DisforDiabetes: SEARCH for Diabetes in Youth

SEARCH for Diabetes in Youth

Diabetes is one of the most common chronic diseases among children in the United States.

When diabetes strikes during childhood, it is routinely assumed to be type 1, or juvenile-onset, diabetes. Type 1 diabetes develops when the body's immune system destroys pancreatic cells that make the hormone insulin that regulates blood sugar. It normally strikes children and young adults. People with type 1 diabetes must have daily insulin injections to survive.

In the last two decades, type 2 diabetes, formerly known as adult-onset diabetes, has been reported among U.S. children and adolescents with increasing frequency. Type 2 diabetes begins when the body develops a resistance to insulin and no longer uses the insulin properly. As the need for insulin rises, the pancreas gradually loses its ability to produce sufficient amounts of insulin to regulate blood sugar.

Reports of increasing frequency of both type 1 and type 2 diabetes in youth has been among the most concerning aspects of the evolving diabetes epidemic. Unfortunately, reliable data on changes over time in the U.S., or even how many children in the U.S. had type 1 or type 2 diabetes, were lacking. In response to this growing public health concern, the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) in 2000 funded the SEARCH for Diabetes in Youth Study www.searchfordiabetes.org . SEARCH is a multicenter, epidemiological study, conducted in six geographically dispersed populations that encompass the racial/ethnic diversity of the U.S. It is designed to characterize the burden of both type 1 and type 2 diabetes, along with the associated complications, the levels of care, and impact on the daily lives of children and youth in the U.S.

Top of Page
SEARCH Facts

In the year 2001, approximately 3.5 million children less than 20 years of age were under surveillance at the six SEARCH centers to estimate how many children or young people had DM (prevalent cases);

SEARCH provides estimates of 2001 DM prevalence (1.8 per 1,000) (Link to directly to PUB MED; Pediatrics, 2006 118(4):1510-8).

SEARCH prevalence data indicate that in the U.S., at least 154,000 children/youth have DM. DM prevalence varies across major racial/ethnic groups:

In children 0-9 years of age non-Hispanic whites have the highest prevalence (about 1/1,000). In this age group across all race/ethnic groups, type 1 DM is the most common form of diabetes. The study found that type 2 DM is extremely rare in children of all races younger than 10 years of age.

Among adolescents and young adults (age 10-19 years), African American and non-Hispanic white youth have the highest burden of DM (about 1 of 315) and Asian/Pacific Islanders have the lowest (about 1 of 746).Type 1 DM prevalence is 2.3/1,000 and it is the most common form of DM in all racial/ethnic groups except in American Indian youth. Type 2 prevalence is 0.4/1,000 and it represented 6% of the cases of diabetes in Non-Hispanic White, 33% in African American, 40% in Asian/Pacific Islander, and 76% among American Indian youth.

Since 2002, approximately 5.5 million children less than 20 years of age (approximately 6 percent), each year have been under surveillance at the SEARCH research centers to estimate how many children/youth develop diabetes (incidence cases) per year;

Based on 2002 and 2003 data, the overall incidence is estimated to be 24.3 per 100,000 per year. Annually, an estimated 15,000 youth are diagnosed with type 1diabetes, and about 3,700 youth are diagnosed with type 2.

Among youth aged <10 years, most diabetes cases are type 1, regardless of race/ethnicity. In this age group the highest incidence of type 1 diabetes is observed in non-Hispanic whites (19/100,000 for 0- to 4- years-old and 28/100,000 for 5- to 9- years-old)

Among older youth (ages 10-14 and 15-19 years), the highest incidence of type 1 diabetes is in non-Hispanic white youth (33/100,000 per year for 10- to 14- years-old and 15/100,000 for 15- to 19- year olds), followed by African American (19.2 and 11.1) and Hispanic (17.6 and 12.1), and lowest among American Indian (7.1 and 4.8) and Asian/Pacific Islanders (8.3 and 6.8).

The incidence of type 2 DM is the highest among American Indians (25.3 and 49.4 for ages 10-14 and 15-19 years, respectively), followed by African Americans (22.3 and 19.4), Asian/Pacific Islanders (11.8 and 22.7) and Hispanics (8.9 and 17.0), and is low (3.0 and 5.6) among non-Hispanic whites.

SEARCH has shown that nutritional intake in adolescents with DM is poor and does not follow current recommendations. Recommendations for total dietary fat intake are met by only 10 percent of youth with DM and recommendations for saturated fat intake by only 7 percent.

SEARCH found that about 9 percent of adolescents with DM have moderate or severely depressed mood symptoms, with more girls than boys being affected. Depressed mood is associated with poor glycemic control and a higher likelihood of emergency room visits. (Pediatrics, 2006; 117:1348-58);

About half of the SEARCH participants had an LDL-C concentration above the optimal level of 100 mg/dL. In older youth (≥ 10 yrs of age), the prevalence of abnormal lipids was higher in those with type 2 (33%) than in those with type 1 diabetes (19%). (J Pediatr, 2006; 149(3); 314-9). Moreover, worse glycemic control was associated with a worse lipid profile, regardless of diabetes type (Arch Pediat Adoles Med 2007;161:159-165)

The prevalence of multiple cardiovascular disease (CVD) risk factors is high in children and adolescents with DM. CVD risk factors are present in both youth with T1 or T2 DM, but were more common in adolescents with T2 DM (Diab Care 2006; 29:1891-1896).
Higher Body Mass Index (BMI) is associated with younger age at diagnosis of T1 DM but, only in children with reduced beta cell function. These data suggest that, only among individuals with already compromised beta-cell function or high rate of beta cell loss, obesity accelerates T1 DM onset. In addition, low birth weight may be a factor in accelerating the onset of T1 DM. These data suggest that the intrauterine environment may be an important determinant of age of onset for T1 DM (Diabetes Care, 2006; 29: 290-4).

Top of Page
Implications

SEARCH provides the foundation for childhood diabetes surveillance efforts in public health, clinic, and research settings. SEARCH data is important to ultimately design and implement public health efforts to prevent type 1, once prevention strategies are identified, and type 2 diabetes in youth.

The data that are acquired by SEARCH regarding the natural history, risk factors of diabetes complications, quality of care and quality of life will also help design and implement interventions that can reduce the risk for both acute and chronic diabetes complications.

Top of Page
SEARCH Research Centers

Kaiser Permanente Southern California, Pasadena CA
University of Colorado Health Sciences Center, Denver CO
Pacific Health Research Institute, Honolulu HI
Children’s Hospital Medical Center, Cincinnati OH
University of South Carolina School of Public Health, Columbia SC
Children’s Hospital and Regional Medical Center, Seattle WA
Coordinating Center: Wake Forest University School of Medicine, Winston-Salem NC
Central Laboratory: Northwest Lipid Research Laboratories, University of Washington, Seattle, WA

Top of Page
For more information

More information on the SEARCH for Diabetes in Youth study is available on the Web at
http://www.searchfordiabetes.org

SEARCH for Diabetes in Youth Diabetes Care 2009 Suppl 2

More information on childhood diabetes is available at these Web sites:

http://www.cdc.gov/diabetes/

http://www.cdc.gov/diabetes/pubs/estimates.htm

http://www.niddk.nih.gov/

http://www.jdrf.org/index.php

http://www.diabetes.org

http://www.ndep.nih.gov/diabetes/pubs/catalog.htm

Reference Documents on Diabetes in Children

Top of Page
SEARCH Publications

SEARCH Study Group. SEARCH for Diabetes in Youth: a multicenter study of the prevalence, incidence and classification of diabetes mellitus in youth. Control Clin Trials. 2004;25(5):458-471.

Dabelea D, D'Agostino RB, Jr., Mayer-Davis EJ, Pettitt DJ, Imperatore G, Dolan LM, Pihoker C, Hillier TA, Marcovina SM, Linder B, Ruggiero AM, Hamman RF, Search for Diabetes in Youth Study Group. Testing the accelerator hypothesis: body size, beta-cell function, and age at onset of type 1 (autoimmune) diabetes. Diabetes Care. 2006;29(2):290-294.

Kershnar AK, Daniels SR, Imperatore G, Palla SL, Petitti DB, Pettitt DJ, Marcovina S, Dolan LM, Hamman RF, Liese AD, Pihoker C, Rodriguez BL. Lipid abnormalities are prevalent in youth with type 1 and type 2 diabetes: the SEARCH for Diabetes in Youth Study. Jl Pediatr. 2006;149(3):314-319.

Lawrence JM, Standiford DA, Loots B, Klingensmith GJ, Williams DE, Ruggiero A, Liese AD, Bell RA, Waitzfelder BE, McKeown RE, Search for Diabetes in Youth Study Group. Prevalence and correlates of depressed mood among youth with diabetes: the SEARCH for Diabetes in Youth Study. Pediatrics. 2006;117(4):1348-1358.

Mayer-Davis EJ, Nichols M, Liese AD, Bell RA, Dabelea DM, Johansen JM, Pihoker C, Rodriguez BL, Thomas J, Williams D, Search for Diabetes in Youth Study Group. Dietary intake among youth with diabetes: the SEARCH for Diabetes in Youth Study. J Am Diet Assoc. 2006;106(5):689-697.

Rodriguez BL, Fujimoto WY, Mayer-Davis EJ, Imperatore G, Williams DE, Bell RA, Wadwa RP, Palla SL, Liu LL, Kershnar A, Daniels SR, Linder B. Prevalence of cardiovascular disease risk factors in U.S. children and adolescents with diabetes: the SEARCH for Diabetes in Youth Study. Diabetes Care. 2006;29(8):1891-1896.

Search for Diabetes in Youth Study Group, Liese AD, D'Agostino RB, Jr., Hamman RF, Kilgo PD, Lawrence JM, Liu LL, Loots B, Linder B, Marcovina S, Rodriguez B, Standiford D, Williams DE. The burden of diabetes mellitus among US youth: prevalence estimates from the SEARCH for Diabetes in Youth Study. Pediatrics. 2006;118(4):1510-1518.

Gilliam LK, Liese AD, Bloch CA, Davis C, Snively BM, Curb D, Williams DE, Pihoker C, SEARCH for Diabetes in Youth Study Group. Family history of diabetes, autoimmunity, and risk factors for cardiovascular disease among children with diabetes in the SEARCH for Diabetes in Youth Study. Pediatr Diabetes. 2007;8(6):354-361.

Maahs DM, Snively BM, Bell RA, Dolan L, Hirsch I, Imperatore G, Linder B, Marcovina SM, Mayer-Davis EJ, Pettitt DJ, Rodriguez BL, Dabelea D. Higher prevalence of elevated albumin excretion in youth with type 2 than type 1 diabetes: the SEARCH for Diabetes in Youth Study. Diabetes Care. 2007;30(10):2593-2598.

Petitti DB, Imperatore G, Palla SL, Daniels SR, Dolan LM, Kershnar AK, Marcovina S, Pettitt DJ, Pihoker C, SEARCH for Diabetes in Youth Study Group. Serum lipids and glucose control: the SEARCH for Diabetes in Youth Study. Arch Pediatr Adolesc Med. 2007;161(2):159-165.

Vehik K, Hamman RF, Lezotte D, Norris JM, Klingensmith G, Bloch C, Rewers M, Dabelea D. Increasing incidence of type 1 diabetes in 0- to 17-year-old Colorado youth. Diabetes Care. 2007;30(3):503-509.

Writing Group for the SEARCH for Diabetes in Youth Study Group, Dabelea D, Bell RA, D'Agostino RB, Jr., Imperatore G, Johansen JM, Linder B, Liu LL, Loots B, Marcovina S, Mayer-Davis EJ, Pettitt DJ, Waitzfelder B. Incidence of diabetes in youth in the United States. [Erratum appears in JAMA. 2007;298(6):627]. JAMA. 2007;297(24):2716-2724.

Albers JJ, Marcovina SM, Imperatore G, Snively BM, Stafford J, Fujimoto WY, Mayer-Davis EJ, Petitti DB, Pihoker C, Dolan L, Dabelea DM. Prevalence and determinants of elevated apolipoprotein B and dense low-density lipoprotein in youths with type 1 and type 2 diabetes. J Clin Endocrinol Metab. 2008;93(3):735-742.

Lawrence JM, Liese AD, Liu L, Dabelea D, Anderson A, Imperatore G, Bell R. Weight-loss practices and weight-related issues among youth with type 1 or type 2 diabetes. Diabetes Care. 2008;31(12):2251-2257.

Liese AD, Liu L, Davis C, Standiford D, Waitzfelder B, Dabelea D, Bell R, Williams D, Imperatore G, Lawrence JM. Participation in pediatric epidemiologic research: the SEARCH for Diabetes in Youth Study experience. Contemp Clin Trials. 2008;29(6):829-836.

Maahs DM, Snively BM, Beyer J, Imperatore G, Bell R, Mayer-Davis EJ, Dolan LM, Pettitt DJ, Hirsch I, Rodriguez B, Dabelea D. Birth weight and elevated albumin to creatinine ratio in youth with diabetes: the SEARCH for Diabetes in Youth Study. Pediatr Nephrol. 2008;23(12):2255-2260.

Naughton MJ, Ruggiero AM, Lawrence JM, Imperatore G, Klingensmith GJ, Waitzfelder B, McKeown RE, Standiford DA, Liese AD, Loots B, SEARCH for Diabetes in Youth Study Group. Health-related quality of life of children and adolescents with type 1 or type 2 diabetes mellitus: SEARCH for Diabetes in Youth Study. Arch Pediatr Adolesc Med. 2008;162(7):649-657.

Pettitt DJ, Lawrence JM, Beyer J, Hillier TA, Liese AD, Mayer-Davis B, Loots B, Imperatore G, Liu L, Dolan LM, Linder B, Dabelea D. Association between maternal diabetes in utero and age at offspring's diagnosis of type 2 diabetes. Diabetes Care. 2008;31(11):2126-2130.

Rewers A, Klingensmith G, Davis C, Petitti DB, Pihoker C, Rodriguez B, Schwartz ID, Imperatore G, Williams D, Dolan LM, Dabelea D. Presence of diabetic ketoacidosis at diagnosis of diabetes mellitus in youth: the Search for Diabetes in Youth Study. Pediatrics. 2008;121(5):e1258-e1266.

Bell RA, Mayer-Davis EJ, Beyer JW, D'Agostino RB, Jr., Lawrence JM, Linder B, Liu LL, Marcovina SM, Rodriguez BL, Williams D, Dabelea D. Diabetes in non-Hispanic white youth: prevalence, incidence, and clinical characteristics: the SEARCH for Diabetes in Youth Study. Diabetes Care. 2009;32 Suppl 2:S102-S111.

Dabelea D, DeGroat J, Sorrelman C, Glass M, Percy CA, Avery C, Hu D, D'Agostino RB, Jr., Beyer J, Imperatore G, Testaverde L, Klingensmith G, Hamman RF. Diabetes in Navajo youth: prevalence, incidence, and clinical characteristics: the SEARCH for Diabetes in Youth Study. Diabetes Care. 2009;32 Suppl 2:S141-S147.

Greenbaum CJ, Anderson AM, Dolan LM, Mayer-Davis EJ, Dabelea D, Imperatore G, Marcovina S, Pihoker C. Preservation of beta-cell function in autoantibody-positive youth with diabetes. Diabetes Care. 2009;32(10):1839-1844.

Gunther AL, Liese AD, Bell RA, Dabelea D, Lawrence JM, Rodriguez BL, Standiford DA, Mayer-Davis EJ. Association between the dietary approaches to hypertension diet and hypertension in youth with diabetes mellitus. Hypertension. 2009;53(1):6-12.

Kahn HS, Morgan TM, Case LD, Dabelea D, Mayer-Davis EJ, Lawrence JM, Marcovina SM, Imperatore G. Association of type 1 diabetes with month of birth among U.S. youth: the SEARCH for Diabetes in Youth Study. Diabetes Care. 2009;32(11):2010-2015.

Lawrence JM, Mayer-Davis EJ, Reynolds K, Beyer J, Pettitt DJ, D'Agostino RB, Jr., Marcovina SM, Imperatore G, Hamman RF. Diabetes in Hispanic American youth: prevalence, incidence, demographics, and clinical characteristics: the SEARCH for Diabetes in Youth Study. Diabetes Care. 2009;32 Suppl 2:S123-S132.

Liu LL, Yi JP, Beyer J, Mayer-Davis EJ, Dolan LM, Dabelea DM, Lawrence JM, Rodriguez BL, Marcovina SM, Waitzfelder BE, Fujimoto WY. Type 1 and Type 2 diabetes in Asian and Pacific Islander U.S. youth: the SEARCH for Diabetes in Youth Study. Diabetes Care. 2009;32 Suppl 2:S133-S140.

Maahs DM, Hamman RF, D'Agostino R, Jr., Dolan LM, Imperatore G, Lawrence JM, Marcovina SM, Mayer-Davis EJ, Pihoker C, Dabelea D. The association between adiponectin/leptin ratio and diabetes type: the SEARCH for Diabetes in Youth Study. J Pediatr. 2009;155(1):133-135.

Mayer-Davis EJ, Bell RA, Dabelea D, D'Agostino R, Jr., Imperatore G, Lawrence JM, Liu L, Marcovina S. The many faces of diabetes in American youth: type 1 and type 2 diabetes in five race and ethnic populations: the SEARCH for Diabetes in Youth Study. Diabetes Care. 2009;32 Suppl 2:S99-101.

Mayer-Davis EJ, Beyer J, Bell RA, Dabelea D, D'Agostino R, Jr., Imperatore G, Lawrence JM, Liese AD, Liu L, Marcovina S, Rodriguez B. Diabetes in African American youth: prevalence, incidence, and clinical characteristics: the SEARCH for Diabetes in Youth Study. Diabetes Care. 2009;32 Suppl 2:S112-S122.

Mayer-Davis EJ, Ma B, Lawson A, D'Agostino RB, Jr., Liese AD, Bell RA, Dabelea D, Dolan L, Pettitt DJ, Rodriguez BL, Williams D. Cardiovascular disease risk factors in youth with type 1 and type 2 diabetes: implications of a factor analysis of clustering. Metab Syndr Relat Disord. 2009;7(2):89-95.

Paris CA, Imperatore G, Klingensmith G, Petitti D, Rodriguez B, Anderson AM, Schwartz ID, Standiford DA, Pihoker C. Predictors of insulin regimens and impact on outcomes in youth with type 1 diabetes: the SEARCH for Diabetes in Youth Study. J Pediatr. 2009;155(2):183-189.

Petitti DB, Klingensmith GJ, Bell RA, Andrews JS, Dabelea D, Imperatore G, Marcovina S, Pihoker C, Standiford D, Waitzfelder B, Mayer-Davis E. Glycemic control in youth with diabetes: the SEARCH for Diabetes in Youth Study. J Pediatr. 2009;155(5):668-672.

Dabelea D, Mayer-Davis EJ, Imperatore G. The value of national diabetes registries: SEARCH for Diabetes in Youth Study. Curr Diab Rep. 2010;10(5):362-369.

Liu LL, Lawrence JM, Davis C, Liese AD, Pettitt DJ, Pihoker C, Dabelea D, Hamman R, Waitzfelder B, Kahn HS. Prevalence of overweight and obesity in youth with diabetes in USA: the SEARCH for Diabetes in Youth Study. Pediatr Diabetes. 2010;11:4-11.

Rodriguez BL, Dabelea D, Liese AD, Fujimoto W, Waitzfelder B, Liu L, Bell R, Talton J, Snively BM, Kershnar A, Urbina E, Daniels S, Imperatore G. Prevalence and correlates of elevated blood pressure in youth with diabetes mellitus: the SEARCH for Diabetes in Youth Study. J Pediatr. 2010;157(2):245-251.

Urbina EM, Wadwa RP, Davis C, Snively BM, Dolan LM, Daniels SR, Hamman RF, Dabelea D. Prevalence of increased arterial stiffness in children with type 1 diabetes mellitus differs by measurement site and sex: the SEARCH for Diabetes in Youth Study. J Pediatr. 2010;156(5):731-737.

Wadwa RP, Urbina EM, Anderson AM, Hamman RF, Dolan LM, Rodriguez BL, Daniels SR, Dabelea D. Measures of arterial stiffness in youth with type 1 and type 2 diabetes: the SEARCH for Diabetes in Youth Study. Diabetes Care. 2010;33(4):881-886.