Sharp Rise in New Onset Pediatric Diabetes During the Covid-19 Pandemic

ABSTRACT

Objectives This study aims to determine the incidence of new onset pediatric diabetes pre-pandemic vs during the pandemic. A second aim is to analyze the presentation based on age, severity, HbA1c, BMI, and Covid testing. Methods This retrospective cohort study includes pediatric patients with newly diagnosed diabetes (Type 1 and 2) admitted to the American Family Children's Hospital (Madison, WI) from 2018 to 2021. Data includes age at diagnosis, body mass index, hemoglobin A1c % and pH at presentation, presence of autoimmune pancreatic antibodies, and Covid-19 PCR results at admission in pre-pandemic (Jan 2018-March 2020) versus pandemic periods (March 2020 onwards). Diabetes was diagnosed as Type 1 when 1 or more pancreatic antibodies were positive, Type 2 when all 4 antibodies were negative and BMI >85th percentile. Statistical analysis was performed using SAS software with the incidence rates analyzed using univariate and multivariate Poisson regression analyses. Results During the pandemic, the incidence of both T1DM and T2DM increased (72% and 257% respectively, Table 1 and Figure 1), and a higher percent of T1DM patients presented in DKA (diabetic ketoacidosis), i.e., pH <7.3 (61.5% vs 48% pre-pandemic). Rates of severe DKA (pH <7.1) increased from 16% in 2018-2019 to 26% in 2020, with a decrease to 22% in 2021. T1DM patients with a BMI >95th percentile increased from fewer than 10% to above 15%. There were no significant differences observed in HbA1c between the two periods. Almost all patients were Covid-19 PCR negative at the time of diagnosis (97% in 2020 and 94.8% in 2021). Conclusions We and others have shown an increased number and severity of newly diagnosed pediatric diabetes cases with the pandemic. The increase in the incidence of pediatric diabetes at our center was not explained by factors such as changes in referral patterns or insurance coverage. Societal factors such as changes in the functionality and accessibility of the healthcare system and parental fears over contracting Covid may have contributed to increased severity at time of presentation. A possible direct diabetogenic effect of Covid-19 remains unknown.