1
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Wang K, Ye F, Chen Y, Xu J, Zhao Y, Wang Y, Lan T. Association Between Enterovirus Infection and Type 1 Diabetes Risk: A Meta-Analysis of 38 Case-Control Studies. Front Endocrinol (Lausanne) 2021; 12:706964. [PMID: 34557158 PMCID: PMC8453141 DOI: 10.3389/fendo.2021.706964] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 08/09/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE The association between enterovirus infection and type 1 diabetes (T1D) is controversial, and this meta-analysis aimed to explore the correlation. METHODS PubMed, Embase, Web of Science, and Cochrane Database were searched from inception to April 2020. Studies were included if they could provide sufficient information to calculate odds ratios and 95% confidence intervals. All analyses were performed using STATA 15.1. RESULTS Thirty-eight studies, encompassing 5921 subjects (2841 T1D patients and 3080 controls), were included. The pooled analysis showed that enterovirus infection was associated with T1D (P < 0.001). Enterovirus infection was correlated with T1D in the European (P < 0.001), African (P = 0.002), Asian (P = 0.001), Australian (P = 0.011), and Latin American (P = 0.002) populations, but no conclusion could be reached for North America. The association between enterovirus infection and T1D was detected in blood and tissue samples (both P < 0.001); no association was found in stool samples. CONCLUSION Our findings suggest that enterovirus infection is associated with T1D.
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Affiliation(s)
- Kan Wang
- Jinhua Maternity and Child Health Care Hospital, Jinhua, China
- Jinhua Women and Children’s Hospital, Jinhua, China
- *Correspondence: Kan Wang, ; Fei Ye,
| | - Fei Ye
- First Department of Neurology, Affiliated Jinhua Hospital, Jinhua Municipal Central Hospital, Zhejiang University School of Medicine, Jinhua, China
- *Correspondence: Kan Wang, ; Fei Ye,
| | - Yong Chen
- Jinhua Maternity and Child Health Care Hospital, Jinhua, China
- Jinhua Women and Children’s Hospital, Jinhua, China
| | - Jianxin Xu
- Jinhua Maternity and Child Health Care Hospital, Jinhua, China
- Jinhua Women and Children’s Hospital, Jinhua, China
| | - Yufang Zhao
- Jinhua Maternity and Child Health Care Hospital, Jinhua, China
- Jinhua Women and Children’s Hospital, Jinhua, China
| | - Yeping Wang
- Jinhua Maternity and Child Health Care Hospital, Jinhua, China
- Jinhua Women and Children’s Hospital, Jinhua, China
| | - Tian Lan
- Jinhua Maternity and Child Health Care Hospital, Jinhua, China
- Jinhua Women and Children’s Hospital, Jinhua, China
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2
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Magliano DJ, Sacre JW, Harding JL, Gregg EW, Zimmet PZ, Shaw JE. Young-onset type 2 diabetes mellitus - implications for morbidity and mortality. Nat Rev Endocrinol 2020; 16:321-331. [PMID: 32203408 DOI: 10.1038/s41574-020-0334-z] [Citation(s) in RCA: 219] [Impact Index Per Article: 54.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/13/2020] [Indexed: 12/20/2022]
Abstract
Accumulating data suggest that type 2 diabetes mellitus (T2DM) in younger people (aged <40 years), referred to as young-onset T2DM, has a more rapid deterioration of β-cell function than is seen in later-onset T2DM. Furthermore, individuals with young-onset T2DM seem to have a higher risk of complications than those with type 1 diabetes mellitus. As the number of younger adults with T2DM increases, young-onset T2DM is predicted to become a more frequent feature of the broader diabetes mellitus population in both developing and developed nations, particularly in certain ethnicities. However, the magnitude of excess risk of premature death and incident complications remains incompletely understood; likewise, the potential reasons for this excess risk are unclear. Here, we review the evidence pertaining to young-onset T2DM and its current and future burden of disease in terms of incidence and prevalence in both developed and developing nations. In addition, we highlight the associations of young-onset T2DM with premature mortality and morbidity.
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Affiliation(s)
- Dianna J Magliano
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.
- Monash University, School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia.
| | - Julian W Sacre
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Jessica L Harding
- Division of Diabetes Translation, Centers for Disease Control and Prevention (CDC), Atlanta, GA, USA
| | - Edward W Gregg
- Faculty of Medicine, School of Public Health, Imperial College, London, UK
| | - Paul Z Zimmet
- Monash University, Department of Diabetes, Melbourne, Victoria, Australia
| | - Jonathan E Shaw
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Monash University, School of Public Health and Preventive Medicine, Melbourne, Victoria, Australia
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3
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Mobasseri M, Shirmohammadi M, Amiri T, Vahed N, Hosseini Fard H, Ghojazadeh M. Prevalence and incidence of type 1 diabetes in the world: a systematic review and meta-analysis. Health Promot Perspect 2020; 10:98-115. [PMID: 32296622 PMCID: PMC7146037 DOI: 10.34172/hpp.2020.18] [Citation(s) in RCA: 328] [Impact Index Per Article: 82.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 10/26/2019] [Indexed: 12/13/2022] Open
Abstract
Background: Diabetes is referred to a group of diseases characterized by high glucose levels in blood. It is caused by a deficiency in the production or function of insulin or both, which can occur because of different reasons, resulting in protein and lipid metabolic disorders. The aim of this study was to systematically review the prevalence and incidence of type 1 diabetes in the world. Methods: A systematic search of resources was conducted to investigate the prevalence and incidence of type 1 diabetes in the world. The databases of Medline (via PubMed and Ovid),ProQuest, Scopus, and Web of Science from January 1980 to September 2019 were searched to locate English articles. The located articles were screened in multiple levels of title, abstract,and full-text and final studies that met the inclusion criteria were retrieved and included in the study. Results: From 1202 located articles, 193 studies were included in this systematic review. The results of meta-analysis showed that the incidence of type 1 diabetes was 15 per 100,000 people and the prevalence was 9.5% (95% CI: 0.07 to 0.12) in the world, which was statistically significant. Conclusion: According to the results, the incidence and prevalence of type 1 diabetes are increasing in the world. As a result, insulin will be difficult to access and afford, especially in underdeveloped and developing countries.
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Affiliation(s)
- Majid Mobasseri
- Endocrine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masoud Shirmohammadi
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Tarlan Amiri
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nafiseh Vahed
- Emergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, Iran
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A Joanna Briggs Institute Affiliated Group, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Hosseini Fard
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A Joanna Briggs Institute Affiliated Group, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Morteza Ghojazadeh
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A Joanna Briggs Institute Affiliated Group, Tabriz University of Medical Sciences, Tabriz, Iran
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4
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Correya TA, Ashraf AP, Griffin R, Aslibekyan S, Kim HD, Middleton S, McCormick K. Temporal trends in incidence of pediatric type 1 diabetes in Alabama: 2000-2017. Pediatr Diabetes 2020; 21:40-47. [PMID: 31591761 DOI: 10.1111/pedi.12927] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 09/12/2019] [Accepted: 09/24/2019] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The incidence of type 1 diabetes has increased in the United States and worldwide. We hypothesized that trends in the annual incidence rates of childhood-onset type 1 diabetes in the state of Alabama would be different by race and sex. METHODS We performed a retrospective observational cohort study, analyzing children with type 1 diabetes (n = 3770) managed at the Children's Hospital of Alabama between 2000 and 2017. We compared crude incidence rates using negative binomial regression models and analyzed differences in annual trends of age-adjusted incidence by race and sex using joinpoint regression. RESULTS The crude type 1 diabetes incidence rate was estimated at 16.7 per 100 000 children <19 years of age in Alabama. Between 2000 and 2007, there was an increase in age-adjusted incidence of type 1 diabetes with an annual percent change (APC) of 10% from 2000 to 2007 and a 1.7% APC decrease from 2007 to 2017. The age-adjusted incidence for Whites and Blacks increased with an average annual percentage change (AAPC) of 4.4% and 2.8%, respectively. A nearly 11% increasing trend in age-adjusted incidence was observed for both races, though the increase plateaued in 2006 for Whites and 2010 for Blacks. CONCLUSIONS Following significantly increasing annual trends for both races, the age-adjusted rate remained statistically stable for Whites and decreased significantly for Blacks. Longer-sustained trend increases for Blacks resulted in type 1 diabetes incidence tripling compared to the doubling of the rate for Whites.
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Affiliation(s)
- Tanya A Correya
- Science and Technology Honors, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ambika P Ashraf
- Division of Pediatric Endocrinology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Russell Griffin
- Department of Epidemiology, UAB School of Public Health, Birmingham, Alabama
| | - Stella Aslibekyan
- Department of Epidemiology, UAB School of Public Health, Birmingham, Alabama
| | - Hae Dong Kim
- Georgia Campus- Philadelphia College of Osteopathic Medicine, Suwanee, Georgia
| | - Sydney Middleton
- University of Alabama School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kenneth McCormick
- Division of Pediatric Endocrinology, University of Alabama at Birmingham, Birmingham, Alabama
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5
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Adeloye D, Chan KY, Thorley N, Jones C, Johnstone D, L'Heveder A, Saftic V, Henderson D, Chopra M, Campbell H, Rudan I. Global and regional estimates of the morbidity due to type I diabetes among children aged 0-4 years: a systematic review and analysis. J Glob Health 2018; 8:021101. [PMID: 30410744 PMCID: PMC6214490 DOI: 10.7189/jogh.08.021101] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Epidemiology of type 1 diabetes mellitus (T1DM) among children aged 0-4 years globally is not well understood. We aim to assess the incidence of T1DM in low- and middle-income countries (LMIC) by conducting a systematic review of previous reports. We also aim to address possible contribution to child mortality and to identify any temporal trends. Methods A systematic review was performed using a carefully designed search strategy to explore MEDLINE, EMBASE and Global Health databases. Data was extracted from all studies that satisfied the inclusion criteria –a total of 83 records extracted from 26 830 sources that were analysed. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) process to assess quality of evidence and applied meta-analysis approaches to assess global and regional incidence and time trends. Results The overall pooled incidence of T1DM in children aged 0-4 years globally is 11.2 (95% CI = 10.0-12.3) per 100 000 child years. The regional incidence were the highest for European Region A (EUR A) at 15.5 (95% CI = 13.5-17.5) per 100 000 child years. EUR C had the incidence of 10.0 (95% CI = 6.5-13.6) and EUR B 5.8 (95% CI = 4.7-7.0), Region of the Americas A (AMR A) 11.4 (95% CI = 7.8-14.9), AMR B of 2.5 (95% CI = 0.2-4.8), Eastern Mediterranean Region (EMR B) 7.1 (95% CI = 4.2-10.0) and Western Pacific Region (WPR A) 7.0 (95% CI = 2.9-11.0) per 100 000 child years, while other regions had very low rates or no data. When data points were categorised in the study periods and re-analysed, an increasing trend of the T1DM incidence was observed, with the incidence of 20.9 (95% CI = 7.8-34.1) per 100 000 child years in the years 2010-2015, preceded by 13.2 (95% CI = 11.0-15.5) in 2000-2009 study period, 10.0 (95% CI = 8.4-11.7) in 1990-1999 and 8.3 (95% CI = 5.1-11.6) in 1980-1989, respectively. Although the data are scarce, and variation and uncertainty are large, we estimated that the number of new cases of T1DM among children aged 0-4 years in the world each year is between 100 000 and 150 000. Conclusions The identified large variation in incidence estimates for different parts of the world, along with scarcity of information and the identified strong temporal increase in T1DM incidence suggest a clear need for further research into this subject.
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Affiliation(s)
- Davies Adeloye
- Centre for Global Health Research and World Health Organization's Collaborating Centre for Population Health, Research and Training, The Usher Institute, University of Edinburgh, UK
| | - Kit Yee Chan
- Centre for Global Health Research and World Health Organization's Collaborating Centre for Population Health, Research and Training, The Usher Institute, University of Edinburgh, UK
| | - Natasha Thorley
- Centre for Global Health Research and World Health Organization's Collaborating Centre for Population Health, Research and Training, The Usher Institute, University of Edinburgh, UK
| | - Charlotte Jones
- Centre for Global Health Research and World Health Organization's Collaborating Centre for Population Health, Research and Training, The Usher Institute, University of Edinburgh, UK
| | - David Johnstone
- Centre for Global Health Research and World Health Organization's Collaborating Centre for Population Health, Research and Training, The Usher Institute, University of Edinburgh, UK
| | - Ari L'Heveder
- Centre for Global Health Research and World Health Organization's Collaborating Centre for Population Health, Research and Training, The Usher Institute, University of Edinburgh, UK
| | - Vanja Saftic
- Child and Youth Protection Center of Zagreb, Croatia.,Croatian Catholic University, Zagreb, Croatia
| | - David Henderson
- Centre for Global Health Research and World Health Organization's Collaborating Centre for Population Health, Research and Training, The Usher Institute, University of Edinburgh, UK
| | | | - Harry Campbell
- Centre for Global Health Research and World Health Organization's Collaborating Centre for Population Health, Research and Training, The Usher Institute, University of Edinburgh, UK
| | - Igor Rudan
- Centre for Global Health Research and World Health Organization's Collaborating Centre for Population Health, Research and Training, The Usher Institute, University of Edinburgh, UK
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6
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Rush T, McGeary M, Sicignano N, Buryk MA. A plateau in new onset type 1 diabetes: Incidence of pediatric diabetes in the United States Military Health System. Pediatr Diabetes 2018; 19:917-922. [PMID: 29446519 DOI: 10.1111/pedi.12659] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 01/29/2018] [Accepted: 01/31/2018] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To describe the incidence and prevalence of type 1 diabetes among pediatric dependents of the US Department of Defense. METHODS The Military Health System (MHS) data repository was used to identify pediatric patients (≤17 years of age) with type 1 diabetes from January 1, 2007 to December 31, 2012. Annual incidence, annual prevalence and adjusted incidence were calculated and stratified by sex, age group, and region of residence. RESULTS Within a 6-year study period from 2007 to 2012, 5616 pediatric patients with type 1 diabetes were identified; 57% male, mean (SD) age of 10.9 (4.2) years. Annual type 1 diabetes incidence (per 100 000 persons) over the 5-year time period ranged from 20.7/100 000 to 21.3/100 000. Incidence for each year was highest in the 10 to 14 years age group and ranged from 30.9/100 000 in 2008 to 35.2/100 000 in 2011. Annual type 1 diabetes prevalence (per 1000 persons) remained stable throughout the study period at 1.5/1000. Adjusted incidence for males was significantly higher compared to females (21.0/100 000 vs 18.1/100 000; P = .001). During the study period, annual incidence remained steady (test for trend, P = .984). CONCLUSIONS The incidence of type 1 diabetes among children appears to plateau during the study period, suggesting a steady state of type 1 diabetes within this pediatric population. The MHS provides an accurate and up to date look at incidence of type 1 diabetes and may reflect broader trends of incidence of pediatric disease for the United States as a whole.
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Affiliation(s)
- Toni Rush
- Health ResearchTx LLC, Trevose, Pennsylvania
| | - Megan McGeary
- Department of Pediatrics, Naval Medical Center Portsmouth, Portsmouth, Virginia.,Uniformed Services University of the Health Sciences, Department of Pediatrics, Bethesda, MD
| | | | - Melissa A Buryk
- Department of Pediatrics, Naval Medical Center Portsmouth, Portsmouth, Virginia.,Uniformed Services University of the Health Sciences, Department of Pediatrics, Bethesda, MD
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7
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Abstract
PURPOSE OF REVIEW Surveillance of type 1 diabetes provides an opportunity to address public health needs, inform etiological research, and plan health care services. We present issues in type 1 diabetes surveillance, review previous and current methods, and present new initiatives. RECENT FINDINGS Few diabetes surveillance systems distinguish between type 1 and type 2 diabetes. Most worldwide efforts have focused on registries and ages < 15 years, resulting in limited information among adults. Recently, surveillance includes use of electronic health information and national health surveys. However, distinguishing by diabetes type remains a challenge. Enhancing and improving surveillance of type 1 diabetes across all age groups could include validating questions for use in national health surveys. In addition, validated algorithms for classifying diabetes type in electronic health records could further improve surveillance efforts and close current gaps in our understanding of the epidemiology of type 1 diabetes.
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Affiliation(s)
- Sharon Saydah
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Diabetes Translation, 4770 Bufford Highway, MS F-75, Atlanta, GA, 30341, USA.
| | - Giuseppina Imperatore
- Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Division of Diabetes Translation, 4770 Bufford Highway, MS F-75, Atlanta, GA, 30341, USA
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8
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Abstract
The Kelly West Award for Outstanding Achievement in Epidemiology is presented in honor of the memory of Kelly M. West, widely regarded as the "father of diabetes epidemiology." Harry Keen described West as characterized by "generosity of spirit, deeply human and humorous, deliberate of address, modest, conciliatory and untiringly persevering. Few people have done so much to change the landscape of diabetes" (1). The award and lecture recognize a leading epidemiologist in the field of diabetes. Dana Dabelea, MD, PhD, received this award at the American Diabetes Association's 77th Scientific Sessions, 9-13 June 2017, in San Diego, CA. She presented the Kelly West Award Lecture, "Diabetes in Youth-Looking Backwards to Inform the Future," on Sunday, 11 June 2017.
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Affiliation(s)
- Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, and Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
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9
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Chen YL, Huang YC, Qiao YC, Ling W, Pan YH, Geng LJ, Xiao JL, Zhang XX, Zhao HL. Climates on incidence of childhood type 1 diabetes mellitus in 72 countries. Sci Rep 2017; 7:12810. [PMID: 28993655 PMCID: PMC5634499 DOI: 10.1038/s41598-017-12954-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 09/12/2017] [Indexed: 12/25/2022] Open
Abstract
We are aimed to systematically assess the worldwide trend in incidence of childhood type 1 diabetes mellitus (CT1DM) from 1965 to 2012 and to discuss whether climate affect incidence of CT1DM. We searched the relevant literatures in detail to judge the effect of different climates on incidence of CT1DM. The climates included Mediterranean, monsoon, oceanic, continental, savanna, and rainforest. According to different climates, we further researched relevant factor such as sunshine durations and latitudes. The overall incidence of CT1DM in 72 countries was 11.43 (95% CI 10.31–12.55) per 100,000 children/yr. The incidence of CT1DM in Oceanic climate [10.56 (8.69–12.42)] is highest compared with other climates; the incidence in 40°–66°34′N/S [14.71 (12.30–17.29)] is higher than other latitude groups; the incidence in sunshine durations with 3–4 hours per day [15.17 (11.14–19.20)] is highest compared with other two groups; the incidence of CT1DM from 2000 to 2012 [19.58 (14.55–24.60)] is higher than other periods; all p < 0.01. Incidence of CT1DM was increasing from 1965 to 2012, but incidence in Oceanic climate is higher than other climates. Furthermore, it is higher in centers with higher latitude and lower sunshine durations. The climates might play a key role in inducing CT1DM.
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Affiliation(s)
- Yin-Ling Chen
- Center of Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, 541004, China.,Department of Immunology, Faculty of basic Medicine, Guilin Medical University, Guilin, 541004, China
| | - Yong-Cheng Huang
- Center of Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, 541004, China
| | - Yong-Chao Qiao
- Department of Immunology, Xiangya School of Medicine, Central South University, Changsha, Hunan, 410078, China
| | - Wei Ling
- Center of Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, 541004, China
| | - Yan-Hong Pan
- Center of Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, 541004, China.,Department of Immunology, Faculty of basic Medicine, Guilin Medical University, Guilin, 541004, China
| | - Li-Jun Geng
- Center of Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, 541004, China.,Department of Immunology, Faculty of basic Medicine, Guilin Medical University, Guilin, 541004, China
| | - Jian-Long Xiao
- Center of Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, 541004, China.,Department of Immunology, Faculty of basic Medicine, Guilin Medical University, Guilin, 541004, China
| | - Xiao-Xi Zhang
- Center of Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, 541004, China. .,Department of Immunology, Faculty of basic Medicine, Guilin Medical University, Guilin, 541004, China.
| | - Hai-Lu Zhao
- Center of Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, 541004, China. .,Department of Immunology, Xiangya School of Medicine, Central South University, Changsha, Hunan, 410078, China. .,Department of Immunology, Faculty of basic Medicine, Guilin Medical University, Guilin, 541004, China.
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10
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Mayer-Davis EJ, Lawrence JM, Dabelea D, Divers J, Isom S, Dolan L, Imperatore G, Linder B, Marcovina S, Pettitt DJ, Pihoker C, Saydah S, Wagenknecht L. Incidence Trends of Type 1 and Type 2 Diabetes among Youths, 2002-2012. N Engl J Med 2017; 376:1419-1429. [PMID: 28402773 PMCID: PMC5592722 DOI: 10.1056/nejmoa1610187] [Citation(s) in RCA: 962] [Impact Index Per Article: 137.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Diagnoses of type 1 and type 2 diabetes in youths present a substantial clinical and public health burden. The prevalence of these diseases increased in the 2001-2009 period, but data on recent incidence trends are lacking. METHODS We ascertained cases of type 1 and type 2 diabetes mellitus at five study centers in the United States. Denominators (4.9 million youths annually) were obtained from the U.S. Census or health-plan member counts. After the calculation of annual incidence rates for the 2002-2012 period, we analyzed trends using generalized autoregressive moving-average models with 2-year moving averages. RESULTS A total of 11,245 youths with type 1 diabetes (0 to 19 years of age) and 2846 with type 2 diabetes (10 to 19 years of age) were identified. Overall unadjusted estimated incidence rates of type 1 diabetes increased by 1.4% annually (from 19.5 cases per 100,000 youths per year in 2002-2003 to 21.7 cases per 100,000 youths per year in 2011-2012, P=0.03). In adjusted pairwise comparisons, the annual rate of increase was greater among Hispanics than among non-Hispanic whites (4.2% vs. 1.2%, P<0.001). Overall unadjusted incidence rates of type 2 diabetes increased by 7.1% annually (from 9.0 cases per 100,000 youths per year in 2002-2003 to 12.5 cases per 100,000 youths per year in 2011-2012, P<0.001 for trend across race or ethnic group, sex, and age subgroups). Adjusted pairwise comparisons showed that the relative annual increase in the incidence of type 2 diabetes among non-Hispanic whites (0.6%) was lower than that among non-Hispanic blacks, Asians or Pacific Islanders, and Native Americans (P<0.05 for all comparisons) and that the annual rate of increase among Hispanics differed significantly from that among Native Americans (3.1% vs. 8.9%, P=0.01). After adjustment for age, sex, and race or ethnic group, the relative annual increase in the incidence of type 1 diabetes was 1.8% (P<0.001) and that of type 2 diabetes was 4.8% (P<0.001). CONCLUSIONS The incidences of both type 1 and type 2 diabetes among youths increased significantly in the 2002-2012 period, particularly among youths of minority racial and ethnic groups. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and the Centers for Disease Control and Prevention.).
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Affiliation(s)
- Elizabeth J Mayer-Davis
- From the Departments of Nutrition and Medicine, University of North Carolina, Chapel Hill (E.J.M.-D.), and the Department of Biostatistical Sciences (J.D., S.I.) and the Division of Public Health Sciences (L.W.), Wake Forest School of Medicine, Winston-Salem - both in North Carolina; the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (J.M.L.), and Santa Barbara (D.J.P.) - both in California; the Department of Epidemiology, Colorado School of Public Health, Aurora (D.D.); the Department of Endocrinology, Children's Hospital Medical Center, Cincinnati (L.D.); the Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta (G.I., S.S.); the Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (B.L.); and the Northwest Lipid Research Laboratory (S.M.) and the Department of Pediatrics, University of Washington (C.P.) - both in Seattle
| | - Jean M Lawrence
- From the Departments of Nutrition and Medicine, University of North Carolina, Chapel Hill (E.J.M.-D.), and the Department of Biostatistical Sciences (J.D., S.I.) and the Division of Public Health Sciences (L.W.), Wake Forest School of Medicine, Winston-Salem - both in North Carolina; the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (J.M.L.), and Santa Barbara (D.J.P.) - both in California; the Department of Epidemiology, Colorado School of Public Health, Aurora (D.D.); the Department of Endocrinology, Children's Hospital Medical Center, Cincinnati (L.D.); the Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta (G.I., S.S.); the Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (B.L.); and the Northwest Lipid Research Laboratory (S.M.) and the Department of Pediatrics, University of Washington (C.P.) - both in Seattle
| | - Dana Dabelea
- From the Departments of Nutrition and Medicine, University of North Carolina, Chapel Hill (E.J.M.-D.), and the Department of Biostatistical Sciences (J.D., S.I.) and the Division of Public Health Sciences (L.W.), Wake Forest School of Medicine, Winston-Salem - both in North Carolina; the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (J.M.L.), and Santa Barbara (D.J.P.) - both in California; the Department of Epidemiology, Colorado School of Public Health, Aurora (D.D.); the Department of Endocrinology, Children's Hospital Medical Center, Cincinnati (L.D.); the Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta (G.I., S.S.); the Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (B.L.); and the Northwest Lipid Research Laboratory (S.M.) and the Department of Pediatrics, University of Washington (C.P.) - both in Seattle
| | - Jasmin Divers
- From the Departments of Nutrition and Medicine, University of North Carolina, Chapel Hill (E.J.M.-D.), and the Department of Biostatistical Sciences (J.D., S.I.) and the Division of Public Health Sciences (L.W.), Wake Forest School of Medicine, Winston-Salem - both in North Carolina; the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (J.M.L.), and Santa Barbara (D.J.P.) - both in California; the Department of Epidemiology, Colorado School of Public Health, Aurora (D.D.); the Department of Endocrinology, Children's Hospital Medical Center, Cincinnati (L.D.); the Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta (G.I., S.S.); the Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (B.L.); and the Northwest Lipid Research Laboratory (S.M.) and the Department of Pediatrics, University of Washington (C.P.) - both in Seattle
| | - Scott Isom
- From the Departments of Nutrition and Medicine, University of North Carolina, Chapel Hill (E.J.M.-D.), and the Department of Biostatistical Sciences (J.D., S.I.) and the Division of Public Health Sciences (L.W.), Wake Forest School of Medicine, Winston-Salem - both in North Carolina; the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (J.M.L.), and Santa Barbara (D.J.P.) - both in California; the Department of Epidemiology, Colorado School of Public Health, Aurora (D.D.); the Department of Endocrinology, Children's Hospital Medical Center, Cincinnati (L.D.); the Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta (G.I., S.S.); the Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (B.L.); and the Northwest Lipid Research Laboratory (S.M.) and the Department of Pediatrics, University of Washington (C.P.) - both in Seattle
| | - Lawrence Dolan
- From the Departments of Nutrition and Medicine, University of North Carolina, Chapel Hill (E.J.M.-D.), and the Department of Biostatistical Sciences (J.D., S.I.) and the Division of Public Health Sciences (L.W.), Wake Forest School of Medicine, Winston-Salem - both in North Carolina; the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (J.M.L.), and Santa Barbara (D.J.P.) - both in California; the Department of Epidemiology, Colorado School of Public Health, Aurora (D.D.); the Department of Endocrinology, Children's Hospital Medical Center, Cincinnati (L.D.); the Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta (G.I., S.S.); the Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (B.L.); and the Northwest Lipid Research Laboratory (S.M.) and the Department of Pediatrics, University of Washington (C.P.) - both in Seattle
| | - Giuseppina Imperatore
- From the Departments of Nutrition and Medicine, University of North Carolina, Chapel Hill (E.J.M.-D.), and the Department of Biostatistical Sciences (J.D., S.I.) and the Division of Public Health Sciences (L.W.), Wake Forest School of Medicine, Winston-Salem - both in North Carolina; the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (J.M.L.), and Santa Barbara (D.J.P.) - both in California; the Department of Epidemiology, Colorado School of Public Health, Aurora (D.D.); the Department of Endocrinology, Children's Hospital Medical Center, Cincinnati (L.D.); the Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta (G.I., S.S.); the Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (B.L.); and the Northwest Lipid Research Laboratory (S.M.) and the Department of Pediatrics, University of Washington (C.P.) - both in Seattle
| | - Barbara Linder
- From the Departments of Nutrition and Medicine, University of North Carolina, Chapel Hill (E.J.M.-D.), and the Department of Biostatistical Sciences (J.D., S.I.) and the Division of Public Health Sciences (L.W.), Wake Forest School of Medicine, Winston-Salem - both in North Carolina; the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (J.M.L.), and Santa Barbara (D.J.P.) - both in California; the Department of Epidemiology, Colorado School of Public Health, Aurora (D.D.); the Department of Endocrinology, Children's Hospital Medical Center, Cincinnati (L.D.); the Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta (G.I., S.S.); the Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (B.L.); and the Northwest Lipid Research Laboratory (S.M.) and the Department of Pediatrics, University of Washington (C.P.) - both in Seattle
| | - Santica Marcovina
- From the Departments of Nutrition and Medicine, University of North Carolina, Chapel Hill (E.J.M.-D.), and the Department of Biostatistical Sciences (J.D., S.I.) and the Division of Public Health Sciences (L.W.), Wake Forest School of Medicine, Winston-Salem - both in North Carolina; the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (J.M.L.), and Santa Barbara (D.J.P.) - both in California; the Department of Epidemiology, Colorado School of Public Health, Aurora (D.D.); the Department of Endocrinology, Children's Hospital Medical Center, Cincinnati (L.D.); the Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta (G.I., S.S.); the Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (B.L.); and the Northwest Lipid Research Laboratory (S.M.) and the Department of Pediatrics, University of Washington (C.P.) - both in Seattle
| | - David J Pettitt
- From the Departments of Nutrition and Medicine, University of North Carolina, Chapel Hill (E.J.M.-D.), and the Department of Biostatistical Sciences (J.D., S.I.) and the Division of Public Health Sciences (L.W.), Wake Forest School of Medicine, Winston-Salem - both in North Carolina; the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (J.M.L.), and Santa Barbara (D.J.P.) - both in California; the Department of Epidemiology, Colorado School of Public Health, Aurora (D.D.); the Department of Endocrinology, Children's Hospital Medical Center, Cincinnati (L.D.); the Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta (G.I., S.S.); the Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (B.L.); and the Northwest Lipid Research Laboratory (S.M.) and the Department of Pediatrics, University of Washington (C.P.) - both in Seattle
| | - Catherine Pihoker
- From the Departments of Nutrition and Medicine, University of North Carolina, Chapel Hill (E.J.M.-D.), and the Department of Biostatistical Sciences (J.D., S.I.) and the Division of Public Health Sciences (L.W.), Wake Forest School of Medicine, Winston-Salem - both in North Carolina; the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (J.M.L.), and Santa Barbara (D.J.P.) - both in California; the Department of Epidemiology, Colorado School of Public Health, Aurora (D.D.); the Department of Endocrinology, Children's Hospital Medical Center, Cincinnati (L.D.); the Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta (G.I., S.S.); the Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (B.L.); and the Northwest Lipid Research Laboratory (S.M.) and the Department of Pediatrics, University of Washington (C.P.) - both in Seattle
| | - Sharon Saydah
- From the Departments of Nutrition and Medicine, University of North Carolina, Chapel Hill (E.J.M.-D.), and the Department of Biostatistical Sciences (J.D., S.I.) and the Division of Public Health Sciences (L.W.), Wake Forest School of Medicine, Winston-Salem - both in North Carolina; the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (J.M.L.), and Santa Barbara (D.J.P.) - both in California; the Department of Epidemiology, Colorado School of Public Health, Aurora (D.D.); the Department of Endocrinology, Children's Hospital Medical Center, Cincinnati (L.D.); the Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta (G.I., S.S.); the Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (B.L.); and the Northwest Lipid Research Laboratory (S.M.) and the Department of Pediatrics, University of Washington (C.P.) - both in Seattle
| | - Lynne Wagenknecht
- From the Departments of Nutrition and Medicine, University of North Carolina, Chapel Hill (E.J.M.-D.), and the Department of Biostatistical Sciences (J.D., S.I.) and the Division of Public Health Sciences (L.W.), Wake Forest School of Medicine, Winston-Salem - both in North Carolina; the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (J.M.L.), and Santa Barbara (D.J.P.) - both in California; the Department of Epidemiology, Colorado School of Public Health, Aurora (D.D.); the Department of Endocrinology, Children's Hospital Medical Center, Cincinnati (L.D.); the Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta (G.I., S.S.); the Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (B.L.); and the Northwest Lipid Research Laboratory (S.M.) and the Department of Pediatrics, University of Washington (C.P.) - both in Seattle
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11
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Folsom LJ, Hannon TS. Collaboration Is Key for Successful Treatment of Youth-Onset Type 2 Diabetes. J Adolesc Health 2017; 60:360-362. [PMID: 28340870 PMCID: PMC5400282 DOI: 10.1016/j.jadohealth.2016.12.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 12/30/2016] [Indexed: 12/31/2022]
Abstract
Type 2 diabetes (T2D) is increasing in U.S. adolescents, particularly those of ethnic and racial minority groups. Risk factors for youth-onset T2D include obesity, family history of T2D, poor diet, lack of exercise, and poverty. The onset of diabetes-related complications is accelerated in adolescents with T2D compared to adults, and knowledge regarding the optimal way to prevent and slow complications is lacking. Existing treatment options are limited, and research into novel pharmacologic treatments is hindered by lack of sufficient patient population for clinical trials. Health care providers and investigators should collaborate both with each other, and with patients and their communities to build networks that will allow comprehensive evaluation of this disease in order to offer optimal, comprehensive care for these adolescents.
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Affiliation(s)
- Lisal J. Folsom
- Section of Pediatric Endocrinology, Department of Pediatrics, Riley Hospital for Children, Indiana University, Indianapolis, Indiana,Division of Endocrinology and Metabolism, Department of Medicine, Indiana University, Indianapolis, Indiana,Address correspondence to: Lisal J. Folsom, M.D., 705 Riley Hospital Drive, Room 5960, Indianapolis, IN 46202., (L.J. Folsom)
| | - Tamara S. Hannon
- Section of Pediatric Endocrinology, Department of Pediatrics, Riley Hospital for Children, Indiana University, Indianapolis, Indiana
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12
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Trepatchayakorn S, Supornsilchai V, Wacharasindhu S, Aroonparkmongkol S, Sahakitrungruang T. Original article. Trends and characteristics of childhood diabetes in a tertiary care center in Thailand. ASIAN BIOMED 2017. [DOI: 10.5372/1905-7415.0806.348] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Abstract
Background: Reports on characteristics of pediatric diabetes in children from Southeast Asian countries are limited.
Objectives: To describe the clinical characteristics, prevalence, glycemic control, and current treatment regimens of diabetes in Thai children.
Materials and Methods: Data from 132 patients seen at our pediatric diabetes clinic at Chulalongkorn University during 2001−2013 were retrospectively reviewed.
Results: We found an increasing number of patients newly-diagnosed with type 1- (T1DM) or type 2- diabetes mellitus (T2DM). The overall proportion of T1DM was 69.7%, T2DM 23.4%, and other types 6.9%. Children with T1DM were younger at diagnosis, had higher initial glucose and glycated hemoglobin A1c (HbA1c), a lower body mass index z-score, lower C-peptide and insulin levels, and were more likely to have classic diabetes symptoms and ketoacidosis, compared with children with T2DM. Mixed diabetes phenotypes were found in about 12%−14% of these children. Glutamic acid decarboxylase and islet antigen-2 autoantibodies were found in 70% and 54% of T1DM patients, respectively, and not in T2DM patients. HbA1c in T1DM was 9.6 ± 2.2% total hemoglobin, and in T2DM was 7.9 ± 2.6%. There were no differences in HbA1c levels between different insulin regimens in the T1DM group.
Conclusion: The number of children with T1DM or T2DM has been increasing and there are overlapping phenotypes in a significant proportion of these children. Correct diagnosis requires clinical evaluation and monitoring of the clinical course. Further research is needed to determine the risk factors for the poor glycemic control found in children with T1DM.
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Affiliation(s)
- Sirawut Trepatchayakorn
- Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Vichit Supornsilchai
- Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Suttipong Wacharasindhu
- Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Suphab Aroonparkmongkol
- Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Taninee Sahakitrungruang
- Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
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13
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Crume TL, Hamman RF, Isom S, Talton J, Divers J, Mayer-Davis EJ, Zhong VW, Liese AD, Saydah S, Standiford DA, Lawrence JM, Pihoker C, Dabelea D. Factors influencing time to case registration for youth with type 1 and type 2 diabetes: SEARCH for Diabetes in Youth Study. Ann Epidemiol 2016; 26:631-7. [PMID: 27664849 PMCID: PMC5322941 DOI: 10.1016/j.annepidem.2016.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 07/28/2016] [Accepted: 07/31/2016] [Indexed: 11/15/2022]
Abstract
PURPOSE The development of a sustainable pediatric diabetes surveillance system for the United States requires a better understanding of issues related to case ascertainment. METHODS Using the SEARCH for Diabetes in Youth registry, we examined whether time from diabetes diagnosis to case registration differed by diabetes type, patient demographics, and the type of provider reporting the case to the study. Plots for time from diagnosis to registration were developed, and differences by key variables were examined using the log-rank test. RESULTS Compared with time to registration for type 1 cases, it took 2.6 (95% confidence interval [CI], 2.5-2.6) times longer to register 50% of type 2 diabetes cases, and 2.3 (95% CI, 2.0-2.5) times longer to register 90% of type 2 cases. For type 1 diabetes cases, a longer time to registration was associated with older age, minority race/ethnicity, and cases, where the referring provider was not an endocrinologist. For type 2 diabetes cases, older age, non-Hispanic white race/ethnicity, and cases reported by providers other than an endocrinologist took longer to identify and register. CONCLUSIONS These findings highlight the need for continued childhood diabetes surveillance to identify future trends and influences on changes in prevalence and incidence.
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Affiliation(s)
- Tessa L Crume
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora.
| | - Richard F Hamman
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora
| | - Scott Isom
- Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC
| | - Jennifer Talton
- Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC
| | - Jasmin Divers
- Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC
| | - Elizabeth J Mayer-Davis
- School of Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill
| | - Victor W Zhong
- School of Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill
| | - Angela D Liese
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia
| | - Sharon Saydah
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Hyattsville, MD
| | - Debra A Standiford
- Division of Endocrinology, Children's Hospital Medical Center, Cincinnati, OH
| | - Jean M Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Catherine Pihoker
- Department of Pediatric Endocrinology, Children's Hospital & Regional Medical Center, University of Washington, Seattle
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora
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14
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Zhong VW, Obeid JS, Craig JB, Pfaff ER, Thomas J, Jaacks LM, Beavers DP, Carey TS, Lawrence JM, Dabelea D, Hamman RF, Bowlby DA, Pihoker C, Saydah SH, Mayer-Davis EJ. An efficient approach for surveillance of childhood diabetes by type derived from electronic health record data: the SEARCH for Diabetes in Youth Study. J Am Med Inform Assoc 2016; 23:1060-1067. [PMID: 27107449 DOI: 10.1093/jamia/ocv207] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 12/02/2015] [Accepted: 12/08/2015] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To develop an efficient surveillance approach for childhood diabetes by type across 2 large US health care systems, using phenotyping algorithms derived from electronic health record (EHR) data. MATERIALS AND METHODS Presumptive diabetes cases <20 years of age from 2 large independent health care systems were identified as those having ≥1 of the 5 indicators in the past 3.5 years, including elevated HbA1c, elevated blood glucose, diabetes-related billing codes, patient problem list, and outpatient anti-diabetic medications. EHRs of all the presumptive cases were manually reviewed, and true diabetes status and diabetes type were determined. Algorithms for identifying diabetes cases overall and classifying diabetes type were either prespecified or derived from classification and regression tree analysis. Surveillance approach was developed based on the best algorithms identified. RESULTS We developed a stepwise surveillance approach using billing code-based prespecified algorithms and targeted manual EHR review, which efficiently and accurately ascertained and classified diabetes cases by type, in both health care systems. The sensitivity and positive predictive values in both systems were approximately ≥90% for ascertaining diabetes cases overall and classifying cases with type 1 or type 2 diabetes. About 80% of the cases with "other" type were also correctly classified. This stepwise surveillance approach resulted in a >70% reduction in the number of cases requiring manual validation compared to traditional surveillance methods. CONCLUSION EHR data may be used to establish an efficient approach for large-scale surveillance for childhood diabetes by type, although some manual effort is still needed.
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Affiliation(s)
- Victor W Zhong
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Jihad S Obeid
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, SC, USA
| | - Jean B Craig
- Biomedical Informatics Center, Medical University of South Carolina, Charleston, SC, USA
| | - Emily R Pfaff
- North Carolina TraCS Institute, University of North Carolina, Chapel Hill, NC, USA
| | - Joan Thomas
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Lindsay M Jaacks
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Daniel P Beavers
- Department of Biostatistical Sciences, School of Medicine, Wake Forest University, Winston-Salem, NC, USA
| | - Timothy S Carey
- Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA
| | - Jean M Lawrence
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Richard F Hamman
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Deborah A Bowlby
- Division of Pediatric Endocrinology, Medical University of South Carolina, Charleston, SC, USA
| | - Catherine Pihoker
- Department of Washington, University of Washington, Seattle, WA, USA
| | - Sharon H Saydah
- Centers for Disease Control and Prevention, Division of Diabetes Translation, Atlanta, GA, USA
| | - Elizabeth J Mayer-Davis
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
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15
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Hamman RF, Bell RA, Dabelea D, D'Agostino RB, Dolan L, Imperatore G, Lawrence JM, Linder B, Marcovina SM, Mayer-Davis EJ, Pihoker C, Rodriguez BL, Saydah S. The SEARCH for Diabetes in Youth study: rationale, findings, and future directions. Diabetes Care 2014; 37:3336-44. [PMID: 25414389 PMCID: PMC4237981 DOI: 10.2337/dc14-0574] [Citation(s) in RCA: 268] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 09/04/2014] [Indexed: 02/03/2023]
Abstract
The SEARCH for Diabetes in Youth (SEARCH) study was initiated in 2000, with funding from the Centers for Disease Control and Prevention and support from the National Institute of Diabetes and Digestive and Kidney Diseases, to address major knowledge gaps in the understanding of childhood diabetes. SEARCH is being conducted at five sites across the U.S. and represents the largest, most diverse study of diabetes among U.S. youth. An active registry of youth diagnosed with diabetes at age <20 years allows the assessment of prevalence (in 2001 and 2009), annual incidence (since 2002), and trends by age, race/ethnicity, sex, and diabetes type. Prevalence increased significantly from 2001 to 2009 for both type 1 and type 2 diabetes in most age, sex, and race/ethnic groups. SEARCH has also established a longitudinal cohort to assess the natural history and risk factors for acute and chronic diabetes-related complications as well as the quality of care and quality of life of persons with diabetes from diagnosis into young adulthood. Many youth with diabetes, particularly those from low-resourced racial/ethnic minority populations, are not meeting recommended guidelines for diabetes care. Markers of micro- and macrovascular complications are evident in youth with either diabetes type, highlighting the seriousness of diabetes in this contemporary cohort. This review summarizes the study methods, describes key registry and cohort findings and their clinical and public health implications, and discusses future directions.
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Affiliation(s)
- Richard F Hamman
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO
| | - Ronny A Bell
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO
| | - Ralph B D'Agostino
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Lawrence Dolan
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Giuseppina Imperatore
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Jean M Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Barbara Linder
- Childhood Diabetes Research Division of Diabetes, Endocrinology and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD
| | | | - Elizabeth J Mayer-Davis
- Department of Nutrition, University of North Carolina, Chapel Hill, NC Department of Medicine, University of North Carolina, Chapel Hill, NC
| | | | - Beatriz L Rodriguez
- John A. Burns School of Medicine, University of Hawaii, Kuakini Medical Center, Honolulu, HI Instituto Tecnologico de Monterrey, Monterrey, Mexico
| | - Sharon Saydah
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
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16
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Lawrence JM, Imperatore G, Dabelea D, Mayer-Davis EJ, Linder B, Saydah S, Klingensmith GJ, Dolan L, Standiford DA, Pihoker C, Pettitt DJ, Talton JW, Thomas J, Bell RA, D'Agostino RB. Trends in incidence of type 1 diabetes among non-Hispanic white youth in the U.S., 2002-2009. Diabetes 2014; 63:3938-45. [PMID: 24898146 PMCID: PMC4207387 DOI: 10.2337/db13-1891] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Accepted: 05/29/2014] [Indexed: 12/11/2022]
Abstract
The SEARCH for Diabetes in Youth Study prospectively identified youth aged <20 years with physician-diagnosed diabetes. Annual type 1 diabetes (T1D) incidence per 100,000 person-years (95% CI) overall, by age-group, and by sex were calculated for at-risk non-Hispanic white (NHW) youth from 2002 through 2009. Joinpoint and Poisson regression models were used to test for temporal trends. The age- and sex-adjusted incidence of T1D increased from 24.4/100,000 (95% CI 23.9-24.8) in 2002 to 27.4/100,000 (26.9-27.9) in 2009 (P for trend = 0.0008). The relative annual increase in T1D incidence was 2.72% (1.18-4.28) per year; 2.84% (1.12-4.58) per year for males and 2.57% (0.68-4.51) per year for females. After adjustment for sex, significant increases were found for youth aged 5-9 years (P = 0.0023), 10-14 years (P = 0.0008), and 15-19 years (P = 0.004) but not among 0-4-year-olds (P = 0.1862). Mean age at diagnosis did not change. The SEARCH study demonstrated a significant increase in the incidence of T1D among NHW youth from 2002 through 2009 overall and in all but the youngest age-group. Continued surveillance of T1D in U.S. youth to identify future trends in T1D incidence and to plan for health care delivery is warranted.
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Affiliation(s)
- Jean M Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Giuseppina Imperatore
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO
| | - Elizabeth J Mayer-Davis
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC School of Medicine, University of North Carolina, Chapel Hill, NC
| | - Barbara Linder
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Sharon Saydah
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Hyattsville, MD
| | | | - Lawrence Dolan
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH Department of Pediatrics, University of Cincinnati, Cincinnati, OH
| | - Debra A Standiford
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | | | - Jennifer W Talton
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Joan Thomas
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Ronny A Bell
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC
| | - Ralph B D'Agostino
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC
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17
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Alatzoglou KS, Webb EA, Le Tissier P, Dattani MT. Isolated growth hormone deficiency (GHD) in childhood and adolescence: recent advances. Endocr Rev 2014; 35:376-432. [PMID: 24450934 DOI: 10.1210/er.2013-1067] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The diagnosis of GH deficiency (GHD) in childhood is a multistep process involving clinical history, examination with detailed auxology, biochemical testing, and pituitary imaging, with an increasing contribution from genetics in patients with congenital GHD. Our increasing understanding of the factors involved in the development of somatotropes and the dynamic function of the somatotrope network may explain, at least in part, the development and progression of childhood GHD in different age groups. With respect to the genetic etiology of isolated GHD (IGHD), mutations in known genes such as those encoding GH (GH1), GHRH receptor (GHRHR), or transcription factors involved in pituitary development, are identified in a relatively small percentage of patients suggesting the involvement of other, yet unidentified, factors. Genome-wide association studies point toward an increasing number of genes involved in the control of growth, but their role in the etiology of IGHD remains unknown. Despite the many years of research in the area of GHD, there are still controversies on the etiology, diagnosis, and management of IGHD in children. Recent data suggest that childhood IGHD may have a wider impact on the health and neurodevelopment of children, but it is yet unknown to what extent treatment with recombinant human GH can reverse this effect. Finally, the safety of recombinant human GH is currently the subject of much debate and research, and it is clear that long-term controlled studies are needed to clarify the consequences of childhood IGHD and the long-term safety of its treatment.
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Affiliation(s)
- Kyriaki S Alatzoglou
- Developmental Endocrinology Research Group (K.S.A., E.A.W., M.T.D.), Clinical and Molecular Genetics Unit, and Birth Defects Research Centre (P.L.T.), UCL Institute of Child Health, London WC1N 1EH, United Kingdom; and Faculty of Life Sciences (P.L.T.), University of Manchester, Manchester M13 9PT, United Kingdom
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Dabelea D, Mayer-Davis EJ, Saydah S, Imperatore G, Linder B, Divers J, Bell R, Badaru A, Talton JW, Crume T, Liese AD, Merchant AT, Lawrence JM, Reynolds K, Dolan L, Liu LL, Hamman RF. Prevalence of type 1 and type 2 diabetes among children and adolescents from 2001 to 2009. JAMA 2014; 311:1778-86. [PMID: 24794371 PMCID: PMC4368900 DOI: 10.1001/jama.2014.3201] [Citation(s) in RCA: 978] [Impact Index Per Article: 97.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Despite concern about an "epidemic," there are limited data on trends in prevalence of either type 1 or type 2 diabetes across US race and ethnic groups. OBJECTIVE To estimate changes in the prevalence of type 1 and type 2 diabetes in US youth, by sex, age, and race/ethnicity between 2001 and 2009. DESIGN, SETTING, AND PARTICIPANTS Case patients were ascertained in 4 geographic areas and 1 managed health care plan. The study population was determined by the 2001 and 2009 bridged-race intercensal population estimates for geographic sites and membership counts for the health plan. MAIN OUTCOMES AND MEASURES Prevalence (per 1000) of physician-diagnosed type 1 diabetes in youth aged 0 through 19 years and type 2 diabetes in youth aged 10 through 19 years. RESULTS In 2001, 4958 of 3.3 million youth were diagnosed with type 1 diabetes for a prevalence of 1.48 per 1000 (95% CI, 1.44-1.52). In 2009, 6666 of 3.4 million youth were diagnosed with type 1 diabetes for a prevalence of 1.93 per 1000 (95% CI, 1.88-1.97). In 2009, the highest prevalence of type 1 diabetes was 2.55 per 1000 among white youth (95% CI, 2.48-2.62) and the lowest was 0.35 per 1000 in American Indian youth (95% CI, 0.26-0.47) and type 1 diabetes increased between 2001 and 2009 in all sex, age, and race/ethnic subgroups except for those with the lowest prevalence (age 0-4 years and American Indians). Adjusted for completeness of ascertainment, there was a 21.1% (95% CI, 15.6%-27.0%) increase in type 1 diabetes over 8 years. In 2001, 588 of 1.7 million youth were diagnosed with type 2 diabetes for a prevalence of 0.34 per 1000 (95% CI, 0.31-0.37). In 2009, 819 of 1.8 million were diagnosed with type 2 diabetes for a prevalence of 0.46 per 1000 (95% CI, 0.43-0.49). In 2009, the prevalence of type 2 diabetes was 1.20 per 1000 among American Indian youth (95% CI, 0.96-1.51); 1.06 per 1000 among black youth (95% CI, 0.93-1.22); 0.79 per 1000 among Hispanic youth (95% CI, 0.70-0.88); and 0.17 per 1000 among white youth (95% CI, 0.15-0.20). Significant increases occurred between 2001 and 2009 in both sexes, all age-groups, and in white, Hispanic, and black youth, with no significant changes for Asian Pacific Islanders and American Indians. Adjusted for completeness of ascertainment, there was a 30.5% (95% CI, 17.3%-45.1%) overall increase in type 2 diabetes. CONCLUSIONS AND RELEVANCE Between 2001 and 2009 in 5 areas of the United States, the prevalence of both type 1 and type 2 diabetes among children and adolescents increased. Further studies are required to determine the causes of these increases.
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Affiliation(s)
- Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, Aurora
| | | | - Sharon Saydah
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Giuseppina Imperatore
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Barbara Linder
- Childhood Diabetes Research Division of Diabetes, Endocrinology and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | - Jasmin Divers
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Ronny Bell
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Angela Badaru
- Department of Pediatric Endocrinology and Diabetes, Children's Hospital and Regional Medical Center, Seattle, Washington
| | - Jennifer W Talton
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Tessa Crume
- Department of Epidemiology, Colorado School of Public Health, Aurora
| | - Angela D Liese
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, Columbia, South Carolina
| | - Anwar T Merchant
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, Columbia, South Carolina
| | - Jean M Lawrence
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Kristi Reynolds
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Lawrence Dolan
- Department of Endocrinology, Children's Hospital Medical Center, Cincinnati, Ohio
| | - Lenna L Liu
- Department of Pediatrics, University of Washington, and Seattle Children's Hospital, Seattle
| | - Richard F Hamman
- Department of Epidemiology, Colorado School of Public Health, Aurora
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Fazeli Farsani S, van der Aa MP, van der Vorst MMJ, Knibbe CAJ, de Boer A. Global trends in the incidence and prevalence of type 2 diabetes in children and adolescents: a systematic review and evaluation of methodological approaches. Diabetologia 2013; 56:1471-88. [PMID: 23677041 DOI: 10.1007/s00125-013-2915-z] [Citation(s) in RCA: 135] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Accepted: 04/04/2013] [Indexed: 12/26/2022]
Abstract
AIMS/HYPOTHESIS This study aimed to systematically review what has been reported on the incidence and prevalence of type 2 diabetes in children and adolescents, to scrutinise the methodological issues observed in the included studies and to prepare recommendations for future research and surveillances. METHODS PubMed, the Cochrane Database of Systematic Reviews, Scopus, EMBASE and Web of Science were searched from inception to February 2013. Population-based studies on incidence and prevalence of type 2 diabetes in children and adolescents were summarised and methodologically evaluated. Owing to substantial methodological heterogeneity and considerable differences in study populations a quantitative meta-analysis was not performed. RESULTS Among 145 potentially relevant studies, 37 population-based studies met the inclusion criteria. Variations in the incidence and prevalence rates of type 2 diabetes in children and adolescents were mainly related to age of the study population, calendar time, geographical regions and ethnicity, resulting in a range of 0-330 per 100,000 person-years for incidence rates, and 0-5,300 per 100,000 population for prevalence rates. Furthermore, a substantial variation in the methodological characteristics was observed for response rates (60-96%), ascertainment rates (53-99%), diagnostic tests and criteria used to diagnose type 2 diabetes. CONCLUSIONS/INTERPRETATION Worldwide incidence and prevalence of type 2 diabetes in children and adolescents vary substantially among countries, age categories and ethnic groups and this can be explained by variations in population characteristics and methodological dissimilarities between studies.
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Affiliation(s)
- S Fazeli Farsani
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, P.O. Box 80082, 3508 TB, Utrecht, the Netherlands
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Lipman TH, Levitt Katz LE, Ratcliffe SJ, Murphy KM, Aguilar A, Rezvani I, Howe CJ, Fadia S, Suarez E. Increasing incidence of type 1 diabetes in youth: twenty years of the Philadelphia Pediatric Diabetes Registry. Diabetes Care 2013; 36:1597-603. [PMID: 23340888 PMCID: PMC3661835 DOI: 10.2337/dc12-0767] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The purpose of this study was to describe the incidence of type 1 diabetes in children in Philadelphia from 2000-2004, compare the epidemiology to the previous three cohorts in the Philadelphia Pediatric Diabetes Registry, and, for the first time, describe the incidence of type 2 diabetes. RESEARCH DESIGN AND METHODS Diabetes cases were obtained through a retrospective population-based registry. Hospital inpatient and outpatient records were reviewed for cases of type 1 and type 2 diabetes diagnosed from 1 January 2000 to 31 December 2004. The secondary source of validation was the School District of Philadelphia. Time series analysis was used to evaluate the changing pattern of incidence over the 20-year period. RESULTS The overall age-adjusted incidence rate in 2000-2004 of 17.0 per 100,000 per year was significantly higher than that of previous cohorts, with an average yearly increase of 1.5% and an average 5-year cohort increase of 7.8% (P = 0.025). The incidence in white children (19.2 per 100,000 per year) was 48% higher than in the previous cohort. Children aged 0-4 years had a 70% higher incidence (12.2 per 100,000 per year) than the original cohort; this increase was most marked in young black children. The overall age-adjusted incidence of type 2 diabetes was 5.8 per 100,000 per year and was significantly higher in black children. CONCLUSIONS The incidence of type 1 diabetes is rising among children in Philadelphia. The incidence rate has increased by 29% since the 1985-1989 cohort. The most marked increases were among white children ages 10-14 years and black children ages 0-4 years. The incidence of type 1 diabetes is 18 times higher than that of type 2 in white children but only 1.6 times higher in black children.
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Affiliation(s)
- Terri H Lipman
- University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA.
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21
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Stanescu DE, Lord K, Lipman TH. The epidemiology of type 1 diabetes in children. Endocrinol Metab Clin North Am 2012; 41:679-94. [PMID: 23099264 DOI: 10.1016/j.ecl.2012.08.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Type 1 diabetes is one of the most common chronic diseases of childhood and adolescence. Multiple registries have assessed its epidemiology and have noted a steady increase in incidence of the disease. This article addresses the epidemiology of type 1 diabetes in children aged 0 to 19 years, by reviewing the available, current data from both US and international registries. The prevalence and incidence data by race, ethnicity, age of onset, sex, season of onset, and temporal trends of the disease are presented. Multiple risk factors have been implicated for the increasing incidence in type 1 diabetes, and these genetic and environmental risk factors are discussed.
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Affiliation(s)
- Diana E Stanescu
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA
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Lipton RB, Drum M, Greeley SAW, Danielson KK, Bell GI, Hagopian WA. HLA-DQ haplotypes differ by ethnicity in patients with childhood-onset diabetes. Pediatr Diabetes 2011; 12:388-95. [PMID: 21418452 PMCID: PMC3406606 DOI: 10.1111/j.1399-5448.2010.00712.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
AIM To understand the etiology of childhood-onset diabetes, we examined genetic risk markers, autoantibodies, and β-cell function in a mixed race group of young patients. METHODS One hundred and forty-five patients aged 0-17 at diagnosis (54% African American, 22% Caucasian, 16% Latino, 8% mixed-other) were studied at mean duration 6.9 ± 5.7 (range 0.1-28.5) yr, including human leukocyte antigen (HLA)-DQA1-DQB1 genotyping, stimulated C peptide (CP), glutamic acid decarboxylase, and insulinoma-associated antigen 2 antibodies (ABs). Based on no residual β-cell function (CP-) and islet autoantibodies (AB+), 111 patients were classified with type 1 diabetes mellitus (T1DM), 22 were CP+ and AB- and thus considered to have type 2 diabetes mellitus (T2DM), and 12 patients had features of both T1DM and T2DM or mixed phenotype. RESULTS Based on the presence of two high-risk HLA-DQA1/B1 haplotypes, 39% of African Americans, 81% of Caucasians, 70% of Latinos, and 67% of mixed-others were at high genetic risk. In patients with T1DM, 41% of African Americans, 80% of Caucasians, 73% of Latinos, and 63% of mixed-others were genetically susceptible. Thirty-one percent of African Americans, including 29% of those with T1DM, could not be characterized because their haplotypes had unknown T1DM associations. These unusual haplotypes comprised 11% in T1DM, 14% in T2DM, and 8% in patients with mixed phenotype. CONCLUSIONS Fifty-nine percent of childhood-onset patients with T1DM were identified with high genetic risk based on known HLA-DQA1/B1 associations. Many non-Caucasian patients carry HLA-DQ alleles whose association with T1DM is undetermined. Genetic approaches can provide insights into the etiology and appropriate treatment of childhood-onset diabetes but only if sufficient data are available in diverse ethnic groups.
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Affiliation(s)
- Rebecca B. Lipton
- Departments of Pediatrics, Health Studies, and Medicine, The University of Chicago, Chicago IL 60637,To whom reprint requests should be addressed. Rebecca B. Lipton, PhD, 5841 S. Maryland Ave. MC 5053, Chicago, IL 60637 phone:1-708-275-6355,
| | - Melinda Drum
- Departments of Pediatrics, Health Studies, and Medicine, The University of Chicago, Chicago IL 60637
| | - Siri Atma W. Greeley
- Departments of Pediatrics, Health Studies, and Medicine, The University of Chicago, Chicago IL 60637
| | - Kirstie K. Danielson
- Departments of Pediatrics, Health Studies, and Medicine, The University of Chicago, Chicago IL 60637
| | - Graeme I. Bell
- Departments of Pediatrics, Health Studies, and Medicine, The University of Chicago, Chicago IL 60637
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Lipton RB, Drum ML, Danielson KK, Greeley SAW, Bell GI, Hagopian WA. Onset features and subsequent clinical evolution of childhood diabetes over several years. Pediatr Diabetes 2011; 12:326-34. [PMID: 21426455 PMCID: PMC3103597 DOI: 10.1111/j.1399-5448.2010.00706.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
AIM To explore whether it is possible to predict a child's eventual diabetes phenotype using characteristics at initial presentation, we reassessed 111 young patients on average 7.8 ± 4.2 (2.2-19.7) [mean ± SD (range)] years after diagnosis. METHODS Medical records at diagnosis for 111 patients, aged 0-17, were compared with their follow-up characteristics including stimulated C-peptide (CP) and islet autoantibodies (AB). RESULTS Initially, 18 patients were obese; 9 displayed other type 2 diabetes (T2DM) features (polycystic ovary syndrome, acanthosis, diagnosed T2DM); the remaining 84 had a classic type 1 diabetes (T1DM) presentation. At follow-up, 83 patients (75%) with no measured CP were classified as T1DM; 17 (15%) were CP+ and AB- and thus considered T2DM. Eleven patients with both T1DM and T2DM features were classified as having mixed diabetes phenotype (MDM). One-fifth (22 subjects) changed presumed phenotype at follow-up. In multivariable models, T1DM patients were younger at diagnosis, had higher initial glucose values, were more likely to have experienced ketoacidosis, and less likely to be obese or of African American ethnicity. CONCLUSIONS/INTERPRETATION Ten percent of subjects had MDM and 15% had T2DM at ∼8 years' duration. Although no onset feature was completely reliable, ketoacidosis and hyperglycemia were more likely to predict T1DM; obesity and African American ethnicity made T2DM more likely. At diagnosis, features of T2DM in addition to obesity were strongly predictive of eventual T2DM phenotype. Given the significant percentage who changed or had mixed phenotype, careful tracking of all young people with diabetes is essential to correctly determine eventual disease type.
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Affiliation(s)
- Rebecca B. Lipton
- Biological Sciences Division, University of Chicago, IL, USA,Corresponding author to whom reprint requests should be addressed. 5841 S. Maryland Avenue, MC 5053 Chicago, IL 60637 USA
| | - Melinda L. Drum
- Biological Sciences Division, University of Chicago, IL, USA
| | | | | | - Graeme I. Bell
- Biological Sciences Division, University of Chicago, IL, USA
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Grigsby-Toussaint DS, Lipton R, Chavez N, Handler A, Johnson TP, Kubo J. Neighborhood socioeconomic change and diabetes risk: findings from the Chicago childhood diabetes registry. Diabetes Care 2010; 33:1065-8. [PMID: 20150301 PMCID: PMC2858176 DOI: 10.2337/dc09-1894] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Accepted: 01/27/2010] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To examine whether patterns in socioeconomic characteristics in Chicago over a 30-year period are associated with neighborhood distribution of youth diabetes risk. RESEARCH DESIGN AND METHODS Incident cases of diabetes in youth aged 0-17 years were identified from the Chicago Childhood Diabetes Registry between 1994 and 2003. Those with a type 2 diabetes-like clinical course or related indicators were classified as non-type 1 diabetic; the remaining cases were considered to have type 1 diabetes. RESULTS Compared with stable diversity neighborhoods, significant associations for type 1 diabetes were found for younger children residing in emerging low-income neighborhoods (relative risk 0.56 [95% CI 0.36-0.90]) and older children residing in emerging high-income neighborhoods (1.52 [1.17-1.98]). For non-type 1 diabetes, older youth residing in desertification neighborhoods were at increased risk (1.47 [1.09-1.99]). CONCLUSIONS Neighborhood socioeconomic characteristics in Chicago may be associated with the risk of diabetes in youth.
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Affiliation(s)
- Diana S Grigsby-Toussaint
- Department of Kinesiology and Community Health and Division of Nutritional Sciences, University of Illinois at Urbana Champaign, Urbana, Illinois, USA.
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Bell J, Parker KL, Swinford RD, Hoffman AR, Maneatis T, Lippe B. Long-term safety of recombinant human growth hormone in children. J Clin Endocrinol Metab 2010; 95:167-77. [PMID: 19906787 DOI: 10.1210/jc.2009-0178] [Citation(s) in RCA: 210] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Between 1985 and 2006, the National Cooperative Growth Study (NCGS) monitored the safety and efficacy of recombinant human growth hormone (rhGH) in 54,996 children. METHODS Enrolled patients were followed until rhGH discontinuation. Investigators submitted adverse event reports for targeted events or those potentially rhGH-related. RESULTS Early concerns about de novo leukemia in patients without risk factors have not been substantiated--three observed vs. 5.6 expected in age-matched general population based on years at risk [standard incidence ratio (SIR), 0.54; 95% confidence interval (CI), 0.11-1.58]. De novo malignancies (intracranial and extracranial) were not significantly increased in patients without risk factors (29 confirmed vs. 26 expected; SIR, 1.12; 95% CI, 0.75-1.61). Second neoplasms occurred in 49 patients, of whom 37 had irradiation for their initial tumors (including five of 16 retinoblastoma patients, three of whom had bilateral retinoblastoma) consistent with an increased risk with rhGH. Thirty-three patients developed type 1 diabetes mellitus (DM) (37 expected; SIR, 0.90; 95% CI, 0.62-1.26). Type 2 DM and nonspecified DM were reported in 20 and eight patients, respectively. Two deaths were reported in patients with Prader-Willi syndrome and five deaths from aortic dissection in patients with Turner syndrome. In patients with organic GH deficiency and idiopathic panhypopituitarism, 11 events of acute adrenal insufficiency occurred, including four deaths, consistent with a reported increased risk for adrenal insufficiency in hypopituitary patients with or without rhGH treatment. CONCLUSION After more than 20 yr, leukemia, a major safety issue initially believed associated with GH, has not been confirmed, but other signals, including risk of second malignancies in patients previously treated with irradiation, have been detected or confirmed through the NCGS. These data further clarify the events associated with rhGH and, although confirming a favorable overall safety profile, they also highlight specific populations at potential risk.
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Affiliation(s)
- J Bell
- Columbia University Medical Center, New York, New York 10032, USA.
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Estrada CL, Danielson KK, Drum ML, Lipton RB. Hospitalization subsequent to diagnosis in young patients with diabetes in Chicago, Illinois. Pediatrics 2009; 124:926-34. [PMID: 19706582 PMCID: PMC2888679 DOI: 10.1542/peds.2008-3826] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Rehospitalization after a diabetes diagnosis in youth signals the failure of outpatient management. We examined risk factors for rehospitalization among young patients with diabetes. PATIENTS AND METHODS We queried 535 participants diagnosed before 18 years of age from the Chicago Childhood Diabetes Registry. Demographic, social, and clinical data were used in logistic models of diabetes-related rehospitalization, as well as, among those rehospitalized, frequent (> or = once per 2 years' duration) versus infrequent rehospitalization rates. RESULTS Mean (range) duration was 5.1 years (0.1-19.2 years). The sample was 55% non-Hispanic black, 11% non-Hispanic white, 26% Hispanic, and 7% other/mixed race; 86% had presumed type 1 diabetes; and 47% were underinsured. Overall, 46% reported rehospitalization for diabetes. In multivariable logistic regression, ever being rehospitalized was significantly associated with diabetes duration (per year, odds ratio [OR]: 1.26; P < .01), female gender (OR: 1.67; P = .01), underinsurance (versus private insurance; OR: 1.79; P < .01), presumed phenotype (non-type 1 diabetes versus type 1; OR: 0.32; P < .01), and diagnosis at a community hospital (versus tertiary care facility; OR: 1.96; P < .01) and tended to be higher for those of nonwhite race (OR: 1.94; P = .07). Among those rehospitalized, multivariable associations with frequent rehospitalization were presumed phenotype (non-type 1 diabetes versus type 1; OR: 2.74; P = .04), head of household not working (versus employed; OR: 1.88; P = .02), and younger age at questionnaire (per year; OR: 0.94; P = .01). CONCLUSIONS Rehospitalization is common in young patients with diabetes, especially for those with limited resources, indicating the need for improved outpatient services. Comprehensive initial education and support available to young patients with diabetes diagnosed at tertiary care facilities and their families may have lasting protective effects.
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Affiliation(s)
- Carmela L. Estrada
- Institute for Endocrine Discovery and Clinical Care, University of Chicago, Chicago, Illinois
| | - Kirstie K. Danielson
- Institute for Endocrine Discovery and Clinical Care, University of Chicago, Chicago, Illinois
| | - Melinda L. Drum
- Department of Health Studies, University of Chicago, Chicago, Illinois
| | - Rebecca B. Lipton
- Institute for Endocrine Discovery and Clinical Care, University of Chicago, Chicago, Illinois, Department of Health Studies, University of Chicago, Chicago, Illinois
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Schober E, Waldhoer T, Rami B, Hofer S. Incidence and time trend of type 1 and type 2 diabetes in Austrian children 1999-2007. J Pediatr 2009; 155:190-3.e1. [PMID: 19476954 DOI: 10.1016/j.jpeds.2009.03.010] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2008] [Revised: 01/29/2009] [Accepted: 03/04/2009] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To analyze the time trend of the nationwide incidence of type 2 diabetes in children and adolescents < or = 15 years of age compared with type 1 diabetes between 1999 and 2007 in Austria. STUDY DESIGN In a prospective, population-based incidence study, all newly diagnosed patients with diabetes < or = 15 years of age were registered by the Austrian Diabetes Incidence Study Group. The Diabetes type was classified on the basis of clinical and laboratory findings according to ADA criteria. Time trends were estimated by linear regression models. RESULTS During the observation period, 1881 patients with type 1 diabetes and 34 patients with type 2 diabetes could be identified. Sixty-two percent of patients with type 2 diabetes were female, 56% had a positive family history for type 2 diabetes, and 74% presented with diabetes-specific symptoms. The incidence of type 1 diabetes in Austria increased from 12.0 to 18.4/100,000 (P < .001) and the incidence of type 2 diabetes remained stable below 0.6/100 000 (P = .706). CONCLUSIONS The incidence of type 2 diabetes in Austrian children is 10-fold lower than reported in other regions and did not increase over the last 8 years. During the same time period, a significant rise in the incidence of type 1 diabetes was observed.
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Affiliation(s)
- Edith Schober
- Department of Pediatrics, Center of Public Health, Medical University of Vienna, Austria.
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Catanzariti L, Faulks K, Moon L, Waters AM, Flack J, Craig ME. Australia's national trends in the incidence of Type 1 diabetes in 0-14-year-olds, 2000-2006. Diabet Med 2009; 26:596-601. [PMID: 19538234 DOI: 10.1111/j.1464-5491.2009.02737.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS To determine the national incidence of Type 1 diabetes in children aged 0-14 years and examine trends in incidence between 2000 and 2006 by age, sex and calendar year. METHODS Case ascertainment was from the Australian National Diabetes Register, a prospective population-based incidence register established in 1999, with two sources of ascertainment: the National Diabetes Services Scheme and the Australasian Paediatric Endocrine Group's state-based registers. Denominator data were from the Australian Bureau of Statistics. RESULTS There were 6350 new cases of Type 1 diabetes (3323 boys and 3027 girls). Case ascertainment was 97.1% complete using the capture-recapture method. The mean adjusted incidence rate for 2000-2006 was 21.6 per 100,000 person-years [95% confidence interval (CI) 21.0, 22.1], and increased from 19.8 in 2000 to 23.4 per 100,000 in 2006, an average increase of 2.8% (95% CI 1.5, 4.1) per year. Mean incidence for the 7-year period increased with age, and was significantly higher in boys aged 0-4 years and 10-14 years than in girls of the same age. CONCLUSIONS The incidence of Type 1 diabetes among 0-14-year-olds in Australia is very high compared with available data from many other countries. The rate of increase observed globally in the last decade has continued well into this decade in Australia. The rising incidence cannot be explained by changes in genetic susceptibility; there is an urgent need to examine the environmental factors that have contributed to this increase. The findings of this study also have important implications for resource planning.
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Affiliation(s)
- L Catanzariti
- Cardiovascular, Diabetes and Kidney Unit, Australian Institute of Health and Welfare, Canberra, ACT 2601, Australia
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Lawrence JM, Mayer-Davis EJ, Reynolds K, Beyer J, Pettitt DJ, D'Agostino RB, Marcovina SM, Imperatore G, Hamman RF. Diabetes in Hispanic American youth: prevalence, incidence, demographics, and clinical characteristics: the SEARCH for Diabetes in Youth Study. Diabetes Care 2009; 32 Suppl 2:S123-32. [PMID: 19246577 PMCID: PMC2647689 DOI: 10.2337/dc09-s204] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To report the 2001 prevalence and 2002-2005 incidence of type 1 and type 2 diabetes in Hispanic American youth and to describe the demographic, clinical, and behavioral characteristics of these youth. RESEARCH DESIGN AND METHODS Data from the SEARCH for Diabetes in Youth Study, a population-based multicenter observational study of youth aged 0-19 years with physician-diagnosed diabetes, were used to estimate the prevalence and incidence of type 1 and type 2 diabetes. Information obtained by questionnaire, physical examination, and blood and urine collection was analyzed to describe the characteristics of youth who completed a study visit. RESULTS Among Hispanic American youth, type 1 diabetes was more prevalent than type 2 diabetes, including in youth aged 10-19 years. There were no significant sex differences in type 1 or type 2 diabetes prevalence. The incidence of type 2 diabetes for female subjects aged 10-14 years was twice that of male subjects (P < 0.005), while among youth aged 15-19 years the incidence of type 2 diabetes exceeded that of type 1 diabetes for female subjects (P < 0.05) but not for male subjects. Poor glycemic control, defined as A1C >or=9.5%, as well as high LDL cholesterol and triglycerides were common among youth aged >or=15 years with either type of diabetes. Forty-four percent of youth with type 1 diabetes were overweight or obese. CONCLUSIONS Factors such as poor glycemic control, elevated lipids, and a high prevalence of overweight and obesity may put Hispanic youth with type 1 and type 2 diabetes at risk for future diabetes-related complications.
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Affiliation(s)
- Jean M Lawrence
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California, USA.
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Mayer-Davis EJ, Beyer J, Bell RA, Dabelea D, D'Agostino R, Imperatore G, Lawrence JM, Liese AD, Liu L, Marcovina S, Rodriguez B. Diabetes in African American youth: prevalence, incidence, and clinical characteristics: the SEARCH for Diabetes in Youth Study. Diabetes Care 2009; 32 Suppl 2:S112-22. [PMID: 19246576 PMCID: PMC2647692 DOI: 10.2337/dc09-s203] [Citation(s) in RCA: 128] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To report the prevalence and incidence of type 1 and type 2 diabetes among African American youth and to describe demographic, clinical, and behavioral characteristics. RESEARCH DESIGN AND METHODS Data from the SEARCH for Diabetes in Youth Study, a population-based, multicenter observational study of youth with clinically diagnosed diabetes aged 0-19 years, were used to estimate the prevalence for calendar year 2001 (692 cases) and incidence based on 748 African American case subjects diagnosed in 2002-2005. Characteristics of these youth were obtained during a research visit for 436 African American youth with type 1 diabetes and 212 African American youth with type 2 diabetes. RESULTS Among African American youth aged 0-9 years, prevalence (per 1,000) of type 1 diabetes was 0.57 (95% CI 0.47-0.69) and for those aged 10-19 years 2.04 (1.85-2.26). Among African American youth aged 0-9 years, annual type 1 diabetes incidence (per 100,000) was 15.7 (13.7-17.9) and for those aged 10-19 years 15.7 (13.8-17.8). A1C was >or=9.5% among 50% of youth with type 1 diabetes aged >or=15 years. Across age-groups and sex, 44.7% of African American youth with type 1 diabetes were overweight or obese. Among African American youth aged 10-19 years, prevalence (per 1,000) of type 2 diabetes was 1.06 (0.93-1.22) and annual incidence (per 100,000) was 19.0 (16.9-21.3). About 60% of African American youth with type 2 diabetes had an annual household income of <$25,000. Among those aged >or=15 years, 27.5% had an A1C >or=9.5%, 22.5% had high blood pressure, and, across subgroups of age and sex, >90% were overweight or obese. CONCLUSIONS Type 1 diabetes presents a serious burden among African American youth aged <10 years, and African American adolescents are impacted substantially by both type 1 and type 2 diabetes.
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Affiliation(s)
- Elizabeth J. Mayer-Davis
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jennifer Beyer
- Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Ronny A. Bell
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Dana Dabelea
- Department of Preventive Medicine and Biometrics, University of Colorado Denver, Denver, Colorado
| | - Ralph D'Agostino
- Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Giuseppina Imperatore
- Division of Diabetes Translation, Centers for Disease Control and Prevention/National Center for Chronic Disease Prevention and Health Promotion, Atlanta, Georgia
| | - Jean M. Lawrence
- Department of Research and Evaluation, Kaiser Permanante Southern California, Pasadena, California
| | - Angela D. Liese
- Center for Research in Nutrition and Health Disparities and Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina
| | - Lenna Liu
- Child Health Institute, University of Washington, Seattle, Washington
| | | | - Beatriz Rodriguez
- Department of Geriatric Medicine, Pacific Health Research Institute, University of Hawaii at Manoa, Honolulu, Hawaii
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Bell RA, Mayer-Davis EJ, Beyer JW, D'Agostino RB, Lawrence JM, Linder B, Liu LL, Marcovina SM, Rodriguez BL, Williams D, Dabelea D. Diabetes in non-Hispanic white youth: prevalence, incidence, and clinical characteristics: the SEARCH for Diabetes in Youth Study. Diabetes Care 2009; 32 Suppl 2:S102-11. [PMID: 19246575 PMCID: PMC2647694 DOI: 10.2337/dc09-s202] [Citation(s) in RCA: 146] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate the incidence, prevalence, and clinical characteristics of diabetes among U.S. non-Hispanic white (NHW) youth. RESEARCH DESIGN AND METHODS Data from the SEARCH for Diabetes in Youth Study (SEARCH study), a multicenter study of diabetes among youth aged 0-19 years, were examined. Incidence rates were calculated per 100,000 person-years across 4 incident years (2002-2005), and prevalence in 2001 was calculated per 1,000 youths. Information obtained by questionnaire, physical examination, and blood and urine collection was analyzed to describe the characteristics of youth who completed an in-person visit. RESULTS The prevalence of type 1 diabetes (at ages 0-19 years) was 2.00/1,000, which was similar for male (2.02/1,000) and female (1.97/1,000) subjects. The incidence of type 1 diabetes was 23.6/100,000, slightly higher for male compared with female subjects (24.5 vs. 22.7 per 100,000, respectively, P = 0.04). Incidence rates of type 1 diabetes among youth aged 0-14 years in the SEARCH study are higher than all previously reported U.S. studies and many European studies. Few cases of type 2 diabetes in youth aged <10 years were found. The prevalence of type 2 diabetes (at ages 10-19 years) was 0.18/1,000, which is significantly higher for female compared with male subjects (0.22 vs. 0.15 per 1,000, P = 0.01). Incidence of type 2 diabetes was 3.7/100,000, with similar rates for female and male subjects (3.9 vs. 3.4 per 1,000, respectively, P = 0.3). High levels of abnormal cardiometabolic and behavioral risk factor profiles were common among youth with both type 1 and type 2 diabetes. For example, within each of four age-groups for youth with type 1 diabetes and two age-groups for youth with type 2 diabetes, >40% had elevated LDL cholesterol, and <3% of youth aged >10 years met current recommendations for intake of saturated fat. Among youth aged >or=15 years, 18% with type 1 and 26% with type 2 diabetes were current smokers. CONCLUSIONS The SEARCH study is one of the most comprehensive studies of diabetes in NHW youth. The incidence of type 1 diabetes in NHW youth in the U.S. is one of the highest in the world. While type 2 diabetes is still relatively rare, rates are several-fold higher than those reported by European countries. We believe efforts directed at improving the cardiometabolic and behavioral risk factor profiles in this population are warranted.
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Affiliation(s)
- Ronny A Bell
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
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