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Pediatric diabetes mellitus hospitalizations and COVID-19 pandemic response measures
Hope Shimony1, Lauren Miller1, Patrick Reich2
1Washington University School of Medicine, Pediatric Endocrinology, St. Louis, MO, USA.
Insights
During the COVID-19 pandemic, pediatric type 2 diabetes (T2DM) hospital admissions tripled, with a higher likelihood of new-onset patients presenting in diabetic ketoacidosis (DKA). Socioeconomic vulnerability was linked to new T2DM cases.
Area of Science:
- Pediatric Endocrinology
- Public Health
- Epidemiology
Background:
- The COVID-19 pandemic has been associated with increased hospital admissions for diabetes mellitus (DM) in the United States.
- Understanding trends in pediatric diabetes during this period is crucial for public health initiatives.
Purpose of the Study:
- To assess hospital admission rates for pediatric type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) between 2019 and 2021.
- To investigate the potential influence of pandemic response measures on these admission rates.
Main Methods:
- Retrospective chart review of 854 T1DM and 135 T2DM admissions in patients under 20 years old (2019-2021).
- Data collected included demographics, admission type, BMI, and Area Deprivation Index (ADI).
- Patients were categorized into pre-pandemic (2019), pandemic pre-vaccine (2020), and pandemic post-vaccine (2021) cohorts.
Main Results:
- T2DM hospitalizations tripled during the pandemic (18 in 2019 to 62 in 2021).
- Higher rates of diabetic ketoacidosis (DKA) were observed in new-onset T1DM and T2DM patients in 2020.
- New-onset T2DM correlated with younger age and higher ADI, indicating socioeconomic vulnerability.
Conclusions:
- While T1DM hospitalizations remained stable, T2DM admissions significantly increased during the pandemic.
- Pediatric patients with new-onset DM during the pandemic were more likely to present with DKA.
- Socioeconomic factors played a role in new-onset T2DM admissions.
Aims:
In the United States, evidence suggests that during the COVID-19 pandemic, admissions of patients with diabetes mellitus (DM) have increased. This study assessed hospital admission rates for pediatric type 1 (T1DM) and type 2 (T2DM) diabetes mellitus during 2019-2021, and the potential influence of the timing of various pandemic response measures.
Methods:
Retrospective chart reviews were conducted of 854 T1DM and 135 T2DM hospital admissions between January 2019 and December 2021 in patients < 20 years old to collect demographic data, admission type, body mass index (BMI), and area deprivation index (ADI, a measure of socioeconomic vulnerability). Patients were divided into three cohorts based on their admission year: 2019 (Pre-pandemic), 2020 (Pandemic, Pre-vaccine), and 2021 (Pandemic, Post-vaccine). Admissions were categorized within each cohort by diagnosis (T1DM or T2DM) and clinical presentation (new onset, diabetic ketoacidosis: DKA). Cohorts were compared using an independent samples t-test for continuous variables or a chi-square test for categorical variables.
Results:
The incidence of T2DM hospitalizations tripled during the pandemic, increasing from 18 in 2019 (Pre-pandemic), to 55 in 2020 (Pandemic, Pre-vaccine), and 62 in 2021 (Pandemic, Post-vaccine). The rate of patients presenting with DKA was 15.4 % (95 % CI: 4 %-26.9 %) higher in 2020 (Pandemic, Pre-vaccine) among patients with new-onset T1DM (72/139 vs. 52/143), and 22.5 % (95 % CI: 9.6 %-35.4 %) higher in 2020 (Pandemic, Pre-vaccine) among T2DM patients (9/40 vs. 0/14). This increased rate of new onset T2DM significantly correlated with younger age (P = 0.046) and higher ADI score (P = 0.017), but not with BMI.
Conclusion:
The incidence of T1DM hospitalizations did not increase during the pandemic; however, they tripled for T2DM patients. All new onset DM pediatric patients during the pandemic were more likely to present in DKA. Patients admitted with new onset T2DM were socioeconomically more vulnerable. For T1DM, the peak of local pediatric diabetes admissions in 2020 occurred slightly later coinciding with the reopening of primary care physicians (PCP) offices and schools.
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