risk factors associated with unintentional pediatric weight gain. The primary objective of this study was to determine the change in incidence of newly diagnosed T2DM in pediatric patients by comparing the 5- years before the COVID-19 pandemic (2015-2020) against the rate observed March 2020-March 2021. Methods We conducted a retrospective chart review of 164 pediatric patients seen in a community-based tertiary care Pediatric Endocrinology practice from 2015-2021 who were newly diagnosed with T2DM (ages 9 to 18). Changes in the demographic and clinical characteristics of newly diagnosed cases since the start of the COVID-19 pandemic were compared against pre-pandemic characteristics. Results We observed a significant increase in the number of pediatric patients diagnosed with T2DM during the first year of the COVID-19 pandemic (n=46) relative to the 5 years prior (average 23.6+/-4.6 per year prior to pandemic, range 19-29 per year, one-sided Grubb's outlier test p=0.03). Upon comparing pre- and during-pandemic characteristics, there was no difference in sex among new diagnoses (42.2% female prior vs 56.8% during, p=0.08, Fisher's exact test), no difference in average BMI at diagnosis (35.2 kg/m2 prior vs 36.9 kg/m2 during, p=0.15, t-test), no difference in average age at diagnosis (14.3 years vs 14.6 years, p=0.49, t-test), no difference in HbA1c at diagnosis (9.4% prior vs 10.0% during, p=0.33, t-test), and no difference in incidence of diabetic ketoacidosis at presentation (21.7% prior vs 16.1% during, p=0.49, Fisher's exact). Conclusions Since the start of the COVID-19 pandemic, we observed a significant increase in incidence of newly diagnosed T2DM in pediatric patients, relative to the five years prior to the pandemic. However, there were no clear demographic or clinical factors differentiating pre-pandemic from during-pandemic diagnoses. Further monitoring and combination with larger datasets will be required to determine whether the increased incidence of T2DM will be a sustained trend and whether clinical or demographic characteristics of newly diagnosed pediatric patients may shift over time.