Diabetes Rates Rocket in US Tweens and Teens

Yael Waknine

May 06, 2014

May 5, 2014 — The prevalence of type 2 diabetes in American tweens and teens has skyrocketed by 35% over an 8-year period, according to new data from the SEARCH for Diabetes in Youth study, published online May 3 in the Journal of the American Medical Association on May 3.

"Our study is really the first in the US to quantify the burden of type 2 diabetes at the population level — and not just in a clinic or group of clinics, [but] in all major racial/ethnic groups in the US — and documents increasing trends in several racial-ethnic groups," emphasized lead author Dana Dabelea, MD, PhD, from the Colorado School of Public Health, Aurora, in an interview with Medscape Medical News.

The results also show that the prevalence of pediatric type 1 diabetes increased by 30% from 2001 to 2009, which was "consistent with worldwide estimates," say the researchers.

The work involved data collected in 2001 and 2009 from 38 counties in 5 states as well as from American Indian reservations in Arizona and New Mexico and involved youths of white, black, Hispanic, Asian Pacific Islander, and American Indian descent.

Although the researchers acknowledge that the study doesn't include information from the past 5 years, they state that these increases "are serious and draw attention to the public-health impact of pediatric diabetes," noting that each new case at a young age means a lifetime burden of difficult and costly treatment, as well as an increased risk for early serious complications.

Greatest Change in Type 2 Diabetes in Hispanic Kids

In 2001, only 588 cases of type 2 diabetes were diagnosed among 1.7 million youth aged 10 to 19 years, for a prevalence rate of 0.34 per 1000. By 2009 the prevalence rate had risen to 0.46 per 1000, reflecting 810 cases in a population of 1.8 million.

The magnitude of the increase was greatest among Hispanics (prevalence, 0.45 per 1000 in 2001 to 0.79 in 2009; P < .001), followed by blacks (0.95 to 1.06 per 1000; = .02), and whites (0.14 to 0.17 per 1000; P < .001); no significant changes were observed among Asian Pacific Islanders (= .73) or American Indians (= .83).

According to Dr. Dabelea, increasing rates of type 2 diabetes likely reflect the current obesity epidemic and also the long-term impact of higher gestational diabetes rates.

"It is likely that prevention of type 2 diabetes in youth will require sustained lifestyle changes that need to be implemented and maintained throughout the life course but starting very early in life, during (or even before) pregnancy," she said. This will include optimizing maternal weight gain and nutrition patterns during pregnancy, promotion of breastfeeding, and promotion of healthy diets and physically active behaviors at the earliest possible times, she added.

Alarm bells have been rung about type 2 diabetes in children; just last year, the TODAY series of studies indicated that some youths with type 2 diabetes have a more aggressive form of the disease than is seen adults, with a high risk for complications such as early renal and cardiovascular disease.

Type 1 Diabetes Also Growing Among Minorities

With respect to type 1 diabetes, 4958 cases were diagnosed among 3.3 million youths aged 0 to 19 years in 2001, for a prevalence rate of 1.48 per 1000. By 2009, the prevalence had risen to 1.93 per 1000, reflecting 6666 new cases among 3.5 million children under the age of 19 years.

As might be expected, the greatest increase in prevalence occurred among white youth (from 1.86 per 1000 in 2001 to 2.55 in 2009; P < .001).

However, significant increases were also observed among minorities, including blacks (1.29 to 1.62 per 1000; P < .001), Hispanics (0.96 to 1.29 per 1000; < .001), and Asian Pacific Islanders (0.50 to 0.60 per 1000; P = .006); no significant changes occurred among American Indians (P = .19).

"Historically, type 1 diabetes has been considered a disease that affects primarily white youth; however, our findings highlight the increasing burden of type 1 diabetes experienced by youth of minority racial/ethnic groups as well," the authors write.

Asked about potential causes for this increase, Dr. Dabelea said the causes of type 1 diabetes in general remain unclear.

"Still, it is likely that something has changed in the environment in which our children are born and raised — both in the US and elsewhere in the world — causing more youth to develop the disease, maybe at increasingly younger ages," she pointed out.

Speculating on potential causes, she mentioned a lack of certain viral or bacterial triggers at an early age ("hygiene hypothesis"), changes in early diet that might negatively affect the developing gut microenvironment, and increased rates of obesity in the general population.

In conclusion, she and her colleagues say that further studies are required to determine the causes of these increases in both type 1 and 2 diabetes in children.

The study was funded by the Centers for Disease Control and Prevention and the National Institute of Diabetes and Digestive and Kidney Diseases. Dr. Dabelea reports no relevant financial relationships. Disclosures for the coauthors are listed in the article.

JAMA. 2014;311:1778-1786. Abstract

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