Lakhasly

Racial and ethnic minorities already experience disproportionately high rates of type 2 diabetes (T2D) and its complications, a disparity stemming from factors like comorbidities, socioeconomic status, healthcare access, and environmental exposures (e.g., overcrowded housing, essential worker roles, inadequate insurance). Pre-pandemic, disparities in diabetes care and outcomes, especially glycemic control and complication development, were evident (5). The COVID-19 pandemic dramatically worsened this, nearly tripling the annualized incidence of youth-onset T2D in the US, with a 61% increase in new cases between the first and second pandemic years (3). This surge was most pronounced among younger patients (mean age at diagnosis dropped from 14.8 years pre-pandemic to 12.9 years in the first pandemic year; P < 0.001), with increased severe presentations like diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome (3). Disparities widened further: Black youth showed significantly worse glycemic control and obesity compared to White youth (relative risk ratio [RRR] 3.0; 95% CI 1.3–6.8), and adolescents from the most deprived neighborhoods had higher rates of stable obesity and poor glycemic control (RRR ADI tertile 3 vs. 1: 1.9; 95% CI 1.2–2.9) (6). The pandemic's indirect effects—healthcare disruptions, reduced access to resources, and increased socioeconomic stressors—exacerbated pre-existing inequities, disproportionately harming minority youth with T2D (5-6, 9). While detailed Asia-Pacific data is absent, US evidence strongly indicates a pandemic-related surge in pediatric T2D, particularly affecting racial/ethnic minorities and those experiencing socioeconomic deprivation (3-6).

Racial and ethnic minorities have experienced a disproportionate burden of type 2 diabetes (T2D) and related macrovascular complications, and evidence from the United States indicates a significant increase in the incidence of T2D among children and adolescents during the COVID-19 pandemic. This increase has been accompanied by widening disparities in outcomes, with minority youth and those from deprived neighborhoods being most affected.

Disproportionate Burden of T2D and Macrovascular Disease in Racial/Ethnic Minorities

Racial and ethnic minority populations have long faced higher rates of T2D and its complications compared to White populations. These disparities are rooted in a complex interplay of factors, including differences in comorbid conditions, socioeconomic status, access to healthcare, and exposure risks. For example, ethnic minorities are more likely to experience barriers such as overcrowded living conditions, essential worker roles, and inadequate health insurance, all of which contribute to worse diabetes outcomes and higher susceptibility to severe complications, including macrovascular disease (5).

Structural inequities—such as limited access to quality diabetes care and persistent socioeconomic disadvantage—have exacerbated these disparities. Prior to the pandemic, ethnic disparities in diabetes care and outcomes were already evident, particularly regarding intermediate outcomes (e.g., glycemic control) and the development of diabetes complications (5).

Impact of the COVID-19 Pandemic on T2D Incidence in Children and Adolescents

Marked Increase in Incidence

During the COVID-19 pandemic, the annualized incidence of youth-onset T2D in the United States nearly tripled compared to pre-pandemic years. Notably, there was a 61% increase in new cases in the second pandemic year compared to the first (3).

This surge was particularly pronounced among younger patients, with the mean age at diagnosis dropping (12.9 years during the first pandemic year vs. 14.8 years pre-pandemic; P < 0.001). Additionally, there was a significant rise in severe presentations such as diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome (3).

Worsening Disparities by Race/Ethnicity and Socioeconomic Status

The pandemic further widened existing disparities in diabetes outcomes among youth:

Race/Ethnicity: Black youth were significantly more likely to experience worsening glycemic control and obesity trajectories compared to White youth (relative risk ratio [RRR] 3.0; 95% CI 1.3–6.8) (6).

Neighborhood Deprivation: Adolescents from the most deprived neighborhoods were more likely to have stable obesity and poor glycemic control (RRR ADI tertile 3 vs. 1: 1.9; 95% CI 1.2–2.9) (6).

These findings highlight that both race and socioeconomic deprivation independently increased the risk of poor diabetes trajectories during the pandemic.

Broader Context: Indirect Effects of the Pandemic

The indirect effects of the COVID-19 pandemic—such as disruptions to routine healthcare, reduced access to diabetes management resources, and increased socioeconomic stressors—have disproportionately impacted racial/ethnic minorities with diabetes (5-6).

Healthcare Disruptions: Fear of infection, reduced primary care availability, and delayed treatment contributed to worse glycemic control and higher mortality from diabetes-related causes (9 ).

Structural Barriers: Long-standing inequities in healthcare access and social determinants of health were amplified during the pandemic, further disadvantaging minority youth with T2D (5-6).

Regional Evidence

While direct data from the Asia-Pacific region are not detailed here, studies from the United States robustly demonstrate a significant increase in T2D incidence among children and adolescents during the pandemic, with pronounced effects among racial/ethnic minorities and those facing socioeconomic deprivation (3-6).