Division of Endocrinology, Children's National Hospital, Washington, District of Columbia, USA.
National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland, USA.
Horm Res Paediatr. 2024;97(3):218-224. doi: 10.1159/000531720. Epub 2023 Jun 30.
Cases and severity of presentation of youth-onset type 2 diabetes (Y-T2D) increased during the COVID-19 pandemic, yet the potential drivers of this rise remain unknown. During this time public health mandates paused in-person education and limited social interactions, resulting in radical lifestyle changes. We hypothesized that the incidence and severity of presentation of Y-T2D increased during virtual learning amidst the COVID-19 pandemic.
We conducted a single-center retrospective chart review to identify all newly diagnosed cases of Y-T2D (n = 387) at a pediatric tertiary care center in Washington, DC during three predetermined learning periods as defined by learning modality in Washington, DC Public Schools: pre-pandemic in-person learning (March 11, 2018-March 13, 2020), pandemic virtual learning (March 14, 2020-August 29, 2021), and pandemic in-person learning (August 30, 2021-March 10, 2022) periods.
Incident cases were stable during pre-pandemic in-person learning (3.9 cases/month, 95% CI: 2.8-5.4 cases/month), increased to a peak during virtual learning (18.7 cases/month, 95% CI: 15.9-22.1 cases/month), and declined with return to in-person learning (4.3 cases/month, 95% CI: 2.8-6.8 cases/month). Y-T2D incidence was 16.9 (95% CI: 9.8-29.1, p < 0.001) and 5.1-fold higher (95% CI: 2.9-9.1, p < 0.001) among non-Hispanic Black and Latinx youth, respectively, throughout the study period. Overall COVID-19 infection rates at diagnosis were low (2.5%) and were not associated with diabetes incidence (p = 0.26).
This study provides timely insights into an important and modifiable correlate of Y-T2D incidence, its disproportionate impact on underserved communities, and the need to consider the effects on long-term health outcomes and preexisting healthcare inequities when designing public policy.
在 COVID-19 大流行期间，青年起病 2 型糖尿病（Y-T2D）的病例和严重程度有所增加，但这种上升的潜在驱动因素尚不清楚。在此期间，公共卫生法规暂停了面对面教育，并限制了社交互动，导致生活方式发生了根本性的变化。我们假设，在 COVID-19 大流行期间，虚拟学习期间 Y-T2D 的发病率和严重程度有所增加。
我们进行了一项单中心回顾性图表审查，以确定在华盛顿特区的一家儿科三级保健中心新诊断的 Y-T2D 病例（n = 387），这些病例发生在华盛顿特区公立学校规定的三个预定学习期间：大流行前的面对面学习（2018 年 3 月 11 日至 2020 年 3 月 13 日）、大流行期间的虚拟学习（2020 年 3 月 14 日至 2021 年 8 月 29 日）和大流行期间的面对面学习（2021 年 8 月 30 日至 2022 年 3 月 10 日）。
大流行前的面对面学习期间，新发病例保持稳定（3.9 例/月，95%置信区间：2.8-5.4 例/月），在虚拟学习期间增加到峰值（18.7 例/月，95%置信区间：15.9-22.1 例/月），随着恢复面对面学习而下降（4.3 例/月，95%置信区间：2.8-6.8 例/月）。在整个研究期间，非西班牙裔黑人和拉丁裔青年的 Y-T2D 发病率分别为 16.9（95%置信区间：9.8-29.1，p < 0.001）和 5.1 倍（95%置信区间：2.9-9.1，p < 0.001）。诊断时的总体 COVID-19 感染率较低（2.5%），与糖尿病发病率无关（p = 0.26）。
本研究及时提供了 Y-T2D 发病率的一个重要且可改变的相关因素的见解，以及其对服务不足社区的不成比例影响，以及在设计公共政策时需要考虑对长期健康结果和先前存在的医疗保健不平等的影响。
