YORK, Pa. — Diabetes was already known to increase a person's risk of catching COVID-19, but a new study from the Centers for Disease Control and Prevention shows an alarming trend: kids who contracted the virus having a higher risk of developing Type 1 or Type 2 diabetes after their infection.
The CDC study used a database of health care insurance claims to look at over half a million kids from March 2020 to June 2021. It found kids who contracted COVID-19 were 166% more likely to be diagnosed with diabetes than those who hadn't.
FOX43 contacted several major healthcare systems in our area to see if they too, were seeing this trend.
"Early on...in the pandemic we were seeing an increase in new diagnoses of Type 1 diabetes," Dr. Christopher Russo of WellSpan Health said. That being said, he said they haven't been seeing it lately, which makes him wonder if the cause has something to do with the variants of the virus or something else.
"Some thought that the same receptors that COVID attacks, which are also present in the pancreas, maybe cause that in children but it's really unknown at this time," Dr. Russo said.
Researchers call the link between COVID-19 and diabetes "complex." They admitted a "percentage" of the new diabetes cases were likely in kids who were prediabetic when they got COVID-19, but said that would not account for "all of the cases."
Researchers also said that it was still not fully clear whether the condition was permanent or if it would fade over time.
Either way, the CDC is now urging pediatricians to screen for diabetes in children who have had COVID-19.
Common symptoms of diabetes include frequent urination, increased thirst, increased hunger, weight loss, tiredness or fatigue, stomach pain and nausea, or vomiting. Dr. Russo advises that if your child is experiencing any of those symptoms after having COVID-19, to call your pediatrician right away.
FOX43 also spoke with doctors at UPMC Children’s Harrisburg, UPMC Children's Hospital of Pittsburgh, the Children's Hospital of Philadelphia, and the Penn State College of Medicine. Their statements can be found below:
Statement from UPMC:
"This CDC study reports a significant observation and highlights the importance for health care providers asking for symptoms and signs of diabetes in the youth during this pandemic.
While there was an approximate 20% increase in 2020 and 2021 in new cases of diabetes in youth at UPMC Children's Hospital of Pittsburgh, the total new onset numbers are comparable to the numbers in 2017, and therefore does not show a trend.
On preliminary look, it appears that approximately 20% of new cases of diabetes in youth was Type 2 diabetes in 2020 compared to approximately 10% in years prior to that suggesting an increase in Type 2 diabetes during the COVID pandemic that is consistent with other observations in the U.S.
However, the CDC study did not differentiate between Type 1 and Type 2 diabetes and the data only included children who are covered in commercial insurances, not including those without commercial health insurance or not seeking health care.
The study is a step to many more questions that need answers. Could it be a direct effect of the virus on the pancreas? Could it be stress on the pancreas due to weight gain/changes in lifestyle due to the COVID pandemic? Could it be stress on the pancreas after an infection, which happens with other infections, and pushes somebody that is already at risk to develop clinical diabetes? The reason for the increase in diabetes needs to be further researched."
- Amr Morsi, MD, Clinical Assistant Professor of Pediatrics, Pediatric Endocrinology and Diabetes, UPMC Children’s Harrisburg
- Ingrid M. Libman, MD, PhD, Associate Professor of Pediatrics and Epidemiology Director, Diabetes Program, UPMC Children's Hospital of Pittsburgh
Statement from Children's Hospital of Philadelphia:
"At CHOP, we have observed a modest rise (20%) in the number of new cases of Type 1 diabetes in the 21 months after the onset of the pandemic. However, since the spring of 2020, we have observed a steady rise in the number of cases of new onset Type 2 diabetes among children and adolescents, with a 76% increase in 2020, and a 130% increase in 2021. The vast majority of these cases were tested, and found not to be directly associated with SARS Co-V2 infection.
Rather, such a profound, gradual progression in the onset of Type 2 diabetes is more likely to be the result of lifestyle changes imposed by the pandemic than any direct effect of COVID infection, the majority of which remains mild or asymptomatic among children and adolescents. Remote education, with the resulting increased screen time and decreased physical activity, are very likely to be contributing factors in these trends."
- Steven M. Willi, MD, Director, Diabetes Center for Children at Children’s Hospital of Philadelphia and Professor of Pediatrics, Clinician Educator Track at the Perelman School of Medicine at the University of Pennsylvania
Statement from Penn State Health:
"Our pediatric diabetes Clinic at Penn State Health is participating in a national, multicenter study of more than 25 pediatric diabetes centers in the USA, comparing the incidence of Type 2 diabetes (T2D) two years before and after the pandemic, and we hope these results are published soon.
In regards to specific data related to the Penn State Pediatric Diabetes Clinic, through the conduction of the 'Youth Onset Type 2 Diabetes Study during COVID-19' at Penn State Health, where Dr. Huerta Saenz is one of the principal investigators, she definitely noticed a remarkable increase in the number of children with new diagnosis of Type 2 diabetes since the start of the pandemic. The increase has been almost twice from before. We have unpublished data related to children with new diagnosis of Type 2 diabetes between 2018 and 2019 and 2020 and 2021 at Penn State, and we have around 150 children with new onset T2D. The severity of presentation at the time of new diagnosis with T2D has been worse in this group.
Before the COVID-19 pandemic, most patients with a new diagnosis of T2D were referred as outpatients. Since the initiation of the pandemic, we had more cases of diabetic ketoacidosis combined with hyperglycemic hyperosmolar syndrome as initial presentations of new onset T2D. These two medical conditions by themselves or combined have high risk of mortality. Fortunately, all our patients were able to recover completely after the initial severe presentations, but they required many days of inpatient hospitalization at the pediatric intensive care unit due to the severity of their cases.
Interestingly, despite these severe presentations as new-onset T2D, these youth did not have COVID-19 infection at the time of presentation to our hospital. It is important to remember that T2D, in contrast to Type 1 diabetes, is associated with certain chronic risk factors and does not appear suddenly like Type 1 diabetes. Therefore, we can somehow prevent and intervene to avoid the progression of T2D.
Many of these children with new-onset T2D already have a prior history of severe obesity, rapid weight gain over several years before the diagnosis, insulin resistance (acanthosis nigricans = darker color of skin folds), borderline hyperglycemia, prediabetes, premature adrenarche, history of being infants of mothers with diabetes, and/or having 1st or 2nd degree family members with T2D.
The COVID-19 pandemic caused the closure of many pediatric care clinics or decreased the number of appointment slots for well-child visits. Many families were scared to go to the hospitals and/or pediatric clinics due to their fear to acquire COVID-19. In addition to that, many children with prior metabolic risk factors for T2D have been doing virtual schooling, which in turn caused a considerable reduction in their levels of physical activity, more access to unstructured snacks during the day, and maybe insufficient parental supervision at home as many working parents did not have the option to supervise their children at home.
If we also add the emotional stress of social isolation, feeling alone without friends, without their regular activities, and an unusual excess of screen time (if no adult supervision at home), it is possible that the sum of these factors enabled their prediabetes to progress faster to T2D during the 2 years of COVID-19 pandemic.
Dr. Huerta-Saenz personally believes that working together with primary care providers to initiate medical and nutritional interventions in children at risk for T2D may prevent the rapid progression of T2D in these children and/or help provide early treatment of T2D to avoid severe presentations.
These interventions may include obtaining lab tests such as hemoglobin A1C, fasting plasma glucose levels, and oral glucose tolerance tests, and even providing glucometer teaching classes to children at risk. Even though these are some impressions about our data at Penn State Health-Pediatric Diabetes clinic, it is important to consider there are comprehensive national data about youth with new onset T2D coming so we can understand this phenomenon better."
- Lina Huerta-Saenz, MD, FAAP, Pediatric Endocrinologist, Division of Pediatric Endocrinology and Diabetes, Assistant Professor of Pediatrics, Penn State College of Medicine
The CDC said the findings highlight the importance of COVID-19 vaccinations.
The entire CDC study can be found here.