Lakhasly

Racial and ethnic minorities already experience disproportionately high rates of type 2 diabetes (T2D) and related complications, a disparity rooted in socioeconomic factors, healthcare access, and exposure risks like overcrowded housing and essential worker roles. The COVID-19 pandemic exacerbated 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. This surge was especially pronounced among younger patients, with a lower mean age at diagnosis and increased severe presentations. The pandemic widened existing disparities: Black youth showed significantly worse glycemic control and obesity compared to White youth (RRR 3.0; 95% CI 1.3–6.8), and adolescents from deprived neighborhoods experienced similarly poor outcomes (RRR 1.9; 95% CI 1.2–2.9). Indirect pandemic effects, including healthcare disruptions, reduced access to diabetes management, and increased socioeconomic stressors, disproportionately impacted minorities. While detailed Asia-Pacific data is absent, US studies strongly indicate a pandemic-related surge in youth T2D incidence, heavily impacting racial/ethnic minorities and those experiencing socioeconomic disadvantage. These long-standing inequities in healthcare access and social determinants of health were significantly amplified by the pandemic.

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).