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.
References
1.
Rabbone
I
, Schiaffini
R
, Cherubini
V
, Maffeis
C
, Scaramuzza
A
. Has COVID-19 delayed the diagnosis and worsened the presentation of type 1 diabetes in children?
Diabetes Care
. 2020
;43
(11
):2870
–2
. 2.
Tittel
SR
, Rosenbauer
J
, Kamrath
C
, Ziegler
J
, Reschke
F
, Hammersen
J
, Did the COVID-19 lockdown affect the incidence of pediatric type 1 diabetes in Germany?
Diabetes Care
. 2020
;43
(11
):e172
–3
. 3.
Dzygalo
K
, Nowaczyk
J
, Szwilling
A
, Kowalska
A
. Increased frequency of severe diabetic ketoacidosis at type 1 diabetes onset among children during COVID-19 pandemic lockdown: an observational cohort study
. Pediatr Endocrinol Diabetes Metab
. 2020
;26
(4
):167
–75
.4.
Ho
J
, Rosolowsky
E
, Pacaud
D
, Huang
C
, Lemay
JA
, Brockman
N
, Diabetic ketoacidosis at type 1 diabetes diagnosis in children during the COVID-19 pandemic
. Pediatr Diabetes
. 2021
;22
(4
):552
–7
. .5.
Chao
LC
, Vidmar
AP
, Georgia
S
. Spike in diabetic ketoacidosis rates in pediatric type 2 diabetes during the COVID-19 pandemic
. Diabetes Care
. 2021
.6.
Müller
JA
, Groß
R
, Conzelmann
C
, Krüger
J
, Merle
U
, Steinhart
J
, SARS-CoV-2 infects and replicates in cells of the human endocrine and exocrine pancreas
. Nat Metab
. 2021
;3
(2
):149
–65
. .7.
Nogueira-de-Almeida
CA
, Del Ciampo
LA
, Ferraz
IS
, Del Ciampo
IRL
, Contini
AA
, Ued
FDV
. COVID-19 and obesity in childhood and adolescence: a clinical review
. J Pediatr
. 2020
;96
(5
):546
–58
. .8.
Stojanovich
L
. Stress and autoimmunity
. Autoimmun Rev
. 2010
;9
(5
):A271
–6
. .9.
Rothe
J
, Buse
J
, Uhlmann
A
, Bluschke
A
, Roessner
V
. Changes in emotions and worries during the Covid-19 pandemic: an online-survey with children and adults with and without mental health conditions
. Child Adolesc Psychiatry Ment Health
. 2021
;15
(1
):11
. .10.
Zhang
H
, Guo
L-W
, Gao
Y-Y
, Yao
H
, Xie
Z-K
, Zhang
W-X
. The impact of the COVID-19 pandemic on pediatric clinical practice in Wenzhou, China: a Retrospective Study
. Front Pediatr
. 2020
;8
.11.
Macy
ML
, Huetteman
P
, Kan
K
. Changes in primary care visits in the 24 weeks after COVID-19 stay-at-home orders relative to the comparable time period in 2019 in metropolitan Chicago and Northern Illinois
. J Prim Care Community Health
. 2020
;11
:2150132720969557
. .12.
American Diabetes Association
. 2. Classification and diagnosis of diabetes: standards of medical care in diabetes-2021
. Diabetes Care
. 2021
;44
(Suppl 1
):S15
–33
. .13.
Kuczmarski
RJ
, Ogden
CL
, Guo
SS
, Grummer-Strawn
LM
, Flegal
KM
, Mei
Z
, 2000 CDC Growth Charts for the United States: methods and development
. Vital Health Stat 11
. 2002;May
;11
(246
):1
–190
.14.
Wolfsdorf
JI
, Glaser
N
, Agus
M
, Fritsch
M
, Hanas
R
, Rewers
A
, ISPAD clinical practice consensus guidelines 2018: diabetic ketoacidosis and the hyperglycemic hyperosmolar state
. Pediatr Diabetes
. 2018
;19
(Suppl 27
):155
–77
. .15.
Zeitler
P
, Haqq
A
, Rosenbloom
A
, Glaser
N
. Hyperglycemic hyperosmolar syndrome in children: pathophysiological considerations and suggested guidelines for treatment
. J Pediatr
. 2011
;158
(1
):9
–2
. .16.
Skinner
AC
, Skelton
JA
. Prevalence and trends in obesity and severe obesity among children in the United States, 1999–2012
. JAMA Pediatr
. 2014
;168
(6
):561
–6
. .17.
Flegal
KM
, Wei
R
, Ogden
CL
, Freedman
DS
, Johnson
CL
, Curtin
LR
. Characterizing extreme values of body mass index-for-age by using the 2000 Centers for Disease Control and Prevention growth charts
. Am J Clin Nutr
. 2009
;90
(5
):1314
–20
. .18.
Subcommittee on Standardized Collection of Race/Ethnicity Data for Healthcare Quality Improvement
. In: Ulmer
C
, McFadden
B
, Nerenz
DR
, editors. Race, ethnicity, and language data: standardization for health care quality improvement
. Washington, DC
: National Academies Press
; 2009
.19.
Goyal
MK
, Simpson
JN
, Boyle
MD
, Badolato
GM
, Delaney
M
, McCarter
R
, Racial and/or ethnic and socioeconomic disparities of SARS-CoV-2 infection among children
. Pediatrics
. 2020
;146
(4
). .20.
Dabelea
D
, Rewers
A
, Stafford
JM
, Standiford
DA
, Lawrence
JM
, Saydah
S
, Trends in the prevalence of ketoacidosis at diabetes diagnosis: the SEARCH for diabetes in youth study
. Pediatrics
. 2014
;133
(4
):e938
–45
. .21.
Divers
J
, Mayer-Davis
EJ
, Lawrence
JM
, Isom
S
, Dabelea
D
, Dolan
L
, Trends in incidence of type 1 and type 2 diabetes among youths: selected counties and Indian Reservations, United States, 2002–2015
. MMWR Morb Mortal Wkly Rep
. 2020
;69
(6
):161
–5
. .22.
Moltchanova
EV
, Schreier
N
, Lammi
N
, Karvonen
M
. Seasonal variation of diagnosis of Type 1 diabetes mellitus in children worldwide
. Diabet Med
. 2009
;26
(7
):673
–8
. .23.
Mayer-Davis
EJ
, Lawrence
JM
, Dabelea
D
, Divers
J
, Isom
S
, Dolan
L
, Incidence trends of type 1 and type 2 diabetes among youths, 2002–2012
. N Engl J Med
. 2017
;376
(15
):1419
–29
. .24.
Filippi
CM
, von Herrath
MG
. Viral trigger for type 1 diabetes: pros and cons
. Diabetes
. 2008
;57
(11
):2863
–71
. .25.
Elhakeem
A
, Heron
J
, Tobias
JH
, Lawlor
DA
. Physical activity throughout adolescence and peak hip strength in young adults
. JAMA Netw Open
. 2020
;3
(8
):e2013463
. .26.
Dunton
GF
, Do
B
, Wang
SD
. Early effects of the COVID-19 pandemic on physical activity and sedentary behavior in children living in the U.S
. BMC Public Health
. 2020
;20
(1
):1351
. .27.
Tulchin-Francis
K
, Stevens
W
Jr., Gu
X
, Zhang
T
, Roberts
H
, Keller
J
, The impact of the coronavirus disease 2019 pandemic on physical activity in US children
. J Sport Health Sci
. 2021
.28.
Parolin
Z
, Lee
EK
. Large socio-economic, geographic and demographic disparities exist in exposure to school closures
. Nat Hum Behav
. 2021
.29.
Centers for Disease Control and Prevention
. National diabetes statistics report, 2020
. Atlanta, GA
; 2020
.30.
Klingensmith
GJ
, Tamborlane
WV
, Wood
J
, Haller
MJ
, Silverstein
J
, Cengiz
E
, Diabetic ketoacidosis at diabetes onset: still an all too common threat in youth
. J Pediatr
. 2013
;162
(2
):330
–4.e1
. .31.
Everett
EM
, Copeland
TP
, Moin
T
, Wisk
LE
. National trends in pediatric admissions for diabetic ketoacidosis, 2006–2016
. J Clin Endocrinol Metab
. 2021
;106
(8
):2343
–54
. .32.
Ebekozien
O
, Agarwal
S
, Noor
N
, Albanese-O’Neill
A
, Wong
JC
, Seeherunvong
T
, Inequities in diabetic ketoacidosis among patients with type 1 diabetes and COVID-19: data from 52 US clinical centers
. J Clin Endocrinol Metabol
. 2020
.33.
Duca
LM
, Wang
B
, Rewers
M
, Rewers
A
. Diabetic ketoacidosis at diagnosis of type 1 diabetes predicts poor long-term glycemic control
. Diabetes Care
. 2017
;40
(9
):1249
–55
. .34.
Fourtner
SH
, Weinzimer
SA
, Levitt Katz
LE
. Hyperglycemic hyperosmolar non-ketotic syndrome in children with type 2 diabetes*
. Pediatr Diabetes
. 2005
;6
:129
–35
. .35.
Schmitt
J
, Rahman
AF
, Ashraf
A
. Concurrent diabetic ketoacidosis with hyperosmolality and/or severe hyperglycemia in youth with type 2 diabetes
. Endocrinol Diabetes Metab
. 2020
;3
(3
):e00160
. .36.
Pines
JM
, Zocchi
MS
, Black
BS
, Carlson
JN
, Celedon
P
, Moghtaderi
A
, Characterizing pediatric emergency department visits during the COVID-19 pandemic
. Am J Emerg Med
. 2021
;41
:201
–4
. .37.
Santoli
JM
, Lindley
MC
, DeSilva
MB
, Kharbanda
EO
, Daley
MF
, Galloway
L
, Effects of the COVID-19 pandemic on routine pediatric vaccine ordering and administration: United States, 2020
. MMWR Morb Mortal Wkly Rep
. 2020
;69
(19
):591
–3
. .38.
Linfoot
P
, Bergstrom
C
, Ipp
E
. Pathophysiology of ketoacidosis in Type 2 diabetes mellitus
. Diabet Med
. 2005
;22
(10
):1414
–9
. .© 2021 S. Karger AG, Basel
2021
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