Pediatric Diabetes on the Rise: Trends in Incident Diabetes During the COVID-19 Pandemic

Rachel Modarelli; Salma Sarah; Megan E. Ramaker; Mboli Bolobiongo; Robert Benjamin; Pinar Gumus Balikcioglu


J Endo Soc. 2022;6(4) 

In This Article

Abstract and Introduction


Context: The effects of the coronavirus disease 2019 (COVID-19) pandemic on the incident cases of pediatric type 1 diabetes (T1D) and type 2 diabetes (T2D) are not clear.

Objective: To identify trends in incidence and presentation of pediatric new-onset T1D and T2D during the COVID-19 pandemic.

Methods: A retrospective chart review was conducted. Demographics, anthropometrics, and initial laboratory results from patients ages 0 through 21 years who presented with new-onset diabetes to a pediatric tertiary care center were recorded.

Results: During the pandemic, incident cases of pediatric T1D increased from 31 in each of the prior 2 years to 46; an increase of 48%. Incident cases of pediatric T2D increased by 231% from 2019 to 2020. The number of incident cases of pediatric T2D increased significantly more than the number of incident cases of pediatric T1D (P = 0.009). Patients with T2D were more likely to present in diabetic ketoacidosis (DKA), though this was not statistically significant (P = 0.093). Severe DKA was higher compared with moderate DKA (P = 0.036) in incident cases of pediatric T2D. During the pandemic, for the first time, incident cases of T2D accounted for more than one-half of all newly diagnosed pediatric diabetes cases (53%).

Conclusions: There were more incident pediatric T1D and T2D cases as well as an increase in DKA severity in T2D at presentation during the COVID-19 pandemic. More importantly, incident T2D cases were higher than the incident T1D during the pandemic. This clearly suggests a disruption and change in the pediatric diabetes trends with profound individual and community health consequences.


The coronavirus disease 2019 (COVID-19) pandemic has introduced countless challenges to the medical field and has brought increased attention to children with preexisting disorders such as diabetes. More than 6 million children have tested positive for COVID-19 since the onset of the pandemic, a number that is projected to continue increasing.[1] Although children have lower rates of COVID-19 mortality, the presence of preexisting conditions such as diabetes can heighten the severity of their clinical presentations. Studies in adults have shown new-onset diabetes as well as expression of preexisting diabetes in a significant proportion of patients with COVID-19, both presenting with more severe infection.[2] Another study discussing the effect of the pandemic on adults with diabetes showed increases in diabetes-related stress, higher in young adults with type 2 diabetes (T2D) compared with older adults.[3] However, there are few studies evaluating the effects of COVID-19 on diabetes-related outcomes in children. Current data are not only limited but contradictory regarding the incidence and severity of presentation in childhood diabetes. Reports range from an increase in diabetic ketoacidosis rates in type 1 diabetes (T1D) and T2D in children to no change or even a decrease in the incidence of T1D during the pandemic.[4–9]

There are several factors proposed to contribute to an increase in either the incidence or severity of pediatric diabetes. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative agent of COVID-19, infects and replicates in cells of the human endocrine and exocrine pancreas, and is suspected to downregulate the renin-angiotensin-aldosterone system, leading to eventual destruction of pancreatic beta cells.[10–13] Additionally, COVID-19 causes an hyperinflammatory state and may induce ketosis and ketoacidosis.[13,14] Other factors include the immense behavioral and environmental changes since the onset of the pandemic. Across the globe, children were enrolled in school virtually, extracurricular activities were limited, and daily routines were adjusted to decrease the potential exposure to COVID-19. Consequences of this included increased screen time, unhealthy eating habits, decreased physical activity, and worsened sleep hygiene, which all have associations with increased body mass index (BMI).[15,16]

The objectives of this retrospective study were to compare the rates of diagnosis of new-onset pediatric T1D and T2D cases and to compare the severity of clinical presentation among patients seen at a single academic medical center during the COVID-19 pandemic with those in the 2 years preceding the pandemic. These are discussed while considering demographic and anthropometric changes in the overall clinic patient cohort. We hypothesized that the n umber of incident cases of both T1D and T2D have increased during the pandemic and that the severity of clinical presentation increased.