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Pediatric Type 2 Diabetes Presentation During the COVID-19 Pandemic

Type 2 diabetes (T2D) is caused by a combination of reduced insulin sensitivity combined with inadequate insulin secretion.1,2 T2D is a growing public health concern in the pediatric population with increasing incidence both nationally3,4 and locally. Earlier screening and treatment are important for youth with T2D. The American Diabetes Association recommends to screen youth with an increased body mass index (BMI, ≥85th percentile), and who have at least one additional risk factor, including minority race/ ethnicity, family history of T2D in a firstor seconddegree relative, maternal history of gestational diabetes, and evidence of insulin resistance on physical examination or comorbidities associated with insulin resistance.1,2 Screening is important as youth with T2D have a more rapid decline in pancreatic β-cell function than adults, and decline in β-cell function is associated with metabolic decompensation and need for insulin therapy.1,5,6 Moreover, youth with T2D often develop related complications within a few years of being diagnosed with the disease.1,5,6 In addition, about 11% youth with T2D present with diabetic ketoacidosis (DKA) and 2% with hyperglycemic hyperosmolar state (HHS), which can be associated with increased morbidity and mortality.7,8 The worldwide outbreak of severe acute respiratory syndrome coronavirus-2 has led to an unprecedented pandemic. Significant concerns have been articulated regarding potential coronavirus disease 2019 (COVID19) exacerbations of and induction of T2D.9,10 Chao and colleagues found that there were higher rates of DKA in youth diagnosed during the COVID-19 pandemic.9 In March 2020, when the COVID-19 pandemic resulted in stay-at-home policies, many outpatient clinic appointments were cancelled. In addition, studies have found that there was also increased medical care avoidance, which itself can lead to harm.11,12 We hypothesize that youth diagnosed with T2D during the COVID-19 pandemic presented later in their disease course compared with patients diagnosed with T2D in the prior 4 years. Methods