Pediatric Diabetes Type 1 and 2 Rose During 2001-2017 in the US

The estimated prevalence of type 1 diabetes (T1D) and type 2 diabetes (T2D) in children and adolescents increased in the United States from 2001 to 2017, according to results of the SEARCH for Diabetes in Youth Study published in JAMA. Researchers hypothesize that ethnicity, environment and obesity may have contributed to the rise.

The study authors analyzed data from clinical centers from 6 geographic areas of the US where the data was collected – California, Colorado, Ohio, South Carolina and Washington State, as well as combined data from Indian health services in selected areas of Arizona and New Mexico. Eligible study participants were 20 and younger at the end of December 31, 2001, December 31, 2009, and December 31, 2017, and had physician-diagnosed diabetes.

Among an average of 3.47 million youth 19 years of age or younger in the observational, cross-sectional, multicenter study for each prevalence year, 4958 children and adolescents out of a total population of 3.35 million had T1D in 2001, 6672 of 3, 46 million had T1D in 2009, and 7759 of 3.61 million had T1D in 2017. For youths aged 10 to 19, 588 of 1.73 million had T2D in 2001, 814 of 1.78 million had T2D in 2009 and 1230 of 1.85 million had T2D in 2017.

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The estimated prevalence of T1D per 1000 youth aged 19 years or younger increased significantly from 1.48 (95% CI, 1.44-1.52) in 2001 to 1.93 (95% CI, 1.88 -1.98) in 2009, to 2.15 (95% CI , 2.10-2.20) in 2017, a significant absolute increase of 0.67 per 1000 young people (95%, CI, 0.64-0 .70) and a relative increase of 45.1% (95% CI, 40.0%-50.4%) over 16 years.

White and black youth had the largest absolute increase in estimated prevalence of T1D from 2001 to 2017: 0.93 per 1000 (95% CI, 0.88-0.98) for whites and 0.89 per 1000 (95% CI, 0.80-0.99) for blacks.

The estimated prevalence of T2D per 1000 youths aged 10 to 19 years increased significantly, from 0.34 (95% CI 0.31-0.37) in 2001 to 0.46 (95% CI 0, 43-0.49) in 2009, to 0.67 (95% CI, 0.63-0.70) in 2017, a significant absolute increase of 0.32 per 1000 young people (95% CI, 0.30-0 .35) and a relative increase of 95.3% (95% CI, 77.0%-115.4%) over 16 years.

Black and Hispanic youth had the largest absolute increase in the estimated prevalence of T2D from 2001 to 2017: 0.85 per 1000 youth (95% CI 0.74-0.97) for blacks and 0.57 per 1000 youth ( 95% CI 0.51-0.64) for Hispanics.

No significant differences were observed with regard to the etiological type and physician diagnosis of type 1 diabetes in general or by age, sex or race and ethnicity or for T2D diabetes in general.

Researchers found a stronger increase in age- and sex-adjusted incidence of type 1 diabetes from 2002 to 2015 among black and Hispanic study enrollees than white enrollees. The etiology of T1D is unknown, the researchers wrote, but environmental factors (infectious and mucosal exposure in the first 2 years of life, added to a pre-existing genetic predisposition to T1D, may play a role).

Childhood obesity increased from 13.9% between 1999-2000 to 18.52% between 2015-2016; this is a likely cause of the increase in T2D, according to the researchers. Black and Mexican-American teens experienced the largest increase in obesity/severe obesity from 1999 to 2018. In addition to the increase in childhood obesity in general, the researchers say the rising numbers may be due to an increase in exposure to maternal obesity. and diabetes (gestational and type 2 diabetes) and exposure to environmental chemicals.

The researchers noted several limitations in the study. Only youth diagnosed with diabetes were included, who may have missed those with undiagnosed T2D diabetes. Nevertheless, the study authors said that the number of individuals “missed” for this reason was “likely small” and that “missed” cases of T1D were less likely due to the severity of symptoms at onset. It was also noted that several groups had relatively small numbers of participants, especially American Indians, Asian and Pacific Islanders. In addition, 2017 was the last year in which the most cases were identified, the study authors did not know whether the 2017 findings reflected the prevalence in 2021.

“While the percentage increase in prevalence was greater for type 2 diabetes, the absolute increase in prevalence was greater for type 1 diabetes, which is more common than type 2 diabetes in young people,” the researchers concluded.

Disclosure: Study authors had no conflicts of interest to disclose.

Reference

Lawrence JM, Divers J, Isom S, et al. Trends in the prevalence of type 1 and type 2 diabetes in children and adolescents in the US, 2001-2017. JAMA. 2021;326(8):717-727. doi: 10.1001/jama.2021.11165

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