[COVID-19] Pandemic is Associated with a Substantial Rise in Frequency and Severity of Presentation of Youth-Onset Type 2 Diabetes, 2022, Magge et al

[forestglip]

The Coronavirus Disease 2019 Pandemic is Associated with a Substantial Rise in Frequency and Severity of Presentation of Youth-Onset Type 2 Diabetes

Spoiler: Authors

Magge, Sheela N.; Wolf, Risa M.; Pyle, Laura; Brown, Elizabeth A.; Benavides, Valeria C.; Bianco, Monica E.; Chao, Lily C.; Cymbaluk, Anna; Balikcioglu, Pinar Gumus; Halpin, Kelsee; Hsia, Daniel S.; Huerta-Saenz, Lina; Kim, Jane J.; Kumar, Seema; Levitt Katz, Lorraine E.; Marks, Brynn E.; Neyman, Anna; O'Sullivan, Katie L.; Pillai, Sabitha Sasidharan; Shah, Amy S.; Shoemaker, Ashley H.; Siddiqui, Juwairriyyah A.W.; Srinivasan, Shylaja; Thomas, Inas H.; Tryggestad, Jeanie B.; Yousif, Maha F.; Kelsey, Megan M.

Published: 2022

[Line breaks added]

Objectives:
To evaluate the frequency and severity of new cases of youth-onset type 2 diabetes in the US during the first year of the pandemic compared with the mean of the previous 2 years.

Study design:
Multicenter (n = 24 centers), hospital-based, retrospective chart review. Youth aged ≤21 years with newly diagnosed type 2 diabetes between March 2018 and February 2021, body mass index ≥85th percentile, and negative pancreatic autoantibodies were included. Demographic and clinical data, including case numbers and frequency of metabolic decompensation, were compared between groups.

Results:
A total of 3113 youth (mean [SD] 14.4 [2.4] years, 50.5% female, 40.4% Hispanic, 32.7% Black, 14.5% non-Hispanic White) were assessed.

New cases of type 2 diabetes increased by 77.2% in the year during the pandemic (n = 1463) compared with the mean of the previous 2 years, 2019 (n = 886) and 2018 (n = 765).

The likelihood of presenting with metabolic decompensation and severe diabetic ketoacidosis also increased significantly during the pandemic.

Conclusions:
The burden of newly diagnosed youth-onset type 2 diabetes increased significantly during the coronavirus disease 2019 pandemic, resulting in enormous strain on pediatric diabetes health care providers, patients, and families.

Whether the increase was caused by coronavirus disease 2019 infection, or just associated with environmental changes and stressors during the pandemic is unclear. Further studies are needed to determine whether this rise is limited to the US and whether it will persist over time.

Web | DOI | PMC | PDF | The Journal of Pediatrics

 

[Hutan]

If there is really is an increased incidence of diabetes following Covid-19, that could be relevant to us.

I haven't read the paper. I wonder though if an increase in diabetes diagnoses might be due to the lockdowns of the early Covid-19 years. If young people are not playing sport and being active as they did before, if they are instead staying at home, eating for something to do and gaining weight, perhaps that would account for an increase in diagnoses. It's interesting that the researchers picked up a change in the sex ratios, with a skew towards boys being more commonly diagnosed. That could support the idea that a significant factor here is a change in lifestyle, from active to sedentary.

 

[Midnattsol]

If there is really is an increased incidence of diabetes following Covid-19, that could be relevant to us.

I haven't read the paper. I wonder though if an increase in diabetes diagnoses might be due to the lockdowns of the early Covid-19 years. If young people are not playing sport and being active as they did before, if they are instead staying at home, eating for something to do and gaining weight, perhaps that would account for an increase in diagnoses. It's interesting that the researchers picked up a change in the sex ratios, with a skew towards boys being more commonly diagnosed. That could support the idea that a significant factor here is a change in lifestyle, from active to sedentary.

While an increase in childhood obesity have been noted, there are other studies that find an increase in both healthy eating and activity levels.

For diabetes type 1 in Norway both genders had an incidence spike in 2022, then a reduced number in 2023 (makes sense as you can only have diabetes onset once and a vulnerable individual could have become sick in 2022 and thus no longer part of the pool of individuals able to be newly ill in 2023), and for boys there was a new spike i 2024. However it's difficult to interpret the numbers as diabetes type 1 incidence has been rising for years and was already on trend to double by 2050. I haven't seen if the rate has increased more or less than the pre-pandemic trend. But interesting that the gender difference was there.

 

[Hutan]

While an increase in childhood obesity have been noted, there are other studies that find an increase in both healthy eating and activity levels.

Might that have varied a lot by country, depending on social welfare arrangements? As in, families reliant on manual work for an income, the sort of work that can't be done from home, and without good access to financial support might be less likely to have parents at home baking sourdough bread, making salads and taking their children to play in the safe park nearby?

Can you recall what has been seen with Type 2 diabetes in Scandinavia?

Would we expect the causes of increases in Type 1 and 2 diabetes to be different?

 

[ScoutB]

Would we expect the causes of increases in Type 1 and 2 diabetes to be different?

Experts should weigh in, but since Type 1 is an autoimmune disease and Type 2 is not, I think we would expect different factors to matter most?

The wikipedia section on causes of Type 1 looks to my layman eyes like a pretty standard mix of hypotheses for autoimmune diseases: they've investigated various foods like dairy and gluten (obesity is only slightly associated to type 1, unlike type 2), vitamin D levels, omega-3s, viral infection... genetically the HLA genes are pretty important.

On type 1 the paper says:

Multicenter and/or population-based studies in the US and Europe suggest that the proportion of youth with type 1 diabetes presenting in diabetic ketoacidosis (DKA) rose early in the pandemic, but the impact on the overall incidence of type 1 diabetes is still unclear.