Incidence of Diabetes in Children and Adolescents During the COVID-19 Pandemic

Abstract

ImportanceThere are reports of increasing incidence of pediatric diabetes since the onset of the COVID-19 pandemic. Given the limitations of individual studies that examine this association, it is important to synthesize estimates of changes in incidence rates.ObjectiveTo compare the incidence rates of pediatric diabetes during and before the COVID-19 pandemic.Data SourcesIn this systematic review and meta-analysis, electronic databases, including Medline, Embase, the Cochrane database, Scopus, and Web of Science, and the gray literature were searched between January 1, 2020, and March 28, 2023, using subject headings and text word terms related to COVID-19, diabetes, and diabetic ketoacidosis (DKA).Study SelectionStudies were independently assessed by 2 reviewers and included if they reported differences in incident diabetes cases during vs before the pandemic in youths younger than 19 years, had a minimum observation period of 12 months during and 12 months before the pandemic, and were published in English.Data Extraction and SynthesisFrom records that underwent full-text review, 2 reviewers independently abstracted data and assessed the risk of bias. The Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guideline was followed. Eligible studies were included in the meta-analysis and analyzed with a common and random-effects analysis. Studies not included in the meta-analysis were summarized descriptively.Main Outcomes and MeasuresThe primary outcome was change in the incidence rate of pediatric diabetes during vs before the COVID-19 pandemic. The secondary outcome was change in the incidence rate of DKA among youths with new-onset diabetes during the pandemic.ResultsForty-two studies including 102 984 incident diabetes cases were included in the systematic review. The meta-analysis of type 1 diabetes incidence rates included 17 studies of 38 149 youths and showed a higher incidence rate during the first year of the pandemic compared with the prepandemic period (incidence rate ratio [IRR], 1.14; 95% CI, 1.08-1.21). There was an increased incidence of diabetes during months 13 to 24 of the pandemic compared with the prepandemic period (IRR, 1.27; 95% CI, 1.18-1.37). Ten studies (23.8%) reported incident type 2 diabetes cases in both periods. These studies did not report incidence rates, so results were not pooled. Fifteen studies (35.7%) reported DKA incidence and found a higher rate during the pandemic compared with before the pandemic (IRR, 1.26; 95% CI, 1.17-1.36).Conclusions and RelevanceThis study found that incidence rates of type 1 diabetes and DKA at diabetes onset in children and adolescents were higher after the start of the COVID-19 pandemic than before the pandemic. Increased resources and support may be needed for the growing number of children and adolescents with diabetes. Future studies are needed to assess whether this trend persists and may help elucidate possible underlying mechanisms to explain temporal changes.

Prevalence and Incidence of Medication-Treated Diabetes and Pattern of Glucose-Lowering Treatment During the COVID-19 Pandemic: Real-World Data from the Electronic Greek Prescription Database

“…A cross--sectional study from Canada showed that the number of individuals with T2DM who were prescribed a non-insulin glucose-lowering medication increased during the post-pandemic period [16]. Although there is some evidence that COVID-19 infection may increase the risk of incident diabetes, and, hence, the use of glucose-lowering medications [7][8][9][10], since this has not been unequivocally proven [11,12], additional data from more countries and a more extended observation period are required to draw definitive conclusions.…”

Shifting landscapes: The environmental impact of urbanisation on childhood myopia, obesity and diabetes

“…Furthermore, the incidence of type 1 diabetes was higher during the COVID-19 pandemic than before. 13 Compared with the year before the pandemic, childhood type-1 diabetes incidence increased by 16% and 28% in the first and second years of the pandemic, respectively. 13 This increase was much more significant than the prepandemic annual incidence rate of 2% to 3% for childhood type-1 diabetes.…”

“…13 Compared with the year before the pandemic, childhood type-1 diabetes incidence increased by 16% and 28% in the first and second years of the pandemic, respectively. 13 This increase was much more significant than the prepandemic annual incidence rate of 2% to 3% for childhood type-1 diabetes. Concerningly, myopia progression is accelerated in children with type-1 diabetes.…”

“…11 These trends seem unstoppable; the negatives of rising population density are seen as being outweighed by the benefits of economies of scale, access to skills and services, interconnection and leisure. The COVID-19 epidemic challenged this idea, making us realise the vulnerability of our lifestyles with pandemic control measures, including school closures, remote learning and home confinements, accelerating the previously rising childhood trends in obesity, 12 diabetes 13 and myopia. 14 Mackey and Lee 15 and Rosenfield 16 synthesised the impact of colliding pandemics (myopia and COVID-19) and the consequences of strict lockdowns on childhood myopia progression.…”

“…Additionally, access to healthcare services, socio-economic status and cultural factors can play a significant role in determining a child's risk for myopia, diabetes and obesity in urban settings. Nonetheless, given the alarming upward trend in the prevalence of myopia, 20 childhood diabetes, 13 severe obesity, the persistence of adiposity from infancy to adulthood 39 and the perilous course of young adults with chronic comorbidities, the healthcare system's economic and clinical service load is predicted to rise.…”