Examining the incidence of type 1 diabetes during the pandemic

An investigation looks into how the incidence of type 1 diabetes changed during the first year of the COVID-19 pandemic.

Recently, the incidence of type 1 diabetes has seen an increase around the world. During the early course of the COVID-19 pandemic, investigators at Rady Children’s Hospital in San Diego, California, noted that the incidence of new-onset type 1 diabetes had significantly increased in comparison to the increases noted in previous 5 years. A review examines whether the increase was significant as well as whether more children were presenting with diabetic ketoacidosis or required an admission to the pediatric intensive care unit.1

The investigators ran a 6-year retrospective review of medical records at Rady Children’s Hospital. Criteria for inclusion were admission to Rady Children’s Hospital San Diego, patient age younger than 19 years, and at least 1 positive type 1 diabetes antibody titer. The medical records were used to find age, sex, hemoglobin A1c, body .mass index z score, COVID-19 infection results, diabetic ketoacidosis as evidenced by use of insulin infusion, and pediatric intensive care unit admission. For the purpose of the of the study, the COVID-19 year was defined as March 19, 2020 to March 18, 2021.

During the COVID-19 year, 187 children were admitted for new-onset type 1 diabetes. In comparison, 119 children were admitted in March 18, 2019 to March 18, 2020. From July 2020 to February 2021, the number of type 1 diabetes diagnoses was more than the anticipated number based on the quarterly moving average of the preceding 5 years (July 2020: 15 diagnoses; 10 forecasted diagnoses; 95% CI, 6.79-13.89; February 2021: 21 diagnoses; 10 forecasted diagnoses; 95% CI, 6.88-13.54). Among the 187 patients in the COVID-19 year, 4 had a COVID-19 infection when they presented. An increase in the percentage of patients with diabetic ketoacidosis when presenting was noted, but no difference between the COVID-19 year and the 5 preceding year was noted for average age at the time of presentation (9.6 [4.2] years vs 9.7 [4.2] years), body mass index z score (−0.39 [1.78] vs −0.43 [1.61]), hemoglobin A1c (11.6% [1.8%] vs 11.7% [1.9%]), or percentage of children requiring PICU admission (16 of 187 [8.6%] vs 41 of 641 [6.4%]). A significant increase in the frequency of diabetic ketoacidosis at the time of diagnosis was found with 49.7% requiring an insulin infusion during the pandemic and 40.7% needing one in the preceding years.

The investigators concluded that case rate of type 1 diabetes was higher during the year of the pandemic than in the proceeding 5 years. Additionally, a significant increase in diabetic ketoacidosis at the time of diagnosis was also noted.

Reference

  1. Gottesman B, Yu J, Tanaka C, Longhurst C, Kim J. Incidence of new-onset type 1 diabetes among US children during the COVID-19 global pandemic. JAMA Pediatr. January 24, 2022. Epub ahead of print. doi:10.1001/jamapediatrics.2021.5801