ESPE Yearbook of Paediatric Endocrinology

Brief summary: Giannini et al. report a timely study on the impact of COVID-19 restrictions on glucose metabolism in children and adolescents with obesity and overweight. They compared data from 741 children over a 13-year period, before and during the COVID-19 pandemic. They found that children in the COVID-19 restriction group did not have significantly increased values of Body Mass Index (BMI), but they did exhibit higher values of Waist Circumference (WC), Waist/Height ratio (WHtR), and body fat mass compared to pre-pandemic children. Fasting glycaemia, glucose, and insulin excursions were also significantly higher in the COVID-19 restriction group. Insulin resistance was higher and insulin secretion was lower in these children, leading to a higher percentage of impaired glucose tolerance. Additionally, High-Density Lipoprotein (HDL) cholesterol levels were significantly lower, and systolic and diastolic blood pressure values were higher in the COVID-19 restriction group.

The COVID-19 restrictions have not only exacerbated the obesity status in children (1) but have also led to significant alterations in glucose and insulin metabolism. In fact, the effects of the COVID-19 pandemic seem to have had a particularly unfavorable impact on the population of vulnerable children at high risk of diabetes, which is underscored by numerous reports of steeply rising numbers of type 2 diabetes cases observed at pediatric diabetes centres (2–4), and epidemiological data demonstrating a significantly increasing incidence of youth-onset type 2 diabetes in 2021, the second year of the pandemic, in Germany (5).

These findings emphasize the urgent need for comprehensive public health strategies to address the short-term and long-term consequences of COVID-19 restrictions on children’s health. Such strategies should focus on promoting healthy lifestyle behaviours, including regular physical activity, balanced nutrition, and appropriate weight management. Additionally, targeted interventions should be implemented to provide support and resources to families and individuals at higher risk, particularly those with a predisposition to type 2 diabetes.

References: 1. Vogel M, Geserick M, Gausche R, Beger C, Poulain T, Meigen C, Körner A, Keller E, Kiess W, Pfäffle R. Age- and weight group-specific weight gain patterns in children and adolescents during the 15 years before and during the COVID-19 pandemic. Int J Obes (Lond) 2021. 2. Marks BE, Khilnani A, Meyers A, Flokas ME, Gai J, Monaghan M, Streisand R, Estrada E. Increase in the Diagnosis and Severity of Presentation of Pediatric Type 1 and Type 2 Diabetes during the COVID-19 Pandemic. Horm Res Paediatr 2021;94:275–284. 3. Chambers MA, Mecham C, Arreola EV, Sinha M. Increase in the number of pediatric new-onset diabetes and diabetic ketoacidosis cases during the COVID-19 pandemic. Endocr Pract 2022;28:479–485. 4. Sasidharan Pillai S, Has P, Quintos JB, Serrano Gonzalez M, Kasper VL, Topor LS, Fredette ME. Incidence, severity, and presentation of type 2 diabetes in youth during the first and second year of the COVID-19 pandemic. Diabetes Care 2023;46:953–958. 5. Denzer C, Rosenbauer J, Klose D, Körner A, Reinehr T, Baechle C, Schröder C, Wiegand S, Holl RW, Prinz N, DPV I. Is COVID-19 to blame? Trends of incidence and sex ratio in youth-onset type 2 diabetes in Germany. Diabetes Care 2023;46:1379–1387.