The Coronavirus Disease 2019 Pandemic is Associated with a Substantial Rise in Frequency and Severity of Presentation of Youth-Onset Type 2 Diabetes

OBJECTIVES

To evaluate the frequency and severity of new cases of youth-onset type 2 diabetes in the US during the first year of the pandemic compared with the mean of the previous 2 years.

STUDY DESIGN

Multicenter (n = 24 centers), hospital-based, retrospective chart review. Youth aged ≤21 years with newly diagnosed type 2 diabetes between March 2018 and February 2021, body mass index ≥85th percentile, and negative pancreatic autoantibodies were included. Demographic and clinical data, including case numbers and frequency of metabolic decompensation, were compared between groups.

RESULTS

A total of 3113 youth (mean [SD] 14.4 [2.4] years, 50.5% female, 40.4% Hispanic, 32.7% Black, 14.5% non-Hispanic White) were assessed. New cases of type 2 diabetes increased by 77.2% in the year during the pandemic (n = 1463) compared with the mean of the previous 2 years, 2019 (n = 886) and 2018 (n = 765). The likelihood of presenting with metabolic decompensation and severe diabetic ketoacidosis also increased significantly during the pandemic.

CONCLUSIONS

The burden of newly diagnosed youth-onset type 2 diabetes increased significantly during the coronavirus disease 2019 pandemic, resulting in enormous strain on pediatric diabetes health care providers, patients, and families. Whether the increase was caused by coronavirus disease 2019 infection, or just associated with environmental changes and stressors during the pandemic is unclear. Further studies are needed to determine whether this rise is limited to the US and whether it will persist over time.

Impaired glucose regulation, SARS-CoV-2 infections and adverse COVID-19 outcomes

Impaired glucose regulation (IGR) is common world-wide, and is correlated with Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) the virus that causes Coronavirus disease 2019 (COVID-19). However, no systematic reviews are available on the topic, and little is known about the strength of the evidence underlying published associations. The current systematic review identified consistent, reproducible associations but several limitations were observed including: (1) a consistent lack of robust confounder adjustment for risk factors collected prior to infection; (2) lack of data on insulin resistance or glycemia measures [Hemoglobin A1c (HbA1c) or glucose]; (3) few studies considering insulin resistance, glucose or HbA1c values in the clinically normal range as a predictor of SARS-CoV-2 risk; (4) few studies assessed the role of IGR as a risk factor for infection among initially uninfected samples; (5) a paucity of population-based data considering SARS-CoV-2 as a risk factor for the onset of IGR. While diabetes status is a clear predictor of poor prognosis following a SARS-CoV-2 infection, causal conclusions are limited. It is uncertain whether interventions targeting dysglycemia to improve SARS-CoV-2 outcomes have potential to be effective, or if risk assessment should include biomarkers of diabetes risk (ie, insulin and glucose or HbA1c) among diabetes-free individuals. Future studies with robust risk factor data collection, among population-based samples with pre-pandemic assessments will be important to inform these questions.

Retinal Vasculometry Associations with Cardiometabolic Risk Factors in the European Prospective Investigation of Cancer-Norfolk Study

PURPOSE

To examine associations between retinal vessel morphometry and cardiometabolic risk factors in older British men and women.

DESIGN

Retinal imaging examination as part of the European Prospective Investigation into Cancer-Norfolk Eye Study.

PARTICIPANTS

Retinal imaging and clinical assessments were carried out in 7411 participants. Retinal images were analyzed using a fully automated validated computerized system that provides novel measures of vessel morphometry.

METHODS

Associations between cardiometabolic risk factors, chronic disease, and retinal markers were analyzed using multilevel linear regression, adjusted for age, gender, and within-person clustering, to provide percentage differences in tortuosity and absolute differences in width.

MAIN OUTCOMES MEASURES

Retinal arteriolar and venular tortuosity and width.

RESULTS

In all, 279 802 arterioles and 285 791 venules from 5947 participants (mean age, 67.6 years; standard deviation [SD], 7.6 years; 57% female) were analyzed. Increased venular tortuosity was associated with higher body mass index (BMI; 2.5%; 95% confidence interval [CI], 1.7%-3.3% per 5 kg/m2), hemoglobin A1c (HbA1c) level (2.2%; 95% CI, 1.0%-3.5% per 1%), and prevalent type 2 diabetes (6.5%; 95% CI, 2.8%-10.4%); wider venules were associated with older age (2.6 μm; 95% CI, 2.2-2.9 μm per decade), higher triglyceride levels (0.6 μm; 95% CI, 0.3-0.9 μm per 1 mmol/l), BMI (0.7 μm; 95% CI, 0.4-1.0 per 5 kg/m2), HbA1c level (0.4 μm; 95% CI, -0.1 to 0.9 per 1%), and being a current smoker (3.0 μm; 95% CI, 1.7-4.3 μm); smoking also was associated with wider arterioles (2.1 μm; 95% CI, 1.3-2.9 μm). Thinner venules were associated with high-density lipoprotein (HDL) (1.4 μm; 95% CI, 0.7-2.2 per 1 mmol/l). Arteriolar tortuosity increased with age (5.4%; 95% CI, 3.8%-7.1% per decade), higher systolic blood pressure (1.2%; 95% CI, 0.5%-1.9% per 10 mmHg), in females (3.8%; 95% CI, 1.4%-6.4%), and in those with prevalent stroke (8.3%; 95% CI, -0.6% to 18%); no association was observed with prevalent myocardial infarction. Narrower arterioles were associated with age (0.8 μm; 95% CI, 0.6-1.0 μm per decade), higher systolic blood pressure (0.5 μm; 95% CI, 0.4-0.6 μm per 10 mmHg), total cholesterol level (0.2 μm; 95% CI, 0.0-0.3 μm per 1 mmol/l), and HDL (1.2 μm; 95% CI, 0.7-1.6 μm per 1 mmol/l).

CONCLUSIONS

Metabolic risk factors showed a graded association with both tortuosity and width of retinal venules, even among people without clinical diabetes, whereas atherosclerotic risk factors correlated more closely with arteriolar width, even excluding those with hypertension and cardiovascular disease. These noninvasive microvasculature measures should be evaluated further as predictors of future cardiometabolic disease.

Determination of hemoglobin A1c and fasting blood glucose reference intervals in captive chimpanzees (Pan troglodytes)

Type 2 diabetes mellitus (T2DM), reaching epidemic proportions in humans, has emerged as a disease in aging captive populations of adult chimpanzees; however, little information is available regarding T2DM in chimpanzees. Our goals were to: (1) distinguish between normal, healthy chimpanzees and those with early (prediabetes) or advanced diabetes; (2) establish and compare the fasting (16 h) blood glucose reference range for chimpanzees at our facility with published reference ranges; and (3) establish hemoglobin A1c (HbA1c) reference intervals for healthy, nondiabetic chimpanzees and define threshold values for prediabetes and diabetes. If reliable, our reference ranges for FBG and HbA1c could become clinical tools for screening animals at risk and for monitoring therapeutic progress. The overall incidence of T2DM in our colony of 260 chimpanzees is 0.8% but is increased to 3.7% in animals older than 30 y (geriatric). For our defined reference intervals, chimpanzees with FBG or HbA1c levels up to the 85th percentile (glucose, less than or equal to 105 mg/dL; HbA1c, less than or equal to 5.0%) were considered healthy; those whose values lay between the 86th and 95th percentiles (glucose, 106 to 119 mg/dL; HbA1c, 5.1% to 5.2%) were possibly prediabetic, and animals whose values exceeded the 95th percentile (glucose, greater than or equal to 120 mg/dL; HbA1c, greater than 5.3%) were identified as potentially having diabetes. We found that our FBG range was comparable to other published results, with a positive correlation between HbA1c and glucose. Furthermore, the negligible HbA1c response to acute stress or recent food consumption suggests that HbA1c is highly useful for evaluating glycemic control during treatment of diabetic chimpanzees and is more informative concerning overall glucose control than are FBG levels alone.

Intrauterine exposure to diabetes is a determinant of hemoglobin A(1)c and systolic blood pressure in pima Indian children

CONTEXT/OBJECTIVE

Given the increasing rates of both childhood obesity and type 2 diabetes (T2DM), we investigated whether maternal diabetes status during pregnancy is a determinant of risk factors associated with T2DM or cardiovascular disease in offspring during childhood.

DESIGN/PARTICIPANTS

Forty-two Pima Indians, aged 7-11 yr, were identified retrospectively from maternal oral glucose tolerance tests as offspring of a diabetic pregnancy (22 ODM, eight males, 14 females) or offspring born before the mother developed diabetes (20 PRE, 12 males, eight females). SETTING/MAIN OUTCOME MEASURES: Weight, height, body mass index, percent body fat, blood pressure, and fasting concentrations of glucose, insulin, hemoglobin A1c (HbA1c), total cholesterol, triglycerides, and high-density lipoprotein-cholesterol were measured while staying in an in-patient clinical research unit and compared in cross-sectional analyses.

RESULTS

After adjustment for age and gender, ODM had significantly higher concentrations of HbA1c (ODM = 5.7 +/- 0.4, PRE = 5.0 +/- 0.4%, P = 0.002), higher systolic (SBP) blood pressure (ODM = 118 +/- 13, PRE = 107 +/- 10 mm Hg; P = 0.02), and lower concentrations of high-density lipoprotein (ODM = 41 +/- 9, PRE = 48 +/- 6 mg/dl, P = 0.03) than PRE. Maternal diabetes status during pregnancy persisted as a significant determinant of SBP (beta = 7.50, P = 0.03) and HbA1c (beta = 0.43, P = 0.002), independent of age, gender, and percent body fat.

CONCLUSION

Intrauterine exposure to diabetes is a significant determinant of higher SBP and HbA1c during childhood, independent of adiposity and a genetic predisposition to T2DM. These data suggest that in utero exposure to diabetes confers an additional independent risk for the development of T2DM and/or cardiovascular disease later in life.