在 COVID-19 大流行期间，儿科 1 型和 2 型糖尿病的诊断和发病严重程度增加。
Increase in the Diagnosis and Severity of Presentation of Pediatric Type 1 and Type 2 Diabetes during the COVID-19 Pandemic.
机构信息
Division of Endocrinology, Children's National Hospital, Washington, District of Columbia, USA.
George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA.
出版信息
Horm Res Paediatr. 2021;94(7-8):275-284. doi: 10.1159/000519797. Epub 2021 Sep 24.
INTRODUCTION
The impact of the COVID-19 pandemic on the incidence of pediatric type 1 (T1D) and type 2 diabetes (T2D) and severity of presentation at diagnosis is unclear.
METHODS
A retrospective comparison of 737 youth diagnosed with T1D and T2D during the initial 12 months of the COVID-19 pandemic and in the preceding 2 years was conducted at a pediatric tertiary care center.
RESULTS
Incident cases of T1D rose from 152 to 158 in the 2 years before the pandemic (3.9% increase) to 182 cases during the pandemic (15.2% increase). The prevalence of diabetic ketoacidosis (DKA) at T1D diagnosis increased over 3 years (41.4%, 51.9%, and 57.7%, p = 0.003); severe DKA increased during the pandemic as compared to the 2 years before (16.8% vs. 28%, p = 0.004). Although there was no difference in the mean hemoglobin A1c (HbA1c) between racial and ethnic groups at T1D diagnosis in the 2-years pre-pandemic (p = 0.31), during the pandemic HbA1c at T1D diagnosis was higher in non-Hispanic Black (NHB) youth (11.3 ± 1.4%, non-Hispanic White 10.5 ± 1.6%, Latinx 10.8 ± 1.5%, p = 0.01). Incident cases of T2D decreased from 54 to 50 cases (7.4% decrease) over the 2-years pre-pandemic and increased 182% during the pandemic (n = 141, 1.45 cases/month, p < 0.001). As compared to the 2-years pre-pandemic, cases increased most among NHB youth (56.7% vs. 76.6%, p = 0.001) and males (40.4% vs. 58.9%, p = 0.005). Cases of DKA (5.8% vs. 23.4%, p < 0.001) and hyperosmolar DKA (0 vs. 9.2%, p = 0.001) increased among youth with T2D during the pandemic.
CONCLUSIONS
During the pandemic, the incidence and severity of presentation of T1D increased modestly, while incident cases of T2D increased 182%, with a nearly 6-fold increase in DKA and nearly a 10% incidence of hyperosmolar DKA. NHB youth were disproportionately impacted, raising concern about worsening of pre-existing health disparities during and after the pandemic.
简介
COVID-19 大流行对儿科 1 型（T1D）和 2 型糖尿病（T2D）的发病率和发病时严重程度的影响尚不清楚。
方法
在一家儿科三级保健中心，对大流行期间和前 2 年期间诊断的 737 名青少年进行了 T1D 和 T2D 的回顾性比较。
结果
T1D 的发病例数在前 2 年大流行期间从 152 例增加到 158 例（增加 3.9%），在大流行期间增加到 182 例（增加 15.2%）。T1D 诊断时糖尿病酮症酸中毒（DKA）的患病率在 3 年内增加（41.4%、51.9%和 57.7%，p=0.003）；大流行期间的严重 DKA 比前 2 年增加（16.8%比 28%，p=0.004）。虽然在大流行前 2 年 T1D 诊断时不同种族和族裔群体的平均血红蛋白 A1c（HbA1c）之间没有差异（p=0.31），但在大流行期间，非西班牙裔黑人（NHB）青少年的 T1D 诊断时的 HbA1c 更高（11.3±1.4%，非西班牙裔白人 10.5±1.6%，拉丁裔 10.8±1.5%，p=0.01）。T2D 的发病例数在前 2 年大流行期间从 54 例减少到 50 例（减少 7.4%），而在大流行期间增加了 182%（n=141，每月 1.45 例，p<0.001）。与大流行前 2 年相比，NHB 青少年（56.7%比 76.6%，p=0.001）和男性（40.4%比 58.9%，p=0.005）的病例增加最多。T2D 患者的 DKA（5.8%比 23.4%，p<0.001）和高渗性 DKA（0 比 9.2%，p=0.001）病例增加。
结论
在大流行期间，T1D 的发病率和发病严重程度略有增加，而 T2D 的发病例数增加了 182%，DKA 增加了近 6 倍，高渗性 DKA 的发病率增加了近 10%。非西班牙裔黑人青少年受到不成比例的影响，这让人担心大流行期间和之后现有的健康差距会恶化。
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