What can be done to support the new generation of young people with diabetes?

The COVID-19 pandemic changed our lives completely, making us rethink how we interact with the world. A recent study by JAMA Network revealed that the pandemic’s impacts are still being felt by some people, even though many restrictions and health measures have been lifted.

JAMA Network, a general medical journal, researched the incidence of diabetes in children and teens during the COVID-19 pandemic. They collected available data from different countries on more than 38,000 young people diagnosed during the pandemic. The systematic review included 42 studies with a total of 102,984 new diabetes cases. The research found that the rate of childhood type 1 diabetes went up by 14% in the first year of the pandemic, and increased to 27% in the second year compared to pre-pandemic numbersⁱ.

While it’s still unclear exactly why childhood type 1 diabetes rates have climbed, researchers have a few theories. Some of the rise might be from catching up after delays and backlogs caused when health services shut down ii. One theory is that COVID-19 can trigger a reaction in some kids that raises their diabetes risk. Another idea is that exposure to certain germs in childhood helps protect against different conditions, including diabetes. Because of lockdowns and physical distancing during the pandemic, a lot of children may not have been exposed to as many germs, missing out on that extra protectionⁱⁱ. Even though we don’t know the exact causes, it’s important to act so this new group of young people with diabetes can get the resources and support they need.

The most troubling part of this big increase in diabetes rates among kids and teens is that there was also a rise in reports of diabetic ketoacidosis (DKA). Of the studies reviewed, 15 countries reported more cases of DKA in the first year of the pandemic, with the rate being 1.26 times higher compared to before COVID i. DKA happens when the body doesn’t have enough insulin to let blood sugar into cells for energy. Instead, the liver breaks down fat for fuel, making acids called ketones. If too many ketones build up, it can quickly become dangerousⁱⁱⁱ.

Because DKA can be life-threatening, one of the most important parts of diabetes care is making sure insulin is given safely through injections. Getting the right dose can be a matter of life or death. For children and teens, being diagnosed with diabetes—and needing regular insulin shots—can be especially overwhelming, causing anxiety and stress. One study found 63% of kids ages 6-17 were afraid of needles^iv. Because needles can add to the stress, medical device manufacturers need to think about what happens when children flinch or pull away during an injection. Devices to deliver insulin, like safety pen needles, need to make sure the full dose gets delivered every time, even if the child moves.

There are two main types of safety mechanisms in pen needles: passive devices and active devices. The main difference is that, in addition to the safety feature, passive devices usually cover the needle both before and after giving the injection, protecting from needlestick injuries. But this can make it harder to see the needle and might require a different injection technique. If a patient is nervous and moves during the injection, the safety on a passive device can activate too soon and stop the full dose from being given. With active devices, the needle stays visible from the moment the safety cap comes off until the safety is activated manually. Being able to see the needle for the whole injection can make users more confident, since they take an active role and have full control over delivering the dose.

In 2020, Owen Mumford, a medical device manufacturer, did a clinical evaluation of safety pen needles, asking healthcare professionals for their opinions after giving insulin shots to kids with both active and passive safety pen needles. The results showed a strong preference for active safety mechanisms. When it came to giving accurate doses, 98% of respondents agreed that they were in control of the dose delivery, and 96% felt confident they could give the full dose with no leakage when using an active safety pen needle^v. By comparison, there was a clear difference for passive devices: only 59% said they were in control of the dose, and just 41% were confident they could deliver the full dose without leakage using a passive safety pen needle v. Accurate insulin dosing is key to avoiding DKA, and this data suggests that active devices give users more confidence and control in making sure the right dose is given.

In 2022, independent research firm MindMetre did another study, looking at how safety devices were used in NHS trusts in the UK after reports of insulin doses not being given correctly. The results showed that 36.4% of NHS Trusts said they had seen insulin pooling, and 25% saw improper insulin doses because of on-site incidents with patients. Both issues were linked to using passive devices. Some Trusts shared more details, with one noting, “Inaccurate insulin dosing was seen as a result of passive safety needles, so we switched to active safety needles,” and “Pooling of insulin was observed when using passive safety needles… again, we switched to active safety needles for this reason^vi.”

As we work through the aftermath of the COVID-19 pandemic, it’s essential to respond to the growing number of young people with type 1 diabetes by making sure every patient gets the treatment that meets their needs. The research from Owen Mumford and MindMetre points to active safety pen needles as a way to provide better confidence in making sure the full dose is given and allowing patients more control over the injection process—especially when dealing with insulin pooling and life-threatening DKA events. As always, healthcare professionals must look at every case individually to figure out the care and device solution that will work best.