153-LB: Initial Presentation of Children with Type 2 Diabetes during the COVID-19 Pandemic

Abstract

Stay at home orders due to the COVID-19 pandemic have exacerbated risk factors for type 2 diabetes. These orders have limited opportunities for daily physical activity, encouraged more screen time and sedentary behaviors, led to disturbed sleep, and promoted consumption of ultra-processed foods. Even modest weight gain over a short period of time can increase the risk for long-term consequences such as type 2 diabetes and cardiovascular disease. During the COVID-19 pandemic, there has been little data on the incidence or severity of new-onset type 2 diabetes in the pediatric population. We conducted a retrospective chart review of admissions for new onset type 2 diabetes from March to December 2019 and for the same period in 2020 at a tertiary care children’s hospital. Eligible patients were identified using ICD-10 codes for type 2 diabetes (E11.*); hyperglycemia (E72.51, E11.65, R73.9, R73.09); and hyperosmolar hyperglycemic syndrome (E13.*, E11.01). Each admission was carefully reviewed, and those with type 1 diabetes or hyperglycemia unrelated to diabetes were excluded. In 2019 the hospitalization rate for new onset type 2 diabetes was 0.27% (8 cases out of 2964 hospitalizations) compared to 0.62% (17 out of 2729) in 2020, p<0.048. In total 23 of 25 children were African American and 19 children were male. Three children in 2019 versus 8 children in 2020 met criteria for DKA while 2 children met criteria for HHS in 2020. The mean admission HbA1c was 12.4% in 2019 vs. 13.1% in 2020; while the mean admission glucose was 441 mg/dL in 2019 vs. 669 mg/dL in 2020. Furthermore, the admission serum osmolality was 314 mmol/kg in 2019 compared to 335 mmol/kg in 2020. Our study found that the incidence of hospitalization for new onset type 2 diabetes was higher in 2020 during the COVID-19 pandemic compared to the same period in 2019. While the labs presented were not statistically different due to the limited number of participants, further studies are warranted to better understand the clinical implications of these findings. Disclosure D. S. Hsia: None. M. Lim: None. R. A. Beyl: None. H. A. Hasan: None. J. Gardner: None. Funding National Institute of General Medical Sciences (U54GM104940)

Impact of the COVID-19 pandemic on cardiometabolic health parameters in children with preexisting dyslipidemia

“…However, there was subset of subjects who did have statistically and clinically significant changes in their lipid panel (including increased TC, non-HDL-C, and TG), In these subjects, increases in HgbA1c, fasting insulin, TC, TG, and ALT were indicative of worsening insulin resistance, dyslipidemia, and hepatic steatosis, respectively. These markers, particularly those indicating worsening insulin resistance (increased fasting insulin and HgbA1c), are consistent with reports of higher rates of pediatric type 2 diabetes during the pandemic 17 , 18 , 19 .…”

“…These changes all have the potential to worsen cardiometabolic health. Recent data have demonstrated an increased incidence and severity for new-onset type 2 diabetes 17 , 18 , 19 , an increase in pediatric BMI 20 , 21 , 22 , and worsening exercise capacity 22 , 23 during the pandemic. Furthermore, decreased socioeconomic status from unemployment or underemployment of parents may exacerbate existing disparities including food insecurity and access to care 24 , 25 , 26 .…”

Impact of SARS‐CoV2 on youth onset type 2 diabetes new diagnoses and severity

“…Some studies have reported an increased rate of diabetic ketoacidosis (DKA) and diabetes‐related admissions during the pandemic both for those with type 1 and type 2 diabetes. 7 , 12 , 14 , 16 Our findings may differ for a variety of reasons. Althoush some studied the difference in total number of DKA or hyperglycemic hyperosmolar state events, we looked at the proportion of new diagnoses that presented with acidosis or hyperosmolarity.…”

“…1 Reports from other centers do indeed show a rise in cases of type 2 diabetes among youth but show variable results in terms of severity and are focused on the early pandemic period. [12][13][14][15][16][17] The cause of the rise in type 2 diabetes is likely multifaceted. SARS-COV2 is hypothesized to directly increase the risk of hyperglycemia by acting at the angiotensin-converting enzyme 2 receptors expressed in key metabolic organs and tissues, including pancreatic beta cells.…”

The Impact of the COVID-19 Pandemic on Healthy Lifestyles in Rural Families

“…This same group published a quantitative survey which indicated 63% of parents reported a decrease in physical activity, which was exacerbated by a lack of playmates and if there was a lack of availability of adult supervision . Other early studies suggest an increased hospitalization rate for children with Type 2 diabetes during the early pandemic, and an increase in mental health problems among children, as well as the important associations between mental health and health behaviors and overweight/obesity status in children (Hsia et al, 2021;Leff et al, 2021;Alves et al, 2021).…”