Department of Research & Evaluation News

A study of more than 1 million Kaiser Permanente members ages 19 and younger found that rates of both type 1 and type 2 diabetes increased among children during the COVID-19 pandemic, particularly for those ages 10 and older, male children, and children in specific racial and ethnic groups. The study was published September 21, 2023, in JAMA Network Open.

“In this prolonged pandemic period, it is now more important than ever to be aware of a possible increased risk of new-onset diabetes in children,” said the study’s lead author Matthew Mefford, PhD, of the Kaiser Permanente Southern California Department of Research & Evaluation.

The new study adds to growing evidence of an uptick in diabetes during the pandemic. It builds on prior research by considering a longer timeline and by taking a closer look at potential disparities in rates of newly diagnosed diabetes among children of different ages, genders, and racial and ethnic groups.

“Our findings highlight how important it is for health care providers to screen thoughtfully for pediatric diabetes and for families to emphasize healthy lifestyles and activity levels for children of all ages,” said co-author John Martin, MD, an internal medicine specialist with the Southern California Permanente Medical Group.

Prepandemic versus postpandemic

For the new research, Dr. Martin, Dr. Mefford, and their colleagues compared rates of newly diagnosed type 1 and type 2 diabetes among children before and after the pandemic began.

More specifically, they examined the electronic health records of Kaiser Permanente members younger than 20 and compared the rates of new-onset diabetes from the prepandemic period of 2016 through 2019 to rates from 2020 through 2021. The total number of patient records analyzed ranged from 979,710 children in 2016 to 1,028,997 children in 2021.

They found that, overall, rates of newly diagnosed diabetes increased during the pandemic compared to before the pandemic, with a markedly greater increase of type 2 diabetes.

Rates of new-onset type 1 diabetes increased by 17%, an uptick that was primarily driven by increased diagnosis among 10- to 19-year-olds, male children, and Hispanic youth. Rates of new-onset type 2 diabetes increased by 62%, mostly driven by increases in 10- to 19-year-olds, Black and Hispanic youth, and both male and female children, with males experiencing a greater increase.

“Our results are very much in alignment with prior research showing concerning trends in the incidence of diabetes—a disease that affects such a large proportion of children,” Dr. Mefford said. “We identified specific groups of kids who could potentially benefit from higher prioritization for screening and monitoring to try and reduce the disparities we found.”

Taking action

The underlying reasons for the rise in new-onset diabetes during the pandemic remain unclear. Dr. Martin said that it is possibly caused by some combination of the biological effects of COVID-19 infection and exacerbation of traditional diabetes risk factors, such as limited exercise, sleep disturbances, and eating processed foods. More research is needed to clarify these possible drivers.

“There are a lot of presumptions at this point, but nobody really knows yet why this is happening,” Dr. Martin said. “What we’re seeing across a large swatch of patients is the possibility that COVID-19 infection could be associated with an increased risk of diabetes and should probably be considered a new risk factor when making screening decisions — especially for patients who start showing traditional symptoms of diabetes when you, as a clinician, weren’t expecting it.”

Meanwhile, families can take action by promoting healthy habits and proactively asking their child’s physician if diabetes screening is appropriate, especially if their child has had COVID-19.

“As an organization, Kaiser Permanente is focused on prevention, and better screening translates to better prevention of both disease and complications of disease,” Dr. Martin said. “We hope that greater awareness of the rising trends shown in our study prompts action on the part of physicians and families.”

Looking ahead, the research team hopes to continue investigating increased rates of diabetes and their potential causes.

“There are definitely lots of questions remaining to be answered to expand on this research,” Dr. Mefford said. “I’m excited about that opportunity.”

In addition to Dr. Mefford and Dr. Martin, co-authors include Rong Wei, MS; Eva Lustigova, MPH; and Kristi Reynolds, PhD, of the Department of Research & Evaluation.