The prevalence of both type 1 and type 2 diabetes has increased substantially among American youth over the past decade, and, with this rise, the rates of diabetes complications have increased. This topic was discussed in a session on pediatric obesity at the 2012 ADA annual meeting.
The SEARCH for Diabetes in Youth study is a project undertaken by the Centers for Disease Control and Prevention and the National Institutes of Health to explore the burden of this disease among young Americans. The study is documenting the number of children and youth under age 20 years who are diagnosed with diabetes in 5 geographically dispersed populations in the United States, reported Dana Dabelea, MD, PhD, Associate Professor, Department of Epidemiology, University of Colorado, Denver.
Preliminary findings were presented at the meeting. From 2001 to 2009, the prevalence of type 2 diabetes among the young (age <20 years) increased by 21%, from 2.9 per 10,000 persons to 3.6 per 10,000 persons; during the same period, the prevalence of type 1 diabetes increased by 23%, from 1.7 per 1000 persons to 2.1 per 1000 persons, reported Dr Dabelea.
In 2009, the estimated number of young Americans under age 20 years who had diabetes was approximately 189,000; of those, approximately 168,000 young patients had type 1 diabetes, and 19,373 young patients had type 2 diabetes.
Only 2% of the cases of type 2 diabetes occurred in youth aged <10 years; however, the prevalence is rising rapidly among young Americans, with increasing age.
Although blacks and American Indians still have the highest prevalence of type 2 diabetes in all age-groups, the increase in the prevalence of type 2 diabetes in American youth was largest among non-Hispanic whites and Hispanics.
The Pediatric Obesity Epidemic
The surge in type 2 diabetes among young Americans is believed to be the result of the obesity epidemic in that age-group, as well as “fetal overnutrition,” in which the developing fetus is exposed to maternal obesity and gestational diabetes associated with pregnancy, said Dr Dabelea. The risk for type 2 diabetes in early life strongly increases with being exposed to maternal diabetes or obesity while in the womb.
“The vicious cycle of obesity creates a transgenerational problem,” Dr Dabelea said, “as the offspring of women who are obese or who have type 2 diabetes during pregnancy are more likely to develop diabetes early in life.”
The consequences of the increase in diabetes prevalence among American youth include signs of early diabetes complications, even after a relatively short duration of the disease. These complications include:
- Neuropathy, which may be related to complications of heart disease later in life; “almost 12% of youth with type 1 diabetes and 26% with type 2 show signs and symptoms of neuropathy,” said Dr Dabelea, and “glucose control correlates strongly with these symptoms”
- In addition, albuminuria is present in 22% of the young patients with type 2 diabetes and 9% of those with type 1 diabetes
- Furthermore, young patients with type 2 diabetes are likely to have proteinuria, which may predispose them to kidney disease later in life.
“All of these data provide evidence that diabetes in youth is not benign,” Dr Dabelea said, noting that more data are needed on this disease among young Americans.