More and More U.S. Kids Being Diagnosed With Diabetes

 Prevalence of type 2 diabetes among American youth has nearly doubled over the past 20 years, a new study found.

Since the turn of the century, the estimated prevalence of type 2 diabetes among Americans ages 10 to 19 years increased by a relative 95.3% (95% CI 77.0%-115.4%), reported Jean Lawrence, ScD, MPH, MSSA, of the National Institute of Diabetes and Digestive and Kidney Diseases in Bethesda, Maryland, and colleagues.

In 2001, a total of 588 of 1.73 million youth had type 2 diabetes. This number steadily increased to 814 of 1.85 million youth in 2009, and subsequently hit 1,230 of 1.85 million by the year 2017, according to the findings in JAMA.

This translated to an absolute increase of 0.32 per 1,000 estimated youths (95% CI 0.30-0.35) diagnosed with type 2 diabetes during this time:

• 2001: 0.34 per 1,000 (95% CI 0.31-0.37)

• 2009: 0.46 per 1,000 (95% CI 0.43-0.49)

• 2017: 0.67 per 1,000 (95% CI 0.63-0.70)

Delving deeper into these rising type 2 diabetes trends among youth, Lawrence's group found some differences by race and ethnicity. Specifically, the steepest absolute increases in type 2 diabetes prevalence from 2001 to 2017 were seen among non-Hispanic Black (0.85 per 1,000; 95% CI 0.74-0.97) and Hispanic (0.57 per 1,000; 95% CI 0.51-0.64) youth.

This steady rise in diabetes prevalence wasn't just isolated to type 2 diabetes, either.

When looking at American youth under the age of 20, a total of 4,958 of 3.35 million youth had type 1 diabetes in 2001. Mirroring trends seen for type 2 diabetes, this number crept up to 6,672 of 3.46 million youth in 2009 and rounded out at 7,759 of 3.61 million youth in 2017.

This translated to a 45.1% (95% CI 40.0%-50.4%) relative increase in type 1 diabetes diagnoses over 16 years for American youth. Paired with this, there was an absolute increase of 0.67 per 1,000 (95% CI 0.64-0.70) estimated youths diagnosed with type 1 diabetes from 2001 to 2017:

• 2001: 1.48 per 1,000 (95% CI 1.44-1.52)

• 2009: 1.93 per 1,000 (95% CI 1.88-1.98)

• 2017: 2.15 per 1,000 (95% CI 2.10-2.20)

This increase in type 1 diabetes prevalence followed a slightly different pattern than seen with type 2 diabetes, as non-Hispanic white youth saw the greatest absolute increase in diagnoses during this time (0.93 per 1,000; 95% CI 0.88-0.98). Non-Hispanic Black youth had the second steepest rise in type 1 diabetes cases, increasing by 0.89 per 1,000 (95% CI 0.88-0.98) from 2001 to 2017.

"Increases in prevalence can be driven by increased incidence, declining mortality, or both," the researchers explained. That being said, though, the team noted, one of the main drivers of this increased incidence is likely due to the rising childhood obesity rates in America -- growing from 13.9% in 1999-2000 to 18.5% in 2015-2016.

And stemming from this, Black and Mexican American teenagers saw some of the largest spikes in obesity prevalence during this time, likely underlying the simultaneous increases in type 2 diabetes.

For this cross-sectional observational study, Lawrence's group looked at both incidence rates and prevalence estimates from the SEARCH for Diabetes in Youth Study, which included data from six U.S. areas: California, Colorado, Ohio, South Carolina, Washington State, and Indian Health Services users in certain areas of Arizona and New Mexico.

The type 1 and type 2 diabetes cases in the study were diagnosed by physicians. Type 1 diabetes was classified as having a presence of at least one autoantibody -- glutamic acid decarboxylase antibody, zinc transporter 8 antibody, or insulinoma-associated antibody -- identified using harmonized assays or antibody-negative and insulin-sensitive based on a clamp validated index. Type 2 diabetes was classified as having no evidence of diabetes autoimmunity or the presence of insulin resistance.

The researchers also pointed out that the 2010 change in diagnostic criteria by the American Diabetes Association, which then recommended an HbA1c reading of at least 6.5% when diagnosing adults, likely did not have any impact on these prevalence trends, since they did not apply to pediatric patients

Disclosures

The study was supported by Kaiser Permanente Southern California's Marilyn Owsley Clinical Research Center, the South Carolina Clinical & Translational Research Institute at the Medical University of South Carolina, NIH/National Center for Advancing Translational Sciences, Seattle Children's Hospital, the University of Washington, University of Colorado Pediatric Clinical and Translational Research Center the Barbara Davis Center, the University of Cincinnati, and the Children with Medical Handicaps program.

Lawrence and co-authors reported no disclosures.

Primary Source

JAMA

Source Reference: Lawrence JM, et al "Trends in prevalence of type 1 and type 2 diabetes in children and adolescents in the US, 2001-2017" JAMA 2021; DOI: 10.1001/jama.2021.11165.

https://www.medpagetoday.com/primarycare/diabetes/94183