Abstract
Background/Objectives: Youth-onset type 2 diabetes (Y-T2D) incidence and severity rose during the COVID-19 pandemic, particularly during periods of widespread public health restrictions-including, but not limited to, virtual learning, stay-at-home orders, closure of recreational facilities, and limitations on in-person healthcare access. This study assessed incidence, severity, and remission rates of Y-T2D following the return to in-person education, focusing on cases diagnosed while such restrictions were in place. Methods: A retrospective chart review was conducted at a pediatric tertiary care center (2018-2024) to identify new Y-T2D diagnoses. We compared incidence rates, disease severity at diagnosis, and remission outcomes before and after the period of comprehensive public health restrictions, defined locally as March 2020-August 2021, during which virtual learning was implemented. Results: Incidence declined from 13.2 to 6.3 cases/month after the major restrictions were lifted. Youth diagnosed after the restrictions period had lower rates of diabetic ketoacidosis (7.1% vs. 20.9%, p < 0.001) and severe hyperglycemia (HbA1c 9.1 ± 2.5% vs. 10.1 ± 2.3%, p < 0.001). Among those diagnosed during the restriction period, 11.1% achieved remission within three years. Remission was associated with lower baseline HbA1c (OR = 9.52, 95% CI: 2.2-41.7, p = 0.003), metformin use (OR = 7.0, CI: 1.9-26.3, p = 0.004), GLP-1 receptor agonist use (OR = 5.8, CI: 1.3-24.4, p = 0.018), and lower likelihood of insulin therapy (OR = 19.5, CI: 2.3-166.7, p = 0.007). Conclusions: The reduction in Y-T2D cases after the lifting of pandemic-related restrictions highlights the impact of pandemic-related environmental changes. Low remission rates-especially among underserved youth-underscore the urgency of early screening, prompt intervention, and equitable access to pediatric diabetes care, and highlight the need to consider the metabolic health impacts of future prolonged public health measures.