About one in every 523 children and adolescents in the United States had physician-diagnosed diabetes in 2001, according to estimates from a major national study called SEARCH for Diabetes in Youth.

SEARCH is the largest surveillance effort of diabetes among youth under the age of 20 ever conducted in the United States, said Ronny A. Bell, Ph.D., M.S., associate professor of epidemiology and prevention at Wake Forest University School of Medicine and a SEARCH co-investigator. It is the first look at the burden of diabetes in youth of all major racial and ethnic groups.

In a report in the October issue of Pediatrics, study investigators estimate that about 154,000 of roughly 80.7 million children and adolescents nationwide had diabetes in 2001. The number of youth with diabetes varies across major U.S. racial and ethnic groups and across age groups.

In children up through 9 years of age, non-Hispanic white children had the highest diabetes rate (about 1 in every 1,000 children). In this age group across all racial and ethnic groups, physician-diagnosed type 1diabetes, previously known as insulin-dependent diabetes, was the most common form of diabetes. The study found that type 2 diabetes was extremely rare in children under 10 years of age of all races.

Among adolescents and young adults, black and non-Hispanic white youth had the highest overall burden of diabetes (about 1 in every 315) and Asian/Pacific Islander had the lowest (about 1 in 746). Type 1diabetes was the most common form of diabetes in all racial/ethnic groups except in American Indian youth.

Type 2 diabetes was found in all racial and ethnic groups in youth 10 to 19. It represented only 6 percent of the cases of diabetes in non-Hispanic whites, 33 percent in blacks, and 40 percent in Asian/Pacific Islanders, but was the most common form of diabetes, at 76 percent, among American Indian youth.

“The study was funded precisely because there was such a lack of systematically collected population-based prevalence data, especially for Type 2 diabetes,” said Angela D. Liese, Ph.D., M.P.H., of the University of South Carolina in Columbia, the lead author.

“This important study has been extremely challenging due to the great difficulty of accurately finding all the cases of diabetes in this age group,” said Michael Engelgau, M.D., acting director of the Division of Diabetes Translation at the Centers for Disease Control and Prevention. “However, the effort is well worth it. This information will be critical to understanding this disease in children, which will lead to actions to better control it and to minimize its effects on our younger generation,” he said.

“This study addresses an important gap in our knowledge, providing national estimates on the prevalence of type 1 and type 2 diabetes in children,” said Judith Fradkin, M.D., director, Division of Diabetes, Endocrinology and Metabolic Diseases of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK.)

Liese said that study investigators would continue to track the incidence of diabetes cases in all of the various population groups over the next few years.

“Increasing obesity in children began in the late 1980s or early 1990s, and people have speculated that the increase in obesity is associated with an increased risk of type 2 diabetes in youth,” Liese said.

The study investigators write, “Diabetes is one of the leading chronic diseases in childhood and adolescence.” The prevalence of 1.82 per thousand is higher, for instance, than the rate of 1.24 per thousand for cancer, but lower than asthma (120 per thousand).

“Diabetes affects quality of life severely for these youth, has a major impact on their families, and has a significant public health impact,” the investigators say in the report. “Persons diagnosed with diabetes before 20 years of age have a markedly lower life expectancy than the general population without diabetes.”

The study was funded by the U.S. Centers for Disease Control and Prevention and NIDDK and involves six clinical centers in the states of California, Colorado, Hawaii, Ohio, South Carolina and Washington. The central laboratory for the study is the Northwest Lipid Research Laboratories in Seattle, Wash. The coordinating center is at the Division of Public Health Sciences at Wake Forest University School of Medicine.