Uptick in Diabetes Cases Seen Among Youth
The prevalence of type 1 and type 2 diabetes rose in the early 21st century among adolescents in the U.S., researchers said here.
Between 2001 and 2009, prevalence of type 1 disease rose 23% and prevalence of type 2 rose 21%, said Dana Dabelea, MD, PhD, of the University of Colorado in Denver, and colleagues during a press briefing at the American Diabetes Association meeting.
While escalating rates of type 2 diabetes go hand-in-hand with an ongoing obesity epidemic, the reasons for rises in rates of type 1 disease are less clear, Dabelea said.
The data for two studies done by Dabelea’s group come from the SEARCH for Diabetes in Youth Study, looking at teens and adolescents under age 20 from regions in Ohio, Colorado, Washington, and South Carolina between 2001 and 2009.
Overall, about 189,000 youths had diabetes in 2009: 168,000 with type 1 and 19,000 with type 2.
The prevalence per 1,000 cases cases was 1.55 (95% CI 1.5-1.6) in 2001 and 2.04 (95% CI 1.99-2.1) in 2009. After adjustment for completeness of ascertainment, the prevalence per 1,000 cases was 1.67 (95% CI 1.62-1.72) in 2001 and 2.06 (95% CI 2.01-2.12) in 2009.
Fast Facts on Diabetes
Diabetes affects 25.8 million people of all ages
8.3 percent of the U.S. population
DIAGNOSED
18.8 million people
UNDIAGNOSED
7.0 million people
Dabelea said there was an increase for most ethnic groups, with the exception of Native Americans, for whom overall numbers were generally small.
In a subanalysis done in Caucasians only, the researchers found that the annual rise in type 1 diabetes was 2.6% during this time period.
Dabelea said it’s unclear why type 1 disease is on the rise, though it may fall under the ‘hygiene hypothesis,” which posits that young children are less exposed to bacteria and viruses that are important in immune system development.
There may also be some environmental factors that prompt children to grow faster and gain more weight early in life, she said, which could put a heavy burden on the pancreas, overloading beta cells and leading to autoimmune attack.
For type 2 disease, prevalence rose 21% between 2001 and 2009, from 2.9 per 10,000 cases to 3.6 per 10,000 cases, the researchers found (P=0.007).
The increases were seen is boys and girls, and in all age groups over 10. Dabelea noted that type 2 disease is “still exceptionally rare” in kids under that age.
The highest prevalence of disease occurred among Native Americans and African Americans, but rates remained flat over time, she said.
Instead, the bulk of the increase occurred among whites and Hispanics. “Pediatric type 2 disease is plateauing in high-risk patients but is still catching up in other racial-ethnic groups,” Dabelea said.
- Among U.S. residents ages 65 years and older, 10.9 million, or 26.9 percent, had diabetes in 2010.
- About 215,000 people younger than 20 years had diabetes type 1 or type 2 - in the United States in 2010.
- About 1.9 million people ages 20 years or older were newly diagnosed with diabetes in 2010 in the United States.
- In 2005–2008, based on fasting glucose or hemoglobin A1C (A1C) levels, 35 percent of U.S. adults ages 20 years or older had prediabetes - 50 percent of adults ages 65 years or older. Applying this percentage to the entire U.S. population in 2010 yields an estimated 79 million American adults ages 20 years or older with prediabetes.
- Diabetes is the leading cause of kidney failure, nontraumatic lower-limb amputations, and new cases of blindness among adults in the United States.
- Diabetes is a major cause of heart disease and stroke.
- Diabetes is the seventh leading cause of death in the United States.
The researchers also noted several early complications in these populations, including nerve, kidney, and cardiovascular risk.
Almost 12% of type 1 diabetic children and 26% of those with type 2 disease showed signs of neuropathy, which could put them at higher risk of lower limb amputations in the future.
Children with type 2 disease were also more likely to have urinary albuminuria than those with type 1 disease, putting them at risk of kidney disease later in life, Dabelea said, and both groups had early markers of cardiovascular autonomic neuropathy, suggesting a future risk of cardiovascular disease.
The researchers also found that all diabetic children who had a more sedentary lifestyle - specifically, those who watched TV for at least three hours per day - had significantly higher glycated hemoglobin (HbA1c) and triglyceride levels than those who watched less TV.
“All of these data provide evidence that diabetes in youth is not benign,” Dabelea said. “It’s associated with early signs of chronic complications that may result in an increased burden of lifelong complications.”
Giuseppina Imperatore, MD, PhD, of the CDC in Atlanta, which sponsored the trial along with the NIH, said the U.S. “needs a healthcare system that’s prepared for the delivery of high-quality care for the growing number of children with diabetes.”
There’s also “an urgent need for the development of effective ways of preventing type 2 diabetes in youth,” she said.
The SEARCH study is supported by the NIH and the CDC.
The researchers reported no conflicts of interest.
Primary source: American Diabetes Association
Source reference: Mayer-Davis E, et al. “Increase in prevalence of type 1 diabetes from the SEARCH for Diabetes in Youth Study: 2001-2009” ADA 2012; Abstract 1248-P.
Additional source: American Diabetes Association