2083-P: Sex Differences across the Course of Pediatric Type 2 Diabetes (T2D) Diagnosed Before and After 2020 Using Computationally Extracted Electronic Health Records (EHR)

Introduction and Objective: Pediatric T2D has increased over the past decades, with declining female predominance since the COVID-19 pandemic. We assessed sex differences across the clinical course of T2D in youth diagnosed before and after 2020. Methods: Youth aged 8-20 years with T2D diagnosed between 2011-2025 were identified from EHR data at a tertiary care center. Sex differences at diagnosis were assessed using chi-square, Fisher’s exact or Kruskal-Wallis tests. Longitudinal outcomes were analyzed using univariable and multivariable regression and mixed-effect models, including interactions with calendar period. Clinical phenotypes were mapped to the Observational Medical Outcomes Partnership (OMOP) common data model and extracted using Apache Spark and structured query language (SQL) pipelines with clinician-curated validation. Results: Among 2,491 youth with T2D (41.6% male, 53.9% Hispanic, 27.9% non-Hispanic Black), males were older at diagnosis and differed in racial/ethnic distribution, with fewer Black youth (p=0.003). The proportion of males increased after 2020 (54.6% vs 45.4%, p<0.001), driven by diagnoses at ≥12 yrs. Males presented with higher A1c and more frequent diabetic ketoacidosis (DKA; 19.0% vs 8.7%) (both p<0.001), remaining significant after adjustment. Diagnosis after 2020 was associated with higher odds of DKA only among males (OR 1.62, p=0.004). Hypertension at diagnosis and dyslipidemia at 2 years were more common in males (both p<0.05). Longitudinal A1c trajectories differed by sex, with higher A1c at diagnosis in males and steeper increases over time in females (p<0.001), while DKA risk improved similarly across sexes. Conclusion: Using computationally extracted EHR data, we show that pediatric T2D is evolving, with increasing male representation and persistent sex differences in disease severity and course. These findings highlight the value of advanced EHR phenotyping to detect epidemiologic shifts in pediatric T2D. Disclosure L. Sobhi: None. D. Palacios: None. S. Aras: None. A. Kadi: None. H. Chen: None. Z. Liu: None. M. Tosur: None. M.J. Redondo: Advisory Panel; Current; Sanofi. Other - Data Safety Monitoring committee; Current; Lilly.