Increase in the Diagnosis and Severity of Presentation of Pediatric Type 1 and Type 2 Diabetes during the COVID-19 Pandemic

Brynn E Marks; Aneka Khilnani; Abby Meyers; Myrto E Flokas; Jiaxiang Gai; Maureen Monaghan; Randi Streisand; Elizabeth Estrada

doi:10.1159/000519797

Increase in the Diagnosis and Severity of Presentation of Pediatric Type 1 and Type 2 Diabetes during the COVID-19 Pandemic

Horm Res Paediatr. 2021;94(7-8):275-284. doi: 10.1159/000519797. Epub 2021 Sep 24.

Authors

Brynn E Marks^{1

2}, Aneka Khilnani², Abby Meyers^{1

2}, Myrto E Flokas¹, Jiaxiang Gai³, Maureen Monaghan^{2

4}, Randi Streisand^{2

4}, Elizabeth Estrada^{1

2}

Affiliations

¹ Division of Endocrinology, Children's National Hospital, Washington, District of Columbia, USA.
² George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
³ Division of Biostatistics, Children's National Hospital, Washington, District of Columbia, USA.
⁴ Division of Psychology and Behavioral Health, Children's National Hospital, Washington, District of Columbia, USA.

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.

Keywords: COVID-19; Diabetic ketoacidosis; Hyperosmolar diabetic ketoacidosis; Pediatric type 1 diabetes; Pediatric type 2 diabetes.

MeSH terms

Adolescent
COVID-19*
Child
Child, Preschool
Databases, Factual
Diabetes Mellitus, Type 1 / diagnosis
Diabetes Mellitus, Type 1 / epidemiology*
Diabetes Mellitus, Type 2 / diagnosis
Diabetes Mellitus, Type 2 / epidemiology*
Diabetic Ketoacidosis / diagnosis
Diabetic Ketoacidosis / epidemiology*
Female
Humans
Incidence
Male
Pandemics
Patient Acuity
Prevalence
Retrospective Studies