Diagnosis of type 2 diabetes doubled among Black children during the first year of the pandemic but decreased among white youth, according to a new study. The first year of the COVID-19 pandemic also saw a higher proportion of young diabetes patients with severe symptoms compared to years prior.
The trend suggests that the racial disparities already present in type 2 diabetes are deepening, and the pandemic may be part of the reason why. Experts say decreases in physical activity, changes in nutrition, and pauses in regular doctor visits during the pandemic might have driven the uptick in diabetes among Black youth. For children across all racial groups, the average number of new diabetes diagnoses increased by nearly 80%.
“This is really scary,” said Dr. Sheela N. Magge, a researcher on the study. “We’re seeing it earlier and it seems to be worse.”
The study, published in the Journal of Pediatrics, looked at the rates of new-onset type 2 diabetes among people ages 8 to 21, comparing diagnoses in the first year of the pandemic to the two years prior. More than 3,100 cases were assessed, spanning 24 treatment centers nationwide. More boys were diagnosed than girls during the pandemic, marking a reversal of previous trends.
The percentage of children diagnosed who also showed the most severe symptoms — often resulting in hospitalization — more than doubled, likely because of the more sedentary lifestyles caused by the COVID-19 lockdowns.
For Black children, the consequences could be deadly.
The younger you’re diagnosed, “the higher the chance you’re going to suffer from the complications of that disease,” said Dr. Garfield Clunie, president of the National Medical Association, which represents Black physicians. This spike in diagnoses is likely to exacerbate health disparities for Black Americans later in life.
The varied rates of diabetes diagnosis during the early pandemic is likely a reflection of racial differences in living environments and access to quality health care, experts said, along with other stressors connected to a history of racism in social, economic, and housing policies.
White families in neighborhoods with access to fresh foods and safe, recreational spaces might have used the pandemic lockdowns as an opportunity to emphasize health and outdoor exercise. Meanwhile, Black families — more likely to live in neighborhoods with fewer resources and higher levels of violence due to systemic racism — might have kept children inside for longer stretches, said Darrell Hudson, a health disparities researcher at the University of Washington in St. Louis.
When school facilities were closed, recess time was cut and children no longer had the daily exercise of walking to school and in between classrooms. Extracurricular activities and after-school sports were also stopped. And because Black Americans were overrepresented among essential workers during the early pandemic, parents’ ability to cook and limit screen time also might have fueled disparities.
“It comes down to the environment that people are embedded in,” Hudson said. “The context where people live is absolutely critical.”
Type 2 diabetes is a chronic illness that prevents the body from properly regulating and processing sugar. When not managed, diabetes can cause irreversible organ damage, including heart disease, nerve and kidney damage, and impaired vision.
“Adult-onset [diabetes] can be lingering for a long time, whereas in pediatric onset we’ve seen people go from prediabetes to type 2 diabetes within months,” said Magge, director of pediatric endocrinology at the Johns Hopkins Children’s Center. For children, “the disease seems to progress faster and they get complications sooner.”
About 1.4 million Americans are diagnosed with diabetes every year. And more than 6,000 youth were diagnosed each year in 2014 and 2015, according to the U.S. Centers for Disease Control and Prevention’s most recent data. About 12% of Black American adults are living with diabetes, the second-highest prevalence among racial and ethnic groups behind American Indians and Alaska Natives.
A family history of diabetes and obesity are risk factors for the illness. About one-third of youth nationwide are at risk for becoming overweight, the CDC says, and Black youth face a particularly high risk.
A healthy diet, adequate exercise, and regular check ups with a physician can help prevent diabetes, said Dr. Gail Nunlee-Bland, a pediatric endocrinologist at Howard University Hospital. But even after diagnosis, she said, Black children face additional barriers to managing the illness.
Treatments that monitor blood sugar are offered less frequently to Black folks, she said. Other barriers — such as insurance companies that are unwilling to pay for technologies that control diabetes, and the lack of children in clinic trials for treatments — stall diabetes management for youth.
The jump in diabetes diagnosis could have long-term implications for the health of Black communities, given the link between the illness and increased risk for heart attack and other cardiovascular complications.
“What’s going to happen with all these kids that have developed type 2 diabetes,” Magge questioned, “and all the complications they could face?”