Worse clinical outcomes are seen during the COVID-19 pandemic for non-Hispanic Black youth with new-onset T2D.
During the early stages of the COVID-19 pandemic, individuals diagnosed with T1D saw an increased rate of severe diabetic ketoacidosis (DKA). However, due to limited research, the effects of the virus on children with diabetes were largely unknown. This retrospective study looked at the pediatric population to compare differences of new-onset of T1D and T2D during the first twelve months of the pandemic. Data taken from two years before the pandemic was used as a baseline. The study assessed the frequency of newly diagnosed diabetes, the severity of the disease, and differences in demographics and anthropometric characteristics.
Researchers collected data from an electronic medical record (EMR) of young patients. It included information on individuals ≤ 21 years of age who were newly diagnosed with T1D or T2D. The baseline plasma glucose, venous pH, serum bicarbonate, and A1c were recorded. The weight and BMI of individuals with T2D were also documented. A significant finding followed a two-tailed p-value of ≤ 0.05. Categorical variables were recorded as frequency and proportion. Continuous variables were recorded as mean, standard deviation, median, and interquartile range. Differences between the populations were expressed using Chi-square, Fisher’s exact, independent samples t-test, ANOVA, and Mann-Whitney test. The Cochran-Armitage trend test evaluated the increased incidence of T1D and T2D. The participants were categorized as having T1D (n=492) or T2D (n=245).
Baseline mean characteristics two years pre-pandemic were divided by female sex (61%), age at diagnosis (13.8), race [white (2%), Black (56%), Asian (3%), other (40%)], A1c (7.7), blood glucose (194), DKA (7.4%), DKA severity [mild (N/A), moderate (2%), severe (6%)]. Baseline mean characteristics one year pre-pandemic were divided by female sex (58%), age at diagnosis (14.1), race [white (8%), Black (58%), Asian (6.9%), other (30%)], A1c (9), blood glucose (283), DKA (4%), DKA severity [mild (N/A), moderate (2%), severe (2%)]. Baseline mean characteristics during the pandemic were divided by female sex (41%), age at diagnosis (14.5), race [white (5%), Black (77%), Asian (0.7%), other (18%)], A1c (10.2), blood glucose (311), DKA (23.4%), DKA severity [mild (11.3%), moderate (4.3%), severe (7.8%)].
Researchers found a 2.9% rise in T1D among youth two years before the pandemic, followed by a 15.2% rise during the pandemic. The prevalence of DKA upon T1D diagnosis increased over the three years (41.4%, 51.9%, 57.7%, p=0.003). Severe DKA also increased from 16.8% to 28% during this time (p=0.004). During the pandemic, A1c was higher upon T1D diagnosis among non- Hispanic Black (NHB) children [NHB (11.3±1.4%), non-Hispanic White (10.5±1.6%), Latinx (10.8±1.5%, p=0.01)] The new onset of T2D declined by 7.4% from year two to year one prior to the pandemic, then increased dramatically by 182% during the pandemic. Cases of T2D among NHB increased from 56.7% to 76.6% over the three years (p=0.001). Cases of DKA increased from 5.8% to 23.4% (p<0.001), and cases of hyperosmolar DKA increased from zero to 9.2% (p=0.001) among patients with T2D during the COVID-19 pandemic.
The COVID-19 pandemic brought on a small increase in T1D cases and a significant increase in T2D cases among the pediatric population. Cases of DKA and hyperosmolar DKA also increased, despite reducing the number of new patients at the center. More patients also required hospital admission due to the increased severity of their disease. NHB youth saw higher A1C and more cases of T2D during the pandemic than non-Hispanic white and Latinx youth. Limitations of this study include not screening for the virus in an outpatient setting and not collecting SARS-CoV-2 antibodies, both leading to an underestimation of patient outcomes. In addition, the study did not have enough power to determine if weight gain contributed to the increase in pediatric patients with T2D. Lastly, using a single center for data might have limited generalizability of the population. The researchers of this study believe more research on why the pandemic disproportionally impacted NHB youth is needed.
- The COVID-19 pandemic brought on a 15.2% increase in T1D cases and a 182% increase in T2D cases among the pediatric individuals examined.
- The prevalence of DKA upon T1D diagnosis during the pandemic increased by 16.3% compared to two years prior.
- Non-Hispanic Black youth saw an 11.3% A1c upon T1D diagnosis during the pandemic. This was higher when compared to non-Hispanic White and Latinx youth.
References for “182% Increase of New-Onset T2D in Youth During the COVID-19 Pandemic”:
Marks, Brynn E et al. “Increase in the Diagnosis and Severity of Presentation of Pediatric Type 1 and Type 2 Diabetes During the COVID-19 Pandemic.” Hormone research in pediatrics, 10.1159/000519797. 24 Sep. 2021, doi:10.1159/000519797. https://www-karger-com.cuhsl.creighton.edu/Article/Abstract/519797
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(November): dc201321-dc. https://pubmed.ncbi.nlm.nih.gov/32778554/
Author: Kornelia Ilias, Pharm.D. Candidate, Creighton University School of Pharmacy and Health Professions