Diabetes in children in the US   (March 1, 2009)

The journal Diabetes Care has just published a discussion of results from the SEARCH for Diabetes in Youth Study, titled The Many Faces of Diabetes in AmericanYouth: Type 1 and Type 2 Diabetes in Five Race and Ethnic Populations . It's a series of articles, one for each race/ethnic group.

The authors describe the study's objective as "to describe childhood diabetes [in children and teenagers less than age 20] as it occurs among the five major race and ethnic groups in the U.S." They evaluated over 9000 kids with type 1 diabetes and almost 1600 with type 2 during the period 2001-2005.

In non-Hispanic white youth, they found that the incidence of type 1 diabetes is "one of the highest in the world" and added "while type 2 diabetes is still relatively rare, rates are several-fold higher than those reported by European countries."

In Hispanic American youth, they noted that type 1 diabetes was more common than type 2 diabetes. The incidence of type 2 diabetes for girls aged 10-14 years was twice that of boys, while among teens aged 15-19 years the incidence of type 2 diabetes exceeded that of type 1 diabetes for girls but not for boys. Poor control (A1C over 9.5%) was common among youth aged ≥15 years with either type of diabetes. Forty-four percent of youth with type 1 diabetes were overweight.

In African American youth, 44.7% with type 1 diabetes were overweight or obese. Among those aged ≥15 years, 27.5% had an A1C ≥9.5%, 22.5% had high blood pressure, and >90% were overweight or obese.

In Navajo youth, diabetes was infrequent in children of less than 10 years of age. However, both prevalence and incidence of diabetes are high in older youth. "The vast majority of diabetes among Navajo youth with diabetes is type 2, although type 1 diabetes is also present, especially among younger children. Navajo youth with either diabetes type were likely to have poor glycemic control, high prevalence of unhealthy behaviors, and evidence of severely depressed mood. Youth with type 2 diabetes had more metabolic factors associated with obesity and insulin resistance... than youth with type 1 diabetes."

In Asian and Pacific Islander U.S. youth, "Most participants with type 2 diabetes were obese (range Asian 71% to Pacific Islander 100%) with mean BMI >33 kg/m2. In those with type 1 diabetes, Pacific Islanders were more likely to be obese, with a mean BMI of 26 vs. 20 kg/m2 for Asian and Asian-Pacific Islander youth... The incidence of type 1 diabetes for youth aged 0-9 years was 6.4 per 100,000 person-years and 7.4 per 100,000 person-years for youth aged 10-19 years. The incidence of type 2 diabetes was 12.1 per 100,000 person-years for youth aged 10-19 years." The authors add that "while the majority of Asian, Pacific Islander, and Asian-Pacific Islander youth had type 1 diabetes, older Asian, Pacific Islander, and Asian-Pacific Islander youth (aged 10-19 years) have an incidence of type 2 diabetes almost double that of type 1 diabetes."

Some random thoughts about all this:

* These dismal statistics clearly show that the epidemic of diabetes, both type 1 and type 2, has hit our children.

* The lack of glucose control that teenagers were found is unsurprising to diabetes professionals, who know that teens and diabetes control are like water and oil: unlikely to mix.

* While we usually think of type 2 diabetes as an adult disorder, the data presented about type 2 diabetes in children mean that the US will have ever-growing numbers of diabetic young adults as these children grow up, and the costs associated with diabetes will inevitably rise.

* Can we do anything to reverse these numbers? It's unclear if type 1 diabetes can be prevented, but clearly the other epidemic (of obesity) is contributing to the increase of type 2 diabetes in children as well as in adults. Changing society's mind-set to encourage healthy foods and more exercise seems a daunting task, but other societal behaviors are changing: seatbelts are now commonly available and worn, and cigaret smoking is decreasing. Perhaps the public health authorities can tackle childhood obesity and someday we'll see lesser numbers of obese kiddies waddling around, and their A1Cs may be normal instead of spectacularly elevated.

* But for the foreseeable future, pediatricians and other physicians caring for children and teenagers will have to be on the lookout for diabetes -- it's there, and it's becoming more common.