Type 2 diabetes cases rise to the tune of 77% observed among youth during COVID 19 pandemic

Researchers at Johns Hopkins Children's Center and associates have documented a steep rise in type 2 diabetes among children during the COVID-19 pandemic. The pandemic was associated with an increase to the tune of 77% 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.

The investigators stated that it was unclear whether COVID-19 infection itself was a factor in the rise, and they point to the switch to virtual learning and shutdown of sports and school activities as "environmental factors" that likely increased risk. The findings have been published in The Journal of Pediatrics.

"It used to be rare to hear about a child with type 2 diabetes, but its prevalence in adolescents has almost doubled in the past 20 years," said Dr. Kesley. "Type 2 diabetes is associated with rapidly progressive disease and early onset of complications and, unfortunately, was on the rise even prior to the COVID-19 pandemic."

Data suggests diagnoses of type 2 diabetes in children are increasing 4-5% per year. Type 2 diabetes occurs when the cells in the body do not respond to insulin, which increases the body's need for insulin. When the body can't keep up with these needs, glucose builds up in the bloodstream.

These increased sugar levels in the body can cause future additional conditions, such as heart disease, kidney failure and blindness. Type 2 diabetes is most likely to affect children who are female, overweight, have a family history of diabetes, Black, Indigenous and people of color (BIPOC), or have insulin resistance. The single biggest cause of type 2 diabetes in children is obesity. In the U.S., nearly one out of every three children are overweight.

The COVID-19 pandemic introduced multiple challenges and increased attention to children with preexisting disorders such as diabetes. "In the spring of 2020 we were inundated with new youth-onset type 2 diabetes cases," said Dr. Kelsey. "We were used to seeing 50-60 new cases per year and that increased to more than 100 new cases in a year.

Colleagues at other institutions were seeing the same thing, so we gathered a team of researchers to evaluate the frequency and severity of new cases during the first year of the pandemic compared to the mean of the prior two years. It was challenging because there is not a funded national registry for youth-onset type 2 diabetes, so this work was done with an enormous and voluntary effort of investigators across the country who are dedicated to treating diabetes in youth.

"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," Dr. Kesley said. "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."

Factors that may be contributing to this increase in youth-onset type 2 diabetes cases could be related to the immense behavioral and environmental changes since the onset of the pandemic. Across the globe, children were enrolled in school virtually, extracurricular activities were limited and daily routines were adjusted to decrease the potential exposure to COVID-19. Consequences of this included increased screen time, unhealthy eating habits, decreased physical activity and poor sleep habits, which all have associations with increased body mass index (BMI).

Whether the increase was caused by COVID-19 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 United States and whether it will persist over time," said Dr. Kesley. "There is still a lot of work to be done."

Reference:

Sheela N. Magge, Risa M. Wolf, Laura Pyle, Maha F. Yousif, Megan M. Kelsey, on behalf of theCOVID-19 and Type 2 Diabetes Consortium ˆPublished: August 17, 2022 DOI: https://doi.org/10.1016/j.jpeds.2022.08.010