1
|
Michalek DA, Tern C, Zhou W, Robertson CC, Farber E, Campolieto P, Chen WM, Onengut-Gumuscu S, Rich SS. A multi-ancestry genome-wide association study in type 1 diabetes. Hum Mol Genet 2024; 33:958-968. [PMID: 38453145 PMCID: PMC11102596 DOI: 10.1093/hmg/ddae024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/22/2023] [Accepted: 02/09/2023] [Indexed: 03/09/2024] Open
Abstract
Type 1 diabetes (T1D) is an autoimmune disease caused by destruction of the pancreatic β-cells. Genome-wide association (GWAS) and fine mapping studies have been conducted mainly in European ancestry (EUR) populations. We performed a multi-ancestry GWAS to identify SNPs and HLA alleles associated with T1D risk and age at onset. EUR families (N = 3223), and unrelated individuals of African (AFR, N = 891) and admixed (Hispanic/Latino) ancestry (AMR, N = 308) were genotyped using the Illumina HumanCoreExome BeadArray, with imputation to the TOPMed reference panel. The Multi-Ethnic HLA reference panel was utilized to impute HLA alleles and amino acid residues. Logistic mixed models (T1D risk) and frailty models (age at onset) were used for analysis. In GWAS meta-analysis, seven loci were associated with T1D risk at genome-wide significance: PTPN22, HLA-DQA1, IL2RA, RNLS, INS, IKZF4-RPS26-ERBB3, and SH2B3, with four associated with T1D age at onset (PTPN22, HLA-DQB1, INS, and ERBB3). AFR and AMR meta-analysis revealed NRP1 as associated with T1D risk and age at onset, although NRP1 variants were not associated in EUR ancestry. In contrast, the PTPN22 variant was significantly associated with risk only in EUR ancestry. HLA alleles and haplotypes most significantly associated with T1D risk in AFR and AMR ancestry differed from that seen in EUR ancestry; in addition, the HLA-DRB1*08:02-DQA1*04:01-DQB1*04:02 haplotype was 'protective' in AMR while HLA-DRB1*08:01-DQA1*04:01-DQB1*04:02 haplotype was 'risk' in EUR ancestry, differing only at HLA-DRB1*08. These results suggest that much larger sample sizes in non-EUR populations are required to capture novel loci associated with T1D risk.
Collapse
Affiliation(s)
- Dominika A Michalek
- Center for Public Health Genomics, University of Virginia, 1330 Jefferson Park Avenue, Charlottesville, VA 22908, United States
| | - Courtney Tern
- Center for Public Health Genomics, University of Virginia, 1330 Jefferson Park Avenue, Charlottesville, VA 22908, United States
| | - Wei Zhou
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital, 185 Cambridge Street, Boston, MA 02114, United States
- Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, 415 Main Street, Cambridge, MA 02142, United States
- Program in Medical and Population Genetics, Broad Institute of Harvard and MIT, 185 Cambridge Street, Boston, MA 02114, United States
| | - Catherine C Robertson
- Center for Public Health Genomics, University of Virginia, 1330 Jefferson Park Avenue, Charlottesville, VA 22908, United States
| | - Emily Farber
- Center for Public Health Genomics, University of Virginia, 1330 Jefferson Park Avenue, Charlottesville, VA 22908, United States
| | - Paul Campolieto
- Center for Public Health Genomics, University of Virginia, 1330 Jefferson Park Avenue, Charlottesville, VA 22908, United States
| | - Wei-Min Chen
- Center for Public Health Genomics, University of Virginia, 1330 Jefferson Park Avenue, Charlottesville, VA 22908, United States
- Department of Public Health Sciences, University of Virginia, 1330 Jefferson Park Avenue, Charlottesville, VA 22908, United States
| | - Suna Onengut-Gumuscu
- Center for Public Health Genomics, University of Virginia, 1330 Jefferson Park Avenue, Charlottesville, VA 22908, United States
- Department of Public Health Sciences, University of Virginia, 1330 Jefferson Park Avenue, Charlottesville, VA 22908, United States
| | - Stephen S Rich
- Center for Public Health Genomics, University of Virginia, 1330 Jefferson Park Avenue, Charlottesville, VA 22908, United States
- Department of Public Health Sciences, University of Virginia, 1330 Jefferson Park Avenue, Charlottesville, VA 22908, United States
| |
Collapse
|
2
|
Mathias P, Corathers SD, Carreon SA, Hilliard ME, Papadakis JL, Weissberg-Benchell J, Raymond JK, Pyatak EA, Agarwal S. Young Adults with Type 1 Diabetes. Endocrinol Metab Clin North Am 2024; 53:39-52. [PMID: 38272597 DOI: 10.1016/j.ecl.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Young adults experience multiple developmental transitions across social, educational, vocational, residential, and financial life domains. These transitions are potential competing priorities to managing a chronic condition such as type 1 diabetes and can contribute to poor psychosocial and medical outcomes. In this narrative review, we describe population outcomes of young adult populations and the unique considerations associated with managing type 1 diabetes in young adulthood. We provide an overview of the current evidence-based strategies to improve care for young adults with type 1 diabetes and recommendations for future directions in the field.
Collapse
Affiliation(s)
- Priyanka Mathias
- Fleischer Institute for Diabetes and Metabolism, Albert Einstein College of Medicine-Montefiore Medical Center, 1180 Morris Park Avenue, Bronx, NY 10467, USA
| | - Sarah D Corathers
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Samantha A Carreon
- Baylor College of Medicine and Texas Children's Hospital, 1102 Bates Avenue, Suite 940, Houston, TX 77030, USA
| | - Marisa E Hilliard
- Baylor College of Medicine and Texas Children's Hospital, 1102 Bates Avenue, Suite 940, Houston, TX 77030, USA
| | - Jaclyn L Papadakis
- Northwestern University Feinberg School of Medicine, Pritzker Department of Psychiatry and Behavioral Health, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 10, Chicago, IL 60611, USA
| | - Jill Weissberg-Benchell
- Northwestern University Feinberg School of Medicine, Pritzker Department of Psychiatry and Behavioral Health, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 10, Chicago, IL 60611, USA
| | - Jennifer K Raymond
- Division of Pediatric Endocrinology, Children's Hospital Los Angeles, 4650 Sunset Boulevard. MS 61, Los Angeles, CA, USA
| | - Elizabeth A Pyatak
- Chan Division of Occupational Science and Occupational Therapy, Ostrow School of Dentistry, University of Southern California, 1540 Alcazar Street, CHP-133, Los Angeles, CA 90089-9003, USA
| | - Shivani Agarwal
- Fleischer Institute for Diabetes and Metabolism, Albert Einstein College of Medicine-Montefiore Medical Center, 1180 Morris Park Avenue, Bronx, NY 10467, USA; NY Regional Center for Diabetes Translation Research, Albert Einstein College of Medicine, 1180 Morris Park Avenue, Bronx, NY 10467, USA.
| |
Collapse
|
3
|
Fan Y, S H Lau E, Wu H, Yang A, Chow E, P S Kong A, C W Ma R, C N Chan J, O Y Luk A. Higher incidence of cardiovascular-kidney complications in Chinese with youth-onset type 2 diabetes versus youth-onset type 1 diabetes attenuated by control of cardio-metabolic risk factors: a population-based prospective cohort study in Hong Kong. Diabetes Res Clin Pract 2023:110728. [PMID: 37217017 DOI: 10.1016/j.diabres.2023.110728] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 05/09/2023] [Accepted: 05/18/2023] [Indexed: 05/24/2023]
Abstract
AIMS To determine and compare the incidence of diabetes complications in Chinese with youth-onset type 2 and type 1 diabetes. METHODS We conducted a population-based prospective cohort study, including 1,260 people with type 2 diabetes and 1,227 with type 1 diabetes diagnosed at age <20 years who underwent metabolic and complication assessment in Hong Kong Hospital Authority between 2000 and 2018. They were followed for incident cardiovascular disease (CVD), end-stage kidney disease (ESKD) and all-cause death until 2019. Multivariable Cox regression analysis was applied to compare the risks of these complications in type 2 versus type 1 diabetes. RESULTS People with type 1 diabetes (median age: 20 years, median diabetes duration: 9 years) and type 2 diabetes (median age: 21 years, median diabetes duration: 6 years) were followed for a mean period of 9.2 and 8.8 years respectively. The risks of CVD (HR [95% CI] 1.66 [1.01-2.72]) and ESKD (HR 1.96 [1.27-3.04]) but not death (HR 1.10 [0.72-1.67]) were higher in type 2 versus type 1 diabetes, adjusted for age at diagnosis, diabetes duration and sex. The association became nonsignificant with further adjustment for glycaemic and metabolic control. Youth-onset type 2 diabetes conferred mortality excess (standardized mortality ratio 4.15 [3.28-5.17]) to age- and sex-matched general population. CONCLUSIONS People with youth-onset type 2 diabetes had higher incidence rates of CVD and ESKD than type 1 diabetes. The excess risks in type 2 diabetes were removed after adjusted for cardio-metabolic risk factors.
Collapse
Affiliation(s)
- Yingnan Fan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Eric S H Lau
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Hongjiang Wu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Aimin Yang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Elaine Chow
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Alice P S Kong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Ronald C W Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China
| | - Andrea O Y Luk
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People's Republic of China.
| |
Collapse
|
4
|
Wagenknecht LE, Lawrence JM, Isom S, Jensen ET, Dabelea D, Liese AD, Dolan LM, Shah AS, Bellatorre A, Sauder K, Marcovina S, Reynolds K, Pihoker C, Imperatore G, Divers J. Trends in incidence of youth-onset type 1 and type 2 diabetes in the USA, 2002-18: results from the population-based SEARCH for Diabetes in Youth study. Lancet Diabetes Endocrinol 2023; 11:242-250. [PMID: 36868256 PMCID: PMC10091237 DOI: 10.1016/s2213-8587(23)00025-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/10/2023] [Accepted: 01/12/2023] [Indexed: 03/05/2023]
Abstract
BACKGROUND The incidence of diabetes is increasing in children and young people. We aimed to describe the incidence of type 1 and type 2 diabetes in children and young people aged younger than 20 years over a 17-year period. METHODS The SEARCH for Diabetes in Youth study identified children and young people aged 0-19 years with a physician diagnosis of type 1 or type 2 diabetes at five centres in the USA between 2002 and 2018. Eligible participants included non-military and non-institutionalised individuals who resided in one of the study areas at the time of diagnosis. The number of children and young people at risk of diabetes was obtained from the census or health plan member counts. Generalised autoregressive moving average models were used to examine trends, and data are presented as incidence of type 1 diabetes per 100 000 children and young people younger than 20 years and incidence of type 2 diabetes per 100 000 children and young people aged between 10 years and younger than 20 years across categories of age, sex, race or ethnicity, geographical region, and month or season of diagnosis. FINDINGS We identified 18 169 children and young people aged 0-19 years with type 1 diabetes in 85 million person-years and 5293 children and young people aged 10-19 years with type 2 diabetes in 44 million person-years. In 2017-18, the annual incidence of type 1 diabetes was 22·2 per 100 000 and that of type 2 diabetes was 17·9 per 100 000. The model for trend captured both a linear effect and a moving-average effect, with a significant increasing (annual) linear effect for both type 1 diabetes (2·02% [95% CI 1·54-2·49]) and type 2 diabetes (5·31% [4·46-6·17]). Children and young people from racial and ethnic minority groups such as non-Hispanic Black and Hispanic children and young people had greater increases in incidence for both types of diabetes. Peak age at diagnosis was 10 years (95% CI 8-11) for type 1 diabetes and 16 years (16-17) for type 2 diabetes. Season was significant for type 1 diabetes (p=0·0062) and type 2 diabetes (p=0·0006), with a January peak in diagnoses of type 1 diabetes and an August peak in diagnoses of type 2 diabetes. INTERPRETATION The increasing incidence of type 1 and type 2 diabetes in children and young people in the USA will result in an expanding population of young adults at risk of developing early complications of diabetes whose health-care needs will exceed those of their peers. Findings regarding age and season of diagnosis will inform focused prevention efforts. FUNDING US Centers for Disease Control and Prevention and US National Institutes of Health.
Collapse
Affiliation(s)
- Lynne E Wagenknecht
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - Jean M Lawrence
- Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Scott Isom
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Elizabeth T Jensen
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Angela D Liese
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Lawrence M Dolan
- Department of Pediatrics, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Amy S Shah
- Department of Pediatrics, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Anna Bellatorre
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Katherine Sauder
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | | | - Kristi Reynolds
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Catherine Pihoker
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Giuseppina Imperatore
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jasmin Divers
- Division of Health Services Research, Department of Foundations of Medicine, New York University Long Island School of Medicine, Mineola, NY, USA
| |
Collapse
|
5
|
Bjornstad P, Chao LC, Cree-Green M, Dart AB, King M, Looker HC, Magliano DJ, Nadeau KJ, Pinhas-Hamiel O, Shah AS, van Raalte DH, Pavkov ME, Nelson RG. Youth-onset type 2 diabetes mellitus: an urgent challenge. Nat Rev Nephrol 2023; 19:168-184. [PMID: 36316388 PMCID: PMC10182876 DOI: 10.1038/s41581-022-00645-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2022] [Indexed: 11/05/2022]
Abstract
The incidence and prevalence of youth-onset type 2 diabetes mellitus (T2DM) and its complications are increasing worldwide. Youth-onset T2DM has been reported in all racial and ethnic groups, but Indigenous peoples and people of colour are disproportionately affected. People with youth-onset T2DM often have a more aggressive clinical course than those with adult-onset T2DM or those with type 1 diabetes mellitus. Moreover, the available treatment options for children and adolescents with T2DM are more limited than for adult patients. Intermediate complications of youth-onset T2DM, such as increased albuminuria, often develop in late childhood or early adulthood, and end-stage complications, including kidney failure, develop in mid-life. The increasing frequency, earlier onset and greater severity of childhood obesity in the past 50 years together with increasingly sedentary lifestyles and an increasing frequency of intrauterine exposure to diabetes are important drivers of the epidemic of youth-onset T2DM. The particularly high risk of the disease in historically disadvantaged populations suggests an important contribution of social and environmental factors, including limited access to high-quality health care, healthy food choices and opportunities for physical activity as well as exposure to stressors including systemic racism and environmental pollutants. Understanding the mechanisms that underlie the development and aggressive clinical course of youth-onset T2DM is key to identifying successful prevention and management strategies.
Collapse
Affiliation(s)
| | - Lily C Chao
- Children's Hospital Los Angeles, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | | | - Allison B Dart
- Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Canada
| | - Malcolm King
- University of Saskatchewan College of Medicine, Saskatoon, Saskatchewan, Canada
| | - Helen C Looker
- National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ, USA
| | - Dianna J Magliano
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- Monash University, School of Public Health and Preventive Medicine, Melbourne, Australia
| | | | - Orit Pinhas-Hamiel
- Paediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Amy S Shah
- Cincinnati Children's Hospital and The University of Cincinnati, Cincinnati, OH, USA
| | | | - Meda E Pavkov
- Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Robert G Nelson
- National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, AZ, USA.
| |
Collapse
|
6
|
Perng W, Conway R, Mayer-Davis E, Dabelea D. Youth-Onset Type 2 Diabetes: The Epidemiology of an Awakening Epidemic. Diabetes Care 2023; 46:490-499. [PMID: 36812420 PMCID: PMC10090267 DOI: 10.2337/dci22-0046] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 11/26/2022] [Indexed: 02/24/2023]
Abstract
In this narrative review, we describe the epidemiology (prevalence, incidence, temporal trends, and projections) of type 2 diabetes among children and adolescents (<20 years), focusing on data from the U.S. and reporting global estimates where available. Secondarily, we discuss the clinical course of youth-onset type 2 diabetes, from prediabetes to complications and comorbidities, drawing comparisons with youth type 1 diabetes to highlight the aggressive course of this condition, which, only recently, has become recognized as a pediatric disease by health care providers. Finally, we end with an overview of emerging topics in type 2 diabetes research that have potential to inform strategies for effective preventive action at the community and individual levels.
Collapse
Affiliation(s)
- Wei Perng
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Rebecca Conway
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
| | | | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| |
Collapse
|
7
|
Tönnies T, Brinks R, Isom S, Dabelea D, Divers J, Mayer-Davis EJ, Lawrence JM, Pihoker C, Dolan L, Liese AD, Saydah SH, D’Agostino RB, Hoyer A, Imperatore G. Projections of Type 1 and Type 2 Diabetes Burden in the U.S. Population Aged <20 Years Through 2060: The SEARCH for Diabetes in Youth Study. Diabetes Care 2023; 46:313-320. [PMID: 36580405 PMCID: PMC9887625 DOI: 10.2337/dc22-0945] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 11/03/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To project the prevalence and number of youths with diabetes and trends in racial and ethnic disparities in the U.S. through 2060. RESEARCH DESIGN AND METHODS Based on a mathematical model and data from the SEARCH for Diabetes in Youth study for calendar years 2002-2017, we projected the future prevalence of type 1 and type 2 diabetes among youth aged <20 years while considering different scenarios of future trends in incidence. RESULTS The number of youths with diabetes will increase from 213,000 (95% CI 209,000; 218,000) (type 1 diabetes 185,000, type 2 diabetes 28,000) in 2017 to 239,000 (95% CI 209,000; 282,000) (type 1 diabetes 191,000, type 2 diabetes 48,000) in 2060 if the incidence remains constant as observed in 2017. Corresponding relative increases were 3% (95% CI -9%; 21%) for type 1 diabetes and 69% (95% CI 43%; 109%) for type 2 diabetes. Assuming that increasing trends in incidence observed between 2002 and 2017 continue, the projected number of youths with diabetes will be 526,000 (95% CI 335,000; 893,000) (type 1 diabetes 306,000, type 2 diabetes 220,000). Corresponding relative increases would be 65% (95% CI 12%; 158%) for type 1 diabetes and 673% (95% CI 362%; 1,341%) for type 2 diabetes. In both scenarios, substantial widening of racial and ethnic disparities in type 2 diabetes prevalence are expected, with the highest prevalence among non-Hispanic Black youth. CONCLUSIONS The number of youths with diabetes in the U.S. is likely to substantially increase in future decades, which emphasizes the need for prevention to attenuate this trend.
Collapse
Affiliation(s)
- Thaddäus Tönnies
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at the Heinrich Heine University, Düsseldorf, Germany
| | - Ralph Brinks
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at the Heinrich Heine University, Düsseldorf, Germany
- Chair for Medical Biometry and Epidemiology, Faculty of Health/School of Medicine, Witten/Herdecke University, Witten, Germany
| | - Scott Isom
- Division of Public Health Sciences, Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, Department of Epidemiology, Colorado School of Public Health, University of Colorado, Denver, CO
| | - Jasmin Divers
- Division of Health Services Research, Department of Foundations of Medicine, New York University Long Island School of Medicine, Mineola, NY
| | - Elizabeth J. Mayer-Davis
- Departments of Nutrition and Medicine, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jean M. Lawrence
- Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | | | - Lawrence Dolan
- Division of Endocrinology, Department of Pediatrics, Cincinnati Children’s Hospital, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Angela D. Liese
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Sharon H. Saydah
- Division of Viral Diseases, National Center for Infectious Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA
| | - Ralph B. D’Agostino
- Division of Public Health Sciences, Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Annika Hoyer
- Biostatistics and Medical Biometry, Medical School EWL, Bielefeld University, Bielefeld, Germany
| | - Giuseppina Imperatore
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| |
Collapse
|
8
|
Peña A, Olson ML, Hooker E, Ayers SL, Castro FG, Patrick DL, Corral L, Lish E, Knowler WC, Shaibi GQ. Effects of a Diabetes Prevention Program on Type 2 Diabetes Risk Factors and Quality of Life Among Latino Youths With Prediabetes: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2231196. [PMID: 36094502 PMCID: PMC9468887 DOI: 10.1001/jamanetworkopen.2022.31196] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
IMPORTANCE Latino youths are disproportionately impacted by prediabetes and type 2 diabetes (T2D). Lifestyle intervention is the first-line approach for preventing or delaying T2D among adults with prediabetes. OBJECTIVE To assess the efficacy of a diabetes prevention program among Latino youths aged 12 to 16 years with prediabetes. DESIGN, SETTING, AND PARTICIPANTS This 2-group parallel randomized clinical trial with 2:1 randomization assessed a lifestyle intervention against usual care among Latino youths with prediabetes and obesity with 6- and 12-month follow-up. The study was conducted at YMCA facilities in Phoenix, Arizona from May 2016 to March 2020. INTERVENTION Participants were randomized to lifestyle intervention (INT) or usual care control (UCC). The 6-month INT included 1 d/wk of nutrition and health education and 3 d/wk of physical activity. UCC included 2 visits with a pediatric endocrinologist and a bilingual, bicultural registered dietitian to discuss diabetes risks and healthy lifestyle changes. MAIN OUTCOMES AND MEASURES Insulin sensitivity, glucose tolerance, and weight-specific quality of life (YQOL-W) at 6- and 12-month follow-up. RESULTS A total of 117 Latino youths (mean [SD] age, 14 [1] years; 47 [40.1%] girls) were included in the analysis. Overall, 79 were randomized to INT and 38 to UCC. At 6 months, the INT led to significant decreases in mean (SE) 2-hour glucose (baseline: 144 [3] mg/dL; 6 months: 132 [3] mg/dL; P = .002) and increases in mean (SE) insulin sensitivity (baseline: 1.9 [0.2]; 6 months: 2.6 [0.3]; P = .001) and YQOL-W (baseline: 75 [2]; 6 months: 80 [2]; P = .006), but these changes were not significantly different from UCC (2-hour glucose: mean difference, -7.2 mg/dL; 95% CI, -19.7 to 5.3 mg/dL; P for interaction = .26; insulin sensitivity: mean difference, 0.1; 95% CI, -0.7 to 0.9; P for interaction = .79; YQOL-W: mean difference, 6.3; 95% CI, -1.1 to 13.7; P for interaction = .10, respectively). Both INT (mean [SE], -15 mg/dL [4.9]; P = .002) and UCC (mean [SE], -15 mg/dL [5.4]; P = .005) had significant 12-month reductions in 2-hour glucose that did not differ significantly from each other (mean difference, -0.3; 95% CI, -14.5 to 14.1 mg/dL; P for interaction = .97). At 12 months, changes in mean (SE) insulin sensitivity in INT (baseline: 1.9 [0.2]; 12 months: 2.3 [0.2]; P = .06) and UCC (baseline: 1.9 [0.3]; 12 months: 2.0 [0.2]; P = .70) were not significantly different (mean difference, 0.3; 95% CI, -0.4 to 1.0; P for interaction = .37). At 12 months, YQOL-W was significantly increased in INT (basline: 75 [2]; 12 months: 82 [2]; P < .001) vs UCC (mean difference, 8.5; 95% CI, 0.8 to 16.2; P for interaction = .03). CONCLUSIONS AND RELEVANCE In this randomized clinical trial, both INT and UCC led to similar changes in T2D risk factors among Latino youths with diabetes; however, YQOL-W was improved in INT compared with UCC. Diabetes prevention interventions that are effective in adults also appeared to be effective in high risk youths. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02615353.
Collapse
Affiliation(s)
- Armando Peña
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix
| | - Micah L. Olson
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix
- Division of Pediatric Endocrinology and Diabetes, Phoenix Children’s Hospital, Phoenix, Arizona
| | - Elva Hooker
- Ivy Center for Family Wellness, The Society of St Vincent de Paul, Phoenix, Arizona
| | - Stephanie L. Ayers
- Southwest Interdisciplinary Research Center, Arizona State University, Phoenix
| | | | | | | | - Elvia Lish
- Ivy Center for Family Wellness, The Society of St Vincent de Paul, Phoenix, Arizona
| | - William C. Knowler
- National Institute of Diabetes and Digestive and Kidney Diseases, Phoenix, Arizona
| | - Gabriel Q. Shaibi
- Center for Health Promotion and Disease Prevention, Arizona State University, Phoenix
- Division of Pediatric Endocrinology and Diabetes, Phoenix Children’s Hospital, Phoenix, Arizona
| |
Collapse
|
9
|
Fan Y, Lau ESH, Wu H, Yang A, Chow E, So WY, Kong APS, Ma RCW, Chan JCN, Luk AOY. Incidence of long-term diabetes complications and mortality in youth-onset type 2 diabetes: A systematic review. Diabetes Res Clin Pract 2022; 191:110030. [PMID: 35934175 DOI: 10.1016/j.diabres.2022.110030] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 06/17/2022] [Accepted: 08/01/2022] [Indexed: 11/16/2022]
Abstract
AIMS This systematic review aims to assess the incidence of chronic kidney disease (CKD), cardiovascular disease (CVD) and mortality in people with type 2 diabetes diagnosed <20 years. METHODS We searched MEDLINE, Embase and Cochrane Library for longitudinal studies published between 1 January 2000 and 31 November 2021. RESULTS Seventeen studies (15 reporting CKD, 3 reporting CVD, 5 reporting mortality) from seven countries of sample size ranging between 96 and 4,141 were eligible. Most studies were conducted in North America and Europe (n = 14). Diabetes duration at enrolment varied from 0 to 8.3 years and follow-up duration from 1 to 12.6 years. The incidence rates (per 1,000 person-year) of albuminuria ranged between 12.4 and 114.8, macroalbuminuria or proteinuria between 10 and 35.0, end-stage kidney disease (ESKD) between 0.4 and 25.0, CVD between 3.7 and 19.5, and mortality between 1.0 and 18.6. The highest incidence rates of albuminuria, ESKD and mortality were recorded in Australian Aboriginal and Pima Indian populations. Youth-onset type 2 diabetes was associated with greater risk of developing CKD compared with type 1 diabetes in most studies. CONCLUSION Studies reporting CVD in youth-onset type 2 diabetes are scarce. Estimated incidence rates of CKD and mortality in youth-onset type 2 diabetes varied across different study populations, potentially higher in indigenous people. Youth with type 2 diabetes are at higher risk of adverse kidney outcomes than their type 1 counterparts. More studies are needed in regions outside of North America and Europe.
Collapse
Affiliation(s)
- Yingnan Fan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Eric S H Lau
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Hongjiang Wu
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Aimin Yang
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Elaine Chow
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Wing-Yee So
- Hong Kong Hospital Authority, Kowloon, Hong Kong, China
| | - Alice P S Kong
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Shatin, Hong Kong, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Ronald C W Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Shatin, Hong Kong, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Juliana C N Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Shatin, Hong Kong, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong, China
| | - Andrea O Y Luk
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, Hong Kong, China; Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Shatin, Hong Kong, China; Li Ka Shing Institute of Health Sciences, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| |
Collapse
|