Youth-onset type 2 diabetes may have increased sharply during the COVID-19 pandemic

1. In a retrospective cohort of about 3,000 children and young adults, new diagnoses of type 2 diabetes increased by 77.2% in the 12-month period beginning March 2020 compared to the previous 24 months.

2. The proportion of patients with new-onset type 2 diabetes presenting in diabetic ketoacidosis or hyperosmolar hyperglycemic state increased to 21% during the first year of the COVID-19 pandemic from 9.0-9.4% the previous two years.

Evidence Rating Level: 2 (Good)

Study Rundown: The incidence of type 2 diabetes in children and young adults has increased significantly in recent years. This multicenter study aimed to quantify the specific effect of the COVID-19 pandemic on this trend by comparing data from March 2020 through February 2021 to the previous two years. About 3,100 patients with new type 2 diabetes were included across 24 diabetes clinics, nearly 1,500 of whom were diagnosed during the pandemic year for an increase of 77.2% over the average of the previous two years. Body mass index (BMI), hemoglobin A1c, and blood glucose on presentation were all higher in patients diagnosed during the pandemic year, and 21% of patients presented in diabetic ketoacidosis (DKA) or hyperosmolar hyperglycemic state (HHS) compared to 9.4% and 9.0% in the previous two years. Because data was sourced only from specialty centers, it is possible that part of the observed increase is due to changes in practice patterns or where patients and their parents chose to seek care. Nonetheless, these data show a substantial and alarming spike in both new cases of type 2 diabetes in children and young adults and in the severity of first presentation, with far more patients presenting in DKA or HHS. Changes in activity, diet, and stress levels during the pandemic may play a role based on the increase in presenting BMI, and it is highly concerning that these factors would have such a rapid impact.

Click to read the study in the Journal of Pediatrics

Relevant Reading: Youth-onset type 2 diabetes consensus report: Current status, challenges, and priorities

In-Depth [retrospective cohort]: Patients aged 21 or younger were included. Type 2 diabetes was defined based on diagnosis of diabetes with at least two negative diabetes-associated antibodies and without positive antibodies. Patients with BMI below the 85^th percentile were excluded. DKA was defined as either pH less than 7.3 or serum bicarbonate level of 15 or lower. There were demographic differences between the groups diagnosed before and after the onset of the pandemic, with significantly higher proportions of Black patients and male patients in 2020-2021. Only 2.5% of patients were positive for COVID-19 at presentation, although data were not available for all patients. The proportion of patients diagnosed and initially managed in the inpatient setting increased from 43% to 57% during the pandemic year. A negative binomial time series model assuming a background trend of 5% more diagnoses per year showed a significant effect of the start of the pandemic in March 2020 on diagnoses (p<0.0001).

Image: PD

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