Diagnoses of Youth-onset Type 2 Diabetes Spiked by 77% During First Year of COVID-19

The incidence of type 2 diabetes (T2D) among youth increased by 77% during the first pandemic year, according to findings of a national multicenter study by the COVID-19 and Type 2 Diabetes Consortium, published in the Journal of Pediatrics on August 17, 2022.

The study, which compared the rate of youth newly diagnosed with T2D during the pandemic with the 2 immediate prepandemic years, also found a significant rise in the severity of disease at initial presentation, according to investigators who write that the proportion of youth having metabolic decompensation at diagnosis more than doubled and a much higher proportion of first-time diagnoses were made in inpatient vs outpatient settings.

The proportion of youth having metabolic decompensation at diagnosis more than doubled during the pandemic year and a much higher proportion of first-time diagnoses were made in inpatient vs outpatient settings. 

The authors note that recently published epidemiologic data trace a rise in youth-onset T2D since the early 2000s but write that “the increase seen in the past year significantly outpaces” the annual increase in incidence of approximately 5% between 2002 and 2012 and even the greater increase of nearly 16% just before the pandemic began.

Whether or not the COVID-19 virus itself was a factor in the sharp rise in 2020 is unclear, according to investigators. They highlight significant pandemic-driven environmental factors affecting young people, including shifts to online learning and shutdown of sports and social activities, as potential contributing factors.

"Not only were they less physically active, they were confined to their homes and spent a lot more time watching TV, playing video games, or with other electronic devices," said study co-first author Sheela N. Magge, MD, MSCE, associate professor of pediatrics at the Johns Hopkins University School of Medicine and director of the Division of Pediatric Endocrinology at the Johns Hopkins Children's Center.

After learning about increases in rates and severity of youth-onset T2D at other US institutions, investigators at Johns Hopkins, in collaboration with the University of Colorado School of Medicine, set out to collect population-based data, compiling retrospective data from electronic medical records (EMRs) from institutions across the country.

Specifically, their objective was to compare the total number of new cases of youth-onset T2D and the proportion of those youth presenting with metabolic decompensation (diabetic ketoacidosis [DKA] and/or hyperosmolar hyperglycemic syndrome [HHS]) from March 2020 – February 2021 with the mean number of cases from the prior 2 years (March 1, 2018 – Feb 29, 2020).

FINDINGS

The research identified 3113 pediatric patients aged 8 to 21 years, from 24 US diabetes clinics with a new diagnosis of T2D between March 2020 and February 2021.

The total number of incident cases of T2D in the first pandemic year was 1463 compared with a mean of 825 cases during the 2 prepandemic years, an increase of 77.3%, according to the study. The increase in new presentations was observed across all participating sites, the authors write. The mean age at presentation was stable over the 3 years.

Racial and ethnic distribution did change over the 3 years (p=.004) with post-hoc analyses revealing an increase in T2D diagnoses among Black youth (p=.002) and a decrease among White youth (p=.039) during the pandemic year.

Boys, Girls, BMI, & DKA

Records for the first year of the pandemic showed that the proportion of boys with new onset T2D (55%) was higher compared to the proportion of girls (45%)—a reversal of the proportion during the 2 years before (55% girls, 45% boys; p<.001), and an unusual finding, the authors write. Though the reasons aren’t clear, they add, more girls than boys are newly diagnosed with T2D.

Body mass index (BMI) at diagnosis was statistically higher during the pandemic year compared with the 2 prepandemic years, the authors write, as were values for HbA1c (median 10.4% vs mean 9.5%, p<.001) and blood glucose (median 286 mg/dL vs mean 243 mg/dL, p<.001).

Approximately 1 in 5, or 21%, of the youth diagnosed with T2D during the pandemic year presented with metabolic decompensation, more than 2 times the proportion with related symptoms at diagnosis (9%) in the prepandemic years. Another indicator of the increased severity of disease in the pandemic year, more patients were newly diagnosed while inpatients (57%) while during the 2 years prior, 57% were diagnosed as outpatients.

Racial/ethnic disparities

Compared with rates during the previous years, the number of new T2D diagnoses among Hispanic youth almost doubled during the first year of the pandemic, and the number of diagnoses among Black youth doubled. Among white youth, the investigators noted a decrease in cases. The authors emphasize that this aspect of their findings demonstrates a deepening of the well-recognized disproportionate impact of T2D on racial and ethnic minority populations.

Referring to the "unprecedented impact of the COVID-19 pandemic" on youth-onset T2D, the researchers in their discussion underscore the already significant strain created by the steady rise in T2D diagnoses not only pediatricians but also on general practitioners and obesity specialists as well who, they observe, continue to manage the expanding population with limited resources. At the same time, they call for all clinicians to be vigilant in screening for T2D to increase early detection and treatment and prevent complications.

The authors caution that the retrospective chart review data are subject to inconsistiency in reporting and to the effects of missing information. It may also be difficult to generalize the findings broadly as the participants were all recruited from diabetes centers vs general practice.

"Follow-up studies will need to assess durability of the trend of increasing type 2 diabetes case numbers and severity, and to further explore potential underlying causes and outcomes," the conclude.

Reference: Magge SN, Wolf RM, Pyle L, et al on behalf of the COVID-19 and Type 2 Diabetes Consortium. The COVID-19 pandemic is associated with a substantial rise in frequency and severity of presentation of youth-onset type 2 diabetes. J Pediatr. 2022. doi: https:// doi.org/10.1016/j.jpeds.2022.08.010