Youth Onset Type 2 Diabetes Spiked During First Year of Pandemic, Study Shows

Megan Kelsey, MD

Data from a new study paints a concerning picture related to the impact of the COVID-19 pandemic on the prevalence of type 2 diabetes among children, with results pointing to a steep rise in prevalence during the pandemic.

Led by investigators at COVID-19 and Type 2 Diabetes Consortium, results of the hospital-based, retrospective chart review, which included data from 24 medical centers across the US, indicate new diagnoses of type 2 diabetes increased by 77.2% during 2020 when compared to the number of diagnoses from the 2 years preceding the pandemic.

“To our knowledge, this is the first multicenter study to report the impact of the COVID-19 pandemic on rates of newly diagnosed youth onset type 2 diabetes,” said study investigator Megan Kelsey, MD, a pediatric endocrinologist at Children’s Hospital Colorado, in a statement. “We found that the pandemic was associated with an increase in new type 2 diabetes cases compared to the two prior years, as well as an increase in proportion of youth presenting in metabolic decompensation.”

A collaboration of clinicians and researchers the COVID-19 and Type 2 Diabetes Consortium includes representatives from multiple US-based institutions, such as the Johns Hopkins Children’s Center, Colorado Children’s Hospital, the Mayo Clinic, Children's Hospital of Philadelphia, and others. With observational reports and anecdotal evidence producing conflicting reports related to apparent increases in prevalence of new-onset type 2 diabetes during the pandemic, investigators from the consortium sought to explore this using electronic medical record data from institutions across the US.

A retrospective multicenter study, the present study leveraged data from 24 medical centers in the US to estimate trends in type 2 diabetes diagnoses among patients aged 21 years or less from March 1, 2018-March 1, 2021. From the 24 centers, investigators obtained data related to 3113 individuals diagnosed with diabetes during the study period. This cohort had a mean age of 14.4 (SD, 2.4) years, 50.5% were female, 40.4% were Hispanic, 32.7% were non-Hispanic Black, and 14.5% were non-Hispanic White.

During 2018 and 2019, investigators identified 886 and 765 new diagnoses of type 2 diabetes, respectively. During the pandemic, a total of 1463 diagnoses of new-onset type 2 diabetes were identified by investigators, which represents a 77.2% increase in rate of diagnosis. Further analysis provided evidence demonstrating a disproportionate number of diagnoses were observed in South and West regions of the country compared to the Northeast region (P=.11). Additionally, investigators highlighted there were no changes observed for mean age at presentation during the study period and also pointed out a greater proportion of boys were diagnosed with type 2 diabetes during the first year of the pandemic than girls, which is a reversal of the percentages observed in prepandemic years.

“This was one of the more unusual findings from our study,” added pediatric endocrinologist Risa Wolf, MD, assistant professor of pediatrics at the Johns Hopkins University School of Medicine and co-first author of the paper, in a statement. “Typically, we see more girls than boys who are newly diagnosed with type 2 diabetes, though it’s unclear why.”

Compared to those diagnosed in prepandemic years, those diagnosed with type 2 diabetes during the pandemic presented with higher median HbA1c (10.4% vs 9.3% [2018-2019] and 9.7% [2019-2020]; P <.001) and higher blood glucose during the pandemic compared with the 2 previous years (286 mg/dL vs 240 mg/dL [2018-2019] and 246 mg/dl [PPY19-20]; P <.001). Investigators noted a greater proportion of patients were diagnosed in inpatient settings during the pandemic as compared to prepandemic years and a greater proportion of patients presented with metabolic decompensation at time of diagnosis compared to prepandemic years.

This study, “The COVID-19 pandemic is associated with a substantial rise in frequency and severity of presentation of youth-onset type 2 diabetes,” was published in the Journal of Pediatrics.