Glycemic control and complications of type 2 diabetes mellitus in children and adolescents during the COVID-19 outbreak

Abstract

Introduction: Obesity has been on the rise in children, adolescents and young adults during the Corona virus disease-2019 (COVID-19) outbreak. Obesity is known as the main risk factor for a number of diseases including type 2 diabetes mellitus (T2DM) and more than 90 percent of T2DM patients are overweight or obese. Along with the rise in obesity during the COVID-19 pandemic, we investigated the impact of COVID-19 pandemic on type 2 diabetes in children and adolescents.

Materials and Methods: A retrospective case analysis of children and adolescents diagnosed with T2DM who visited Korea University Hospital in both 2019 and 2020. We investigated changes in weight and body mass index (BMI)-standard deviation scores (SDS), glycated hemoglobin (HbA1c), diabetic complications, and management from 2019 to 2020.

Results: The Mean age of patients at study was 15.48 ± 2.15 years old and the mean disease duration was 2.56 ± 1.51 years. 70.6 % of patients were obese and the mean BMI-SDS was higher in 2020 than before the COVID-19 pandemic (2.21 ± 1.25 vs 2.35 ± 1.43, P=0.044). From 2019 to 2020, HbA1c level has also increased (6.5±2.72 mg/dL vs 7.3±3.70 mg/dL, P<0.001) and blood pressure (BP), total cholesterol, non-high density lipoprotein (HDL) cholesterol have also significantly increased. Obesity was found to be independent predictor of increased HbA1c in multivariable analysis (95% confidence interval 1.071-50.384, P=0.042). In non-obese subjects, HbA1c level has not significantly increased during the COVID-19 outbreak. In obese subjects, HbA1c and BMI-SDS have increased during the COVID-19 outbreak (6.45±2.30 mg/dL vs 7.20±3.05 mg/dL, P<0.001, 2.88 ± 0.75 vs 3.08±0.98, P=0.045, respectively). Diastolic BP, total cholesterol were also higher in 2020 compared to 2019 (P=0.037, 0.019 respectively).

Conclusion: During the COVID-19 outbreak, glycemic control and complications of type 2 DM have deteriorated in children and adolescents. This tendency was prominent in obese patients. Obese type 2 DM patients should be more closely monitored in glycemic control and complications.