ADA 81st Symposium: COVID-19 and New-Onset Type 2 Diabetes

How has the COVID-19 pandemic affected the incidence of type 2 diabetes and other conditions such as Hyperosmolar Hyperglycemic Syndrome (HHS) within the younger population? 

With the fear of spreading the virus, governments worldwide have had to initiate quarantines for their people to contain COVID-19, prevent overcrowding in hospitals, and minimize the death toll. The pandemic has ushered many unknowns onto the world, with many people struggling to adjust to this new lifestyle. With more people staying at home, the disruption of regular routines has led to little daily exercise, increased sedentary behaviors, and encouraged unhealthy diets. While this is unwelcomed even for healthy adults, this could be especially detrimental for the younger population. The purpose of the study was to assess how the pandemic affected the incidence and severity of new-onset type 2 diabetes in the younger population.

This study was a retrospective chart review of admissions (n= 25) for new-onset type 2 diabetes. The periods for this study spanned from March to December 2019 and March to December 2020. The sampled population for this study included patients under 19 years of age that were associated with ICD-10 codes for type 2 diabetes, hyperglycemia, and HHS. The majority of patients were African American males with an average age of 13.5 for the 2019 data set and 14.3 for the 2020 data set. Admissions excluded from this retrospective study included patients with type 1 diabetes and hyperglycemia that was unrelated to a diabetes diagnosis.

The data was collected and analyzed; the results showed no difference in age, sex, and race, but there was an increase in the average BMI from 32.1 to 34.6 kg/ m² (P-Value= 0.29). In addition, there was an increase in glucose levels (P-Value= 0.14), average HbA1c (P-Value= 0.59), and osmolarity levels (P-Value= 0.19) when looking at 2020 admissions compared to 2019 admissions. As for the Diabetic Keto Acidosis (DKA) cases, there was an increase from three cases in 2019 to eight (P-Value= 0.31) in 2020. Similar to DKA cases, HHS cases increased from having none in 2019 to two cases in 2020 (P-Value= 0.45). Hospitalization rates for the inclusion criteria in 2019 were 0.27% (8/2964 hospitalizations) and 0.62% (17/2729 hospitalizations) in 2020 with a P-Value <0.05.

Serum Glucose (mg/ dL)

• 2019: 441
• 2020: 669

HbA1c (%)

• 2019: 12.4
• 2020: 13.1

Serum osmolarity (mmol/ kg)

• 2019: 314
• 2020: 335

DKA criteria met (n)

• 2019: 3
• 2020: 8

HHS criteria met (n)

• 2019: 0
• 2020: 2

To summarize, there was an increased incidence of new-onset type 2 diabetes in these locations during the pandemic in 2020 compared to 2019 of the same timeframe. However, despite an increase in the different parameters between the 2019 and 2020 data sets, the results were not statistically significant. This result could be due to the limitation of this study, a small sample size. Therefore, further research is required to support the results of this study.

Practice Pearls:

• There was an increase in the onset of new diabetes during the pandemic.
• The number of cases for DKA and HHS rose during the pandemic.
• Despite the increase in the interested parameters, none were statistically significant.

Hsia, Daniel S et al. “153-LB: Initial Presentation of Children with Type 2 Diabetes during the COVID-19 Pandemic.” American Diabetes Association 81^st Scientific Sessions. Diabetes, June 25, 2021 (Requires ADA Symposium login.)

Alan Martinez, PharmD Candidate, University of South Florida Taneja College of Pharmacy