Type 1 Diabetes Diagnoses Spiked During the Pandemic

Significantly more children were diagnosed with type 1 diabetes (T1D) during the COVID-19 pandemic compared with previous years, a single-institution study suggested.

From March 2020 to March 2021, a total of 187 children were admitted for new onset T1D at a San Diego children’s hospital, a 57% increase over the 119 children in the prior year, according to Jane Kim, MD, of the University of California San Diego, and colleagues.

And for part of this pandemic period (July 2020 to February 2021), they found significantly more new diagnoses than would be predicted based on averages from the previous 5 years. For example, it was expected there would be 10 new diagnoses in February 2021, but in reality there were 21, the group wrote in a JAMA Pediatrics research letter.

Not only were there more new cases of T1D than expected, but more children initially presented with diabetic ketoacidosis (DKA) during the 1-year pandemic period as well (50% compared to an average of 41% over the prior 5 years).

“By measuring a 12-month interval after the onset of the COVID-19 pandemic, our cross-sectional study accounted for seasonal variation in the onset of new T1D cases,” Kim’s group pointed out. They also noted that they included data on the 5 years prior in order to account for the expected annual increases in cases, which have been increasing globally each year.

Despite the noted increase in DKA frequency, the researchers observed no significant difference in the percentage of kids that needed to be admitted to pediatric intensive care (8.6% during the pandemic vs 6.4% in the years prior), nor were there differences in average age at presentation (9.6 vs 9.7 years, respectively), BMI z-score (-0.39 vs -0.43), or HbA1c levels (11.6% vs 11.7%).

The study was limited to individuals 18 and younger admitted to Rady Children’s Hospital San Diego for a new case of T1D from March 2015 to March 2021. Patients had to have at least one positive T1D antibody titer. During the 5 years prior to the pandemic, 641 children were admitted to the hospital.

For kids diagnosed during the pandemic, 2.1% (4 of 187) were positive for COVID-19 at the time of diagnosis.

“As the only children’s hospital in the greater San Diego area, we routinely admit children with new-onset diabetes who require initiation of insulin treatment, and we monitor almost all patients newly diagnosed with T1D,” the group explained.

Kim’s group did note that despite the increase in the number of new cases, the number of children seen in their pediatric endocrine clinic didn’t “substantially” change.

Although all children diagnosed during the pandemic were tested for COVID-19 upon admission, the group didn’t perform antibody testing to check for past infection, an important limitation as recent CDC data have suggested that kids who test positive for COVID-19 may have an increased risk for T1D as well as other types of diabetes.