is COVID-19 causing an increase in diabetes?

As the COVID-19 pandemic lingers on, we wanted an update on its impact on diabetes. Read on for our conversation with endocrinologist Yelena Nicholson, DO on the current research and findings, and what we're seeing at Dayton Children's.

have instances of diabetes increased in children in recent years?
Yes, both type 1 and type 2 diabetes have been increasing in children for the last 20 years. A 2017 estimate stated that 208,000 people under 20 years old have diabetes.

why has type 1 diabetes been increasing? has COVID-19 played a role in recent increases?
We suspect that some people are genetically more likely to develop type 1 when exposed to an environmental trigger. The trigger stimulates an immune attack on cells in the pancreas that produce insulin. This leads to type 1.

We are still learning about COVID-19 and its impact. So far, most of the evidence is coming from different countries or hospitals looking at an increase in new onset diabetes in 2020 and 2021. That said, it appears that COVID-19 does not cause type 1 diabetes directly, but that it can be one of the environmental triggers that causes the immune system to attack insulin-producing cells.

why has type 2 diabetes been increasing? has COVID-19 played a role in recent increases?
The increase in type 2 has been linked to:

• Genetics
• Increasing unhealthy food choices and food portions
• Lack of exercise
• Increased TV and gaming times

These factors can combine leading to rapid weight gain, causing insulin not to work well. This can lead to insulin resistance, or less insulin production in the case of type 2 diabetes.

While COVID-19 is likely not directly causing an increase in type 2, it could have an indirect effect. Kids staying at home, not going to school, not participating in sports, not playing with friends outside, and consuming more unhealthy foods can all contribute to the increase.

have we seen an increase of new onsets of diabetes at Dayton Children’s since the COVID-19 pandemic began?
Yes, so far we have seen 1.4 times our usual number of new onsets of both type 1 and type 2 diabetes. We’re expecting that to increase to 1.5 times by the end of the year.

how does COVID-19 affect kids with diabetes?
We do not yet know exactly how COVID-19 affects diabetes patients. Most children with diabetes who get COVID are ok if they have good control of their diabetes and are not immunocompromised. However, any sickness in a child with diabetes can impact blood sugar. If your child gets sick with COVID-19 or any other illness, follow your sick day plan for how to treat. You should also follow relevant guidelines on returning to school, work, sports, etc. after a COVID-19 infection or exposure.

can new onset diabetes look like other illnesses, like COVID?
New onset diabetes can be hidden by symptoms of COVID, or another virus or infection. If a child comes to the emergency department for shortness of breath or rapid breathing, those symptoms may mean the child has COVID or another respiratory virus. They may also be breathing rapidly because they are in DKA from undiagnosed diabetes. If you are worried about your child, take them to see a medical provider. Don’t delay care.

any advice for parents and children during this time?

1. If your child is sick, do not delay care. Some children with new onset type 1 and 2 diabetes have been waiting to go to the doctor. When they arrive to the hospital they are much sicker. Many of our new diabetes patients have been in diabetic ketoacidosis (DKA), a very dangerous condition that happens when the body starts using fat instead of glucose for energy.
2. If your child is eligible, they should receive the COVID-19 vaccine. All eligible children, including children with diabetes, should be vaccinated against COVID-19 unless they have had a previous reaction to the COVID vaccine or an ingredient in the vaccine. Read more about the COVID vaccine and eligibility here.
3. If your child is not vaccinated against COVID-19, they should wear a mask.

should COVID-19 vaccinated children with diabetes get a COVID booster?
As of mid-November, the booster has only been approved for adults 18 years old and older with underlying conditions (including diabetes). So, at this time, kids under the age of 18 do not qualify.