Increase in T1D Diagnosis During COVID-19 Pandemic Unlikely To Reflect New Pattern

Jane J. Kim, MD

New research from a tertiary care center for children in San Diego observed the incidence of new-onset type 1 diabetes (T1D) during the COVID-19 pandemic in 2020 and 2021 increased compared to previous years.

Led by Jane J. Kim, MD, Department of Pediatrics, University of California, San Diego, a 6-year retrospective review evaluated the significance of the increased incidence and whether or not more children had diabetic ketoacidosis (DKA) or required pediatric intensive care unit admission.

Ultimately, Kim and colleagues noted the number of inpatient admissions decreased by 19% from 2019 - 2020, while the number of children seen at the pediatric endocrine clinic and residing in the surrounding region did not change substantially.

“Therefore, the observed increase in diabetes diagnoses during the COVID-19 pandemic is unlikely to reflect changes in referral number or pattern,” they wrote.

The Study

The cross-sectional study used a self-service reporting tool from the electronic medical record at Rady Children’s Hospital San Diego. Inclusion criteria included admission to the hospital, patients aged ≤19 years, and ≤1 positive T1D antibody tier.

Additionally, age, sex, hemoglobin A1c, body mass index z score, COVID-19 infection results, DKA evidenced by use of insulin infusion, and PICU admission extracted from each patient’s medical record.

Patients were tested for acute COVID-19 infection on admission, defined as the year after California’s stay-at-home orders from March 2020 - March 2021. Then, prior data from March 2015 - March 2020 were analyzed to ensure that the increase in new-onset T1D diagnosis was not due to previous annual rate of increase.

Investigators performed an autoregressive integrated moving average to forecast the predicted trend of new-onset T1D cases during the COVID-19 year.

Data

The results showed from March 2020 - March 2021, 187 children (mean age, 9.6 years; 106 girls, 56.7%) were admitted for new-onset T1D, compared to 119 children admitted the previous year (57% increase).

From July 2020 - February 2021, the number of new diagnoses of T1D exceeded the number of patients anticipated within the 95% confidence interval based on the quarterly moving average of the preceding 5 years (July 2020, 15 diagnoses; 10 forecasted diagnoses; 95% CI, 6.79 - 13.89 versus February 2021, 21 diagnoses; 10 forecasted diagnoses; 95% CI, 6.88 - 13.54).

At the time of presentation, 4 of 187 (2.1%) had a COVID-19 infection at the time of presentation. An increase in the percentage of patients who presented with DKA was observed, with no difference in mean age at presentation (9.6 versus 9.7 years), body mass index z score (-0.39 versus -0.43), hemoglobin A1c (11.6% versus 11.7%), or percentage of children requiring PICU admission (16 of 187, 8.6% versus 41 of 641, 6.4%).

Further, Kim and colleagues observed a significant increase in the frequency of DKA at the time of T1D diagnosis. Data show 93 of 187 patients (49.7%) required an insulin infusion during the COVID-19 pandemic, which increased from 261 of 641 patients (40.7%) in the 5 years before the pandemic.

The study, “Incidence of New-Onset Type 1 Diabetes Among US Children During the COVID-19 Global Pandemic,” was published in JAMA Pediatrics.