Young people were more likely to be initially diagnosed with type 2 diabetes (T2D) during the pandemic, while there was a significant increase in the number of new-onset pediatric T2D cases during the first 9 months of the COVID-19 crisis, researchers reported.
Most of these cases involved non-Hispanic Black children and males, according to presentations at the American Diabetes Association (ADA) virtual meeting.
The researchers' rationale for conducting these studies of pediatric tertiary care centers was similar: "There are limited type 2 data available on the pediatric population" during the pandemic, said Brynn Marks, MD, MSHPEd, of Children's National Hospital in Washington.
In the first ADA study, a retrospective chart review, among the 2,729 patients admitted to Our Lady of the Lake Children's Health in Baton Rouge between March-December 2020, 17 children were first diagnosed with T2D (0.62%), reported Daniel Hsia, MD, of the Pennington Biomedical Research Center at Louisiana State University in Baton Rouge.
That was an increase over the 0.27% (eight of 2,964) who were first diagnosed from March-December 2019 (P<0.05). Of the 25 total kids diagnosed, 23 were Black and 19 were male, he stated.
Also, the mean age for T2D onset was 14.3 years in 2020 versus 13.5 in 2019 (P=0.48) with the population limited to people under age 19.
In addition, "While the number of participants was limited and the labs presented were not statistically different, there was a suggestion of increased admission acuity in 2020 compared to 2019," Hsia and colleagues wrote in the ADA presentation.
Patients were identified using ICD-10 codes for T2D, hyperglycemia, and hyperosmolar hyperglycemic syndrome (HHS), while patients with type 1 diabetes (T1D) and hyperglycemia not related to diabetes were excluded.
The number of patients with diabetic ketoacidosis (DKA) increased from three to eight (P=0.31), while the number of patients with HHS increased from zero to two (P=0.45), he reported. Both conditions typically require admission to the ICU. Mean serum glucose increased from 441 to 669 mg/dL (P=0.14), HbA1c from 12.4% to 13.1% (P=0.59), and serum osmolarity from 314 to 335 mmol/kg (P=0.19).
Orders to stay home during the pandemic "have limited opportunities for daily physical activity, encouraged more screen time and sedentary behaviors, led to disturbed sleep, and promoted consumption of ultra-processed foods. Even modest weight gain over a short period of time can increase the risk for long-term consequences such as type 2 diabetes and cardiovascular disease," the authors wrote.
"Further studies are warranted to better understand the clinical implications of these findings," they stated.
"While our study examined hospital admissions for type 2 diabetes in children at one center, the results may be a microcosm of what is happening at other children's hospitals across the country," Hsia said in a press release. "Unfortunately, COVID-19 disrupted our lives in more ways than we realize. Our study reinforces the importance of maintaining a healthy lifestyle for children even under such difficult circumstances."
Hsai said his group hopes to pool their data with others to see if the results reflect regional or national trends.
Marks and colleagues conducted a cross-sectional review of data from their institution, defining "youth" as ages 21 and under, and defining data as pre-pandemic from March 11, 2019 to March 10, 2020 while pandemic data came from March 11, 2020 to March 10, 2021.
The group examined overall diagnosis rates, demographic and clinical characteristics, and presentation severity, Marks explained.
They found that T2D diagnoses nearly tripled from 50 before the pandemic to 141 during the pandemic, and increases were prominent among non-Hispanic Black youth. T2D diagnoses in Non-Hispanic Blacks as a share of all diagnoses increased from 58% to 76.7% (P=0.06). The percentage of female patients with a T2D diagnosis declined from 58% to 41.1% (P=0.05).
The number of cases per month increased from 0.12 (P=0.65) to 1.45 (P=0.001), "and it was continuing to rise when data collection ceased," Marks said. The percentage of diagnosed T2D cases diagnosed rose from 24% to 44% versus T1D cases.
Also, the number of youth presenting with DKA went from two to 33 (P=0.001), while the percentage needing inpatient management increased from 36% to 60.3%, according to the researchers.
Disclosures
Hsia and co-authors disclosed no relationships with industry.
Marks disclosed funding from Tandem Diabetes Care and supplies from Dexcom.
Primary Source
American Diabetes Association
Source Reference: Hsia DS, et al "Initial Presentation of Children with Type 2 Diabetes during the COVID-19 Pandemic" ADA 2021.
Secondary Source
American Diabetes Association
Source Reference: Marks B, et al "The COVID-19 Pandemic and New-Onset Pediatric Type 2 Diabetes" ADA 2021
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