In a recent study published in JAMA Network Open, researchers examined diabetes incidence among youth in the United States before and during the coronavirus disease 2019 (COVID-19) pandemic.
Study: Incidence of Diabetes Among Youth Before and During the COVID-19 Pandemic. Image Credit: PeopleImages.com - Yuri A/Shutterstock.com
Background
Youth-onset diabetes is a chronic condition that puts people at risk of early complications and comorbidities.
Prior research revealed increases in type 1 and type 2 diabetes from 2002 to 2018 in the US, with substantial heterogeneity among ethnic and racial groups. Besides conventional risk factors, respiratory viruses may impact susceptibility or trigger autoimmunity in individuals with type 1 diabetes symptoms.
Nevertheless, there is limited research on how respiratory viruses impact type 2 diabetes. Moreover, risk factors for diabetes might have been aggravated during the COVID-19 pandemic.
Recent studies indicate increased rates of new-onset diabetes during the pandemic in young adults and children. However, these studies were limited to assessing variation by sex, age, and ethnicity/race.
About the study
In the present study, researchers assessed new-onset diabetes incidence between 2016 and 2021 in Kaiser Permanente Southern California (KPSC), an integrated healthcare delivery system covering more than one-fifth of the population in Southern California. KPSC members under 20 were identified during 2016-21, and annual cohorts were created.
Subjects were excluded if they had any evidence of diabetes before the incidence year or had less than one day of enrolment in the health plan the year before.
The researchers defined the evidence of diabetes before the incidence year as having ≥ 2 diabetes diagnosis codes in any setting.
Individuals with incident diabetes were those meeting one of the following criteria in the past year:
1) ≥ 1 inpatient primary discharge diagnosis for diabetes and ≥ 1 outpatient indicator of diabetes,
2) ≥ 1 outpatient diabetes diagnosis on separate days,
3) ≥ 1 outpatient diabetes diagnosis and medication prescription for diabetes,
4) ≥ 1 outpatient diabetes diagnosis and ≥ 2 abnormal laboratory results indicating diabetes.
Further, diabetes type was defined according to the number of diagnosis codes for diabetes one year after the incidence date. Patient characteristics were determined at diagnosis, including sex, age, race/ethnicity, body mass index (BMI), healthcare utilization, and laboratory results.
Trends in baseline characteristics were determined using Mantel-Haenszel and Cochran-Armitage tests for categorical and continuous variables, respectively.
Incident diabetes rates were calculated annually as well as quarterly. Additionally, rates were estimated by sex, age group, and race/ethnicity. Incidence rates were reported per 100,000 person-years. Incidence rate differences and ratios were estimated by comparing 2020-21 rates with 2016-19 rates.
Findings
The researchers identified 1,200 type 1 diabetes patients, 1,100 type 2 diabetes cases, and 63 individuals with other diabetes during 2016-21. Type 1 diabetes patients were aged, on average, 11 years, whereas type 2 diabetes patients were aged, on average, 15.7 years.
Most type 2 diabetes patients were females (53.1%) and Hispanic (66%). However, most type 1 diabetes patients were males (52.3%) and non-Hispanic White (36.4%).
There were no differences in sociodemographics, BMI, hemoglobin A1C (HbA1c) levels, and blood glucose levels from 2016 to 2021, whereas healthcare utilization increased in this period.
Type 1 diabetes incidence rates increased from 19.55 in 2016 to 24.27 in 2021. Incidence rates of type 2 diabetes surged from 15.66 in 2016 to 29.44 in 2021.
Further, incidence rates of other diabetes increased from 0.98 in 2016 to 1.22 in 2021. The incidence rates of type 1 and type 2 diabetes were 17% and 62% higher during 2020-21 relative to 2016-19, respectively.
Incidence rates of type 1 diabetes reduced from 26.2 in the first quarter (Q1) of 2016 to 18.3 in 2021 Q4, whereas the rates of type 2 diabetes increased from 18.4 in 2016 Q1 to 20.3 in 2021 Q4.
Conclusions
In sum, incidence rates of type 1 and type 2 diabetes were higher during the COVID-19 pandemic than before. Increases were evident overall and among specific subsets, such as males, the 10-19 age group, and some ethnic/racial minorities.
The incidence of type 2 diabetes spiked during Q3 and Q4 of 2020, particularly among Hispanic and Black individuals, suggesting a disproportionate burden in these subsets.
Further studies are necessary to delineate the differential impact of behavioral and physiological risk factors.
COVID-19 pandemic caused significant decline in special education identification