Trends in Incident Pediatric Diabetes and the COVID-19 Pandemic

ABSTRACT

Objectives To identify trends in presentation and incidence of pediatric new-onset type 1 diabetes (T1D) and type 2 diabetes (T2D) during the COVID-19 pandemic. Methods Demographics, anthropometrics, and initial labs from patients ages 0-21 who presented with new-onset diabetes to a pediatric tertiary care center were recorded over a three-year time period from April 1, 2018 until March 31, 2021. Time periods were separated as follows April 1, 2018- March 31, 2019, April 1, 2019- March 31, 2020, and April 1, 2020- March 31, 2021. The final time period represents the COVID-19 pandemic. Microsoft Excel (2016) was used to calculate descriptive statistics (eg. Mean, standard deviations) and perform statistical analysis of continuous variables (eg. ANOVA). Statistical analysis of categorical variables (eg. sex, race, ethnicity) was performed by Chi-squared test or Fisher's exact test using R studio version 3.5.2. Cochran Armitage tests were performed to assess for trends in severity of diabetic patients from 2018 to 2020 and to determine if COVID-19 impacted diabetes severity using R (version 1.4.1106) and the DescTools package. Results In total, 207 patients were diagnosed with incident diabetes from April 2018 through March 2021, 108 with T1D and 86 with T2D. During the pandemic incident cases of pediatric T1D increased from 31 in each of the prior two years to 46;an increase of 48%. The number of patients with T1D presenting with mild diabetic ketoacidosis (DKA) significantly increased from 6% to 23% (p-value = 0.027). Incident cases of pediatric T2D increased by 231% from 2019 to 2020. The rate of patients with T2D presenting in DKA increased overall from 12% (n=2) in 2018 and 6% (n=1) in 2019, to 23% in 2020 (n=12), an increase of 91.7% from 2018 to 2020 . Furthermore, patients with T2D presenting with mild DKA increased by 116%. Prior to the pandemic, incident cases of T2D accounted for 35% of all newly diagnosed pediatric diabetes cases. During the pandemic, for the first time, incident cases of T2D accounted for more than half of the all newly diagnosed pediatric diabetes cases (53%). Conclusions There were more incident pediatric T1D and T2D cases as well as an increase in DKA at presentation during the COVID-19 pandemic. More importantly, incident T2D cases were higher than the incident T1D during the pandemic. This clearly suggests a disruption and change in the childhood diabetes trends with profound individual and community health consequences.