Type 2 Diabetes Cases in Kids Still Rising After 'Return to Normal'

CHICAGO -- An increase in pediatric type 2 diabetes cases that began during school closures amid the COVID-19 pandemic has not returned to baseline, according to a retrospective study.

Compared with the year before COVID emerged, the number of new pediatric type 2 diabetes cases ballooned during the first year of the pandemic (March 2020 through February 2021; P=0.005), and then jumped again during the second year (March 2021 through February 2022; P=0.0006), reported Esther Bell-Sambataro, MD, of Nationwide Children's Hospital and the Ohio State University in Columbus, during ENDO 2023, the annual meeting of the Endocrine Society.

"Even though we may have returned to pre-pandemic times in several aspects, the increased risk of our youth developing type 2 diabetes that started during the pandemic appears to have persisted in the second year of the pandemic," she said.

This was the opposite finding of what the researchers hypothesized when they initiated this chart review at their institution.

The researchers believed they would see an increase in the first year of the COVID pandemic, due to school shutdowns causing kids to be less active, snacking more often, and eating more unhealthy foods.

"During the pandemic, we did see quite a bit of really decreased physical activity," Bell-Sambataro told MedPage Today. "Kids were out of school. Oftentimes, breakfast and lunch -- meals that they have at school which now are being provided at home -- might not have been as nutritious or as well-balanced."

"And so, we expected that once they returned back to school, things would normalize, which is not what we found," she added.

Similar results were seen for type 1 diabetes, Bell-Sambataro said, with body mass index (BMI) among all kids with new-onset type 1 diabetes diagnoses increasing significantly during the pandemic.

The mean BMI Z-score among all youths with new-onset diabetes increased from 0.58 in the year before the pandemic to 0.86 in the first year of the pandemic and to 1.29 in the second year.

HbA1C levels also increased significantly in the first year of the pandemic among kids with type 2 diabetes, with mean levels of 7.8% at diagnosis in the year before the pandemic rising to 10.1% and 9.7% in the first 2 years of the pandemic.

"We did find that there is something else that is causing this increase in type 2 diabetes, and we just need further studies to figure out what other things are contributing, including COVID-19," Bell-Sambataro noted. "At this time, we don't know that there is a true contribution to pathophysiology, but that is something that we'll need to continue to study."

Commenting on the study, Joseph Henske, MD, of the University of Arkansas for Medical Sciences in Little Rock, told MedPage Today that "this study raises a number of questions, including whether COVID-19 itself has an effect on development of type 2 diabetes. Also, COVID-19 is not over, it is still here, and that may be having an effect on these children and their risk of diabetes."

About half of the children who were diagnosed with both type 1 and 2 diabetes were girls in all time frames studied. The proportion of Black kids diagnosed also increased from 15% during the year before the pandemic to 27% during the second year of the pandemic. Throughout the study, the children were about 12 years old at diagnosis.

"We must continue to monitor our at-risk youth and have a low threshold to screen for type 2 diabetes in those with genetic risk factors, obesity, and less active lifestyles," Bell-Sambataro said. "The rapid change in the landscape of pediatric diabetes with a growing proportion of type 2 diabetes is an alarming trend that requires additional longitudinal and multicenter studies."

Comment