In a multi-site study of medical records, researchers at Johns Hopkins Children’s Center and across the United States say they have documented a steep rise in type 2 diabetes among children during the COVID-19 pandemic. In the study, published in The Journal of Pediatrics,[1] the investigators said it is unclear whether the virus infection itself was a factor, or if it was environmental factors such as a move to remote learning, or the shutdown of sports and school activities that may have caused the increased risk.
The researchers identified 3,113 pediatric patients during that period, ages 8-21 and from 24 centers across the U.S. The average number of new diagnoses per year in the two pre-pandemic years increased from 825 to 1,463 during the first year of the pandemic, an increase of 77%.
Researchers said before the pandemic, type 2 diabetes was increasing among children around the world according to the Centers for Disease Control and Prevention (CDC), and because rates of childhood diabetes are known to rise and fall over time, the investigators launched a nationwide review of medical records to assess the impact of the pandemic, Sheela N. Magge, MD, MSCE, director of the Division of Pediatric Endocrinology at the Children’s Center, said in a statement on the study.
Magge, an associate professor of pediatrics at the Johns Hopkins University School of Medicine and co-first author of the paper, said reduced physical activity and weight gain are well-known risk factors for type 2 diabetes.
“During the COVID-19 lockdown, children were removed from normal day-to-day routines like going to school, playing sports and other hobbies,” she explained. “Not only were they less physically active, they were confined to their homes and spent a lot more time watching TV, playing video games, or with other electronic devices.”
Type 2 diabetes is a chronic disorder that affects the body’s ability to regulate, use and process sugar. Without treatment and control, it can cause heart disease, nerve and kidney damage, impaired vision and other irreversible injury to organs. Although generally associated with adults, an estimated one-third of American youth are considered at risk because of being overweight and obese. Magge adds that previous research from other institutions has shown that children diagnosed with diabetes appear to get complications faster than adults.
For the new study, conducted in collaboration with the University of Colorado School of Medicine, the researchers compared the rates of new-onset type 2 diabetes among people age 8 to 21 in the two years prior to the pandemic (March 1, 2018 to Feb. 29, 2020) to the first year of the pandemic (March 1, 2020 to Feb. 28, 2021).
During the first year of the pandemic, the records showed that more boys (55%) were diagnosed with type 2 diabetes than girls (45%), a reversal of the percentages during the pre-pandemic years. “This was one of the more unusual findings from our study,” says pediatric endocrinologist Risa Wolf, MD, assistant professor of pediatrics at the Johns Hopkins University School of Medicine and co-first author of the paper. “Typically, we see more girls than boys who are newly diagnosed with type 2 diabetes, though it’s unclear why.”
Compared with rates during the previous years, the number of diagnoses among Hispanic youth almost doubled during the first year of the pandemic, while the number of diagnoses among Black youth did double. Researchers said the number of cases in white youth decreased.
Type 2 diabetes is already known to disproportionately affect ethnic and racial minority populations and families with socioeconomic challenges, and the new study appears to show that such disparities deepened during the pandemic, Magge explained.
The new analysis documented the rise in cases with measures of increased body mass index (body fat based on height and weight) and higher blood glucose and hemoglobin A1c test results (standard diagnostic measures of diabetes).
In addition, during the pre-pandemic years, more patients were diagnosed while outpatients (57%) than during the pandemic year when more were diagnosed and treated as inpatients (57%), suggesting greater severity.
Overall, the researchers found that 21% of the young people diagnosed presented with “metabolic decompensation,” of which the most serious symptoms include vomiting, lethargy, confusion and rapid breathing. Pre-pandemic, such symptoms occurred in only 9% of children with new-onset type 2 diabetes. Because the study involved a retrospective review of medical records, the investigators said there is potential for inconsistencies in reporting or missing information.
Wolf said parents should talk to their children’s doctors about weight increases. Magge said now is the time to for parents to focus on exercising and healthy diets for kids.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com