Pediatric Diabetes on the Rise: Trends in Incident Diabetes During the COVID-19 Pandemic

Rachel Modarelli; Salma Sarah; Megan E. Ramaker; Mboli Bolobiongo; Robert Benjamin; Pinar Gumus Balikcioglu

J Endo Soc. 2022;6(4)

Abstract and Introduction

Abstract

Context: The effects of the coronavirus disease 2019 (COVID-19) pandemic on the incident cases of pediatric type 1 diabetes (T1D) and type 2 diabetes (T2D) are not clear.

Objective: To identify trends in incidence and presentation of pediatric new-onset T1D and T2D during the COVID-19 pandemic.

Methods: A retrospective chart review was conducted. Demographics, anthropometrics, and initial laboratory results from patients ages 0 through 21 years who presented with new-onset diabetes to a pediatric tertiary care center were recorded.

Results: During the pandemic, incident cases of pediatric T1D increased from 31 in each of the prior 2 years to 46; an increase of 48%. Incident cases of pediatric T2D increased by 231% from 2019 to 2020. The number of incident cases of pediatric T2D increased significantly more than the number of incident cases of pediatric T1D (P = 0.009). Patients with T2D were more likely to present in diabetic ketoacidosis (DKA), though this was not statistically significant (P = 0.093). Severe DKA was higher compared with moderate DKA (P= 0.036) in incident cases of pediatric T2D. During the pandemic, for the first time, incident cases of T2D accounted for more than one-half of all newly diagnosed pediatric diabetes cases (53%).

Abstract and Introduction
Materials and Methods
Results
Discussion
References

Table 1. Type 1 diabetes demographic data
	2018–2019 N = 31	2019–2020 N = 31	2020–2021 N = 46	P value
Age, y (mean ± SD)	9.87 ± 3.49	10.39 ± 4.89	10.46 ± 3.67	0.806
Sex
Male	14 (45%)	14 (45%)	30 (65%)	0.12
Female	17 (55%)	17 (55%)	16 (35%)	0.12
Race, N (%)
White	20 (65%)	18 (58%)	30 (65%)	0.80
Black or African American	8 (26%)	10 (33%)	10 (22%)	0.59
More than 1 race	1 (3%)	0 (0%)	0 (0%)	0.57
American Indian or Alaska Native	0 (0%)	1 (3%)	0 (0%)	0.57
No response	2 (6%)	2 (6%)	6 (13%)	0.53
Ethnicity, N (%)
Hispanic or Latino	3 (10%)	3 (10%)	6 (13%)	0.86
Non-Hispanic or Latino	27 (87%)	27 (87%)	39 (85%)	1
No response	1 (3%)	1 (3%)	1 (2%)	1
Insurance, N (%)
Public	9 (29%)	15 (48%)	19 (41%)	0.29
Private	21 (68%)	16 (52%)	24 (52%)	0.33
Uninsured	1 (3%)	0 (0%)	3 (7%)	0.39

Age is represented in years indicated by group mean ± SD. Race, ethnicity, and insurance are indicated by number of participants (N) and percent of group total.

Table 2. Type 2 diabetes demographic data
	2018–2019 N = 17	2019–2020 N = 16	2020–2021 N = 53	P value
Age, y (mean ± SD)	14.00 ± 2.35	12.94 ± 2.64	13.81 ± 2.35	0.376
Sex
Male	7 (41%)	7 (44%)	25 (47%)	0.90
Female	10 (59%)	9 (56%)	28 (53%)	0.90
Race, N (%)
White	2 (12%)	3 (19%)	4 (8%)	0.42
Black or African American	12 (70%)	13 (81%)	33 (62%)	0.40
More than 1 race	0 (0%)	0 (0%)	0 (0%)	1
American Indian or Alaska Native	0 (0%)	0 (0%)	2 (4%)	1
No response	3 (18%)	0 (0%)	14 (26%)	0.55
Ethnicity, N (%)
Hispanic or Latino	3 (18%)	0 (0%)	11 (20%)	0.13
Non-Hispanic or Latino	14 (82%)	16 (100%)	39 (74%)	0.55
No response	0 (0%)	0 (0%)	3 (6%)	1
Insurance, N (%)
Public	12 (71%)	12 (75%)	39 (73%)	1
Private	5 (29%)	3 (19%)	12 (23%)	0.82
Uninsured	0 (0%)	1 (6%)	2 (4%)	0.54

Age is represented in years indicated by group mean ± SD. Race, ethnicity, and insurance are indicated by number of participants (N) and percent of group total.

Table 3. Type 1 diabetes initial laboratory results
	2018–2019	2019–2020	2020–2021	P value
	Mean ± SD	Mean ± SD	Mean ± SD
HbA1c (%)	12.28 ± 2.52	12.68 ± 2.06	12.09 ± 2.54	0.565
Initial glucose (mg/dL)	462.61 ± 151.14	522.84 ± 172.35	497.61 ± 257.95	0.522
pH, venous	7.22 ± 0.18	7.23 ± 0.16	7.25 ± 0.17	0.808
Bicarbonate, venous (mmol/L)	16.36 ± 8.53	15.51 ± 8.08	17.08 ± 8.05	0.719
βOHB (mmol/L)	5.68 ± 2.53	4.79 ± 2.72	4.89 ± 2.82	0.544
Anion gap (mmol/L)	17.71 ± 6.27	18.31 ± 5.47	17.72 ± 6.28	0.900
Initial C-peptide (ng/mL)	0.49 ± 0.44	0.53 ± 0.32	0.71 ± 1.01	0.396
Plasma osmolarity (mOsm/kg)	298.86 ± 11.50	299.08 ± 11.64	298.42 ± 12.96	0.971

P values indicated from ANOVA tests to identify significant changes throughout the 3 years.
Abbreviations: βOHB, beta hydroxybutyrate; HbA1c, hemoglobin A1c.

Table 4. Type 1 diabetes secondary organ involvement and autoimmune laboratory results
	2018–2019	2019–2020	2020–2021	P value
	Mean ± SD	Mean ± SD	Mean ± SD
ALT (U/L)	19.69 ± 6.45	16.65 ± 3.89	23.46 ± 23.03	0.310
AST (U/L)	17.38 ± 4.79	17.26 ± 6.23	20.75 ± 7.97	0.162
BUN (mg/dL)	15.87 ± 11.5	13.55 ± 5.57	13.02 ± 4.67	0.251
Creatinine (mg/dL)	0.87 ± 0.63	0.83 ± 0.31	0.83 ± 0.35	0.904
WBC (×10⁹/L)	11.92 ± 8.1	10.48 ± 10.2	10.20 ± 6.39	0.589
Platelet (×10⁹/L)	335.00 ± 78.66	322.55 ± 10.65	310.38 ± 91.77	0.569
Hgb (g/dL)	14.66 ± 1.06	14.51 ± 1.32	14.81 ± 1.54	0.663
FT4 (ng/dL)	0.97 ± 0.23	0.93 ± 0.23	0.94 ± 0.2	0.779
TSH (μIU/mL)	2.56 ± 2.80	1.96 ± 1.46	2.21 ± 1.31	0.482
IgA (mg/dL)	169.46 ± 103.4	167.34 ± 100.6	176.21 ± 100.4	0.929
TTG (Units)	8.32 ± 10.96	12.69 ± 25.17	17.41 ± 36.53	0.412

P values indicated from ANOVA tests to identify significant changes throughout the 3 years.
Abbreviations: ALT, alanine aminotransferase; AST, aspartate aminotransferase; BUN, blood urea nitrogen; FT4, free thyroxine; Hgb, hemoglobin; Ig, immunoglobulin; TTG, tissue transglutaminase; WBC, white blood cell.

Table 5. Type 2 diabetes initial laboratory results
	2018–2019	2019–2020	2020–2021	P value
	Mean ± SD	Mean ± SD	Mean ± SD
HbA1c (%)	9.04 ± 2.62	9.56 ± 2.67	10.31 ± 2.85	0.223
Initial glucose (mg/dL)	248.06 ± 146.8	276.13 ± 145.16	358.64 ± 293.71	0.209
pH, venous	7.27 ± 0.11	7.27 ± 0.11	7.26 ± 0.13	0.986
Bicarbonate, venous (mmol/L)	21.36 ± 6.98	23.00 ± 4.81	20.82 ± 7.03	0.662
βOHB (mmol/L)	2.84 ± 3.51	2.39 ± 1.67	3.60 ± 0.769	0.769
Anion gap (mmol/L)	11.82 ± 4.42	12.10 ± 4.58	15.00 ± 0.254	0.254
Initial C-peptide (ng/ml)	3.68 ± 2.82	3.10 ± 2.24	2.84 ± 0.674	0.674
Plasma osmolarity (mOsm/kg)	292.51 ± 6.31	294.09 ± 9.89	299.08 ± 0.425	0.425

P values indicated from ANOVA tests to identify significant changes throughout the 3 years.
Abbreviations: βOHB, beta hydroxybutyrate; HbA1c, hemoglobin A1c.

Table 6. Type 2 diabetes initial secondary organ involvement and autoimmune laboratory results
	2018–2019	2019–2020	2020–2021	P value
	Mean ± SD	Mean ± SD	Mean ± SD
ALT (U/L)	41.77 ± 45.36	53.10 ± 99.38	50.89 ± 53.89	0.881
AST (U/L)	32.38 ± 33.63	33.33 ± 46.48	38.49 ± 32.44	0.831
BUN (mg/dL)	9.61 ± 3.36	10.67 ± 3.89	10.11 ± 5.90	0.881
Creatinine (mg/dL)	0.72 ± 0.22	0.80 ± 0.34	0.90 ± 0.72	0.600
WBC (×10⁹/L)	10.00 ± 9.46	9.46 ± 3.65	10.22 ± 4.67	0.913
Platelet (×10⁹/L)	345.28 ± 73.35	322.43 ± 49.77	296.42 ± 69.9	0.171
Hgb (g/dL)	14.01 ± 1.72	14.39 ± 1.20	14.41 ± 1.83	0.858
FT4 (ng/dL)	2.21 ± 3.74	1.03 ± 0.18	0.94 ± 0.18	0.087
TSH (μIU/mL)	1.37 ± 0.79	7.91 ± 15.90	2.28 ± 1.15	0.022
IgA (mg/dL)	170.8 ± 65.09	143.0 ± 21.21	199.60 ± 93.1	0.586
TTG (units)	3.80 ± 1.64	3.50 ± 0.71	3.60 ± 2.08	0.975

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Pediatric Diabetes on the Rise: Trends in Incident Diabetes During the COVID-19 Pandemic

Abstract and Introduction

Abstract

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