[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.

 

[Midnattsol]

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?

I think we can expect to see variation also within countries.

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?

In Norway there was a spike in diabetes 2 in adults in 2022, and a return to "normal" rates of new onset in 2023. Data for 2024 has not been published yet. In 2014-2018 there was ~5k cases/year, in 2019-2020 there was ~10k cases/year, from 2021-2022 we had ~40k cases/year and 2022-2023 there was again ~10k cases.

 

[boolybooly]

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.

I wonder if an alternative hypothesis might be that covid directly affects the renin angiotensin system (RAS) because of the way it targets ACEII receptors to gain ingress into cells. RAS/ACEII receptor attack was I believe a concern in the early investigations of covid pathology in the elderly.

The types of diabetes presenting with covid have been described as novel presentations. This review indicates cases predominantly classified as type 2.

Risk of incident diabetes after COVID-19 infection: A systematic review and meta-analysis - PMC

COVID-19 might be a risk factor for various chronic diseases. However, the association between COVID-19 and the risk of incident diabetes remains unclear. We aimed to meta-analyze evidence on the relative risk of incident diabetes in patients with ...

pmc.ncbi.nlm.nih.gov

Risk of incident diabetes after COVID-19 infection: A systematic review and meta-analysis

Ten articles involving 11 retrospective cohorts with a total of 47.1 million participants proved eligible. We found a 64 % greater risk (RR = 1.64, 95%CI: 1.51 to 1.79) of diabetes in patients with COVID-19 compared with non-COVID-19 controls, which could increase the number of diabetes events by 701 (558 more to 865 more) per 10,000 persons. We detected significant subgroup effects for type of diabetes and sex. Type 2 diabetes has a higher relative risk than type 1. Moreover, men may be at a higher risk of overall diabetes than women. Sensitivity analysis confirmed the robustness of the results.

This makes sense to me because where default RAS activity is not regulated by adequate AngII cleavage into Ang1-7 it can produce activity which resembles diabetes 2. See ref in my previous post i.e. insulin resistance etc.

Post in thread 'Post COVID Migraine in a Six Day Cycle'

Oct 24, 2025

"COVID-19 and Diabetes: A Comprehensive Review of Angiotensin Converting Enzyme 2, Mutual Effects and Pharmacotherapy"

COVID-19 and Diabetes: A Comprehensive Review of Angiotensin Converting Enzyme 2, Mutual Effects and Pharmacotherapy - PMC

The potential relationship between diabetes and COVID-19 has been evaluated. However, new knowledge is rapidly emerging. In this study, we systematically reviewed the relationship between viral cell surface receptors (ACE2, AXL, CD147, DC-SIGN, ...

pmc.ncbi.nlm.nih.gov

Ang II acts on type 1 angiotensin receptor (AT1R), which increases blood pressure levels by inducing vasoconstriction and by increasing renal reabsorption of sodium as well as water. Moreover, Ang II promotes oxidative stress, inflammation and fibrosis (4). In addition to causing pulmonary edema and lung injury, it can also lead to insulin resistance, endothelial dysfunction and proteinuria. These...

• boolybooly

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Where covid spike is blocking ACEII receptors or whole virus infection is stripping them from the cell surface during ingestion, AngII conversion might be significantly curtailed by lack of available converting enzyme meaning default RAS activity would predominate. If you consider covid targets ACEII in multiple tissues including the blood vessel endothelium it suggests a large endothelial surface area could be adversely affected.

So my hypothesis would be this novel presentation of a new form of diabetes might be directly due to covids attack on the ACEII receptor in tissues. Though it raises questions about the longevity of the aftermath.

 

[rvallee]

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.

I don't find this hypothesis compelling. School lunches are usually not healthy, so much that eating real home food probably made up for any such possibility. Same for the physical activity. Things obviously vary a lot between school systems but like everything else in society basic education has significantly enshitiffied in the last generation or so and most of the cuts were in everything fun and active. Most of those activities are outside organized sports and other things, very few of which shut down for an extended period.

But anyway this is a US study and they had almost no such thing as 'lockdowns' in the vast majority of places. Schools closed and that's what you mean here but it's still a big stretch. The whole blaming of everything on 'lockdowns' that actually happened as vilified almost nowhere is so annoying, and we can pretty much easily tell that there is nothing to it by the fact that no study has actually done a comparison between places that had strict measures and places that did not. Because it would break the convenient lie.