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Children and Diabetes — More Information

Diabetes is one of the most common chronic diseases in children and adolescents; about 151,000 people below the age of 20 years have diabetes.

When diabetes strikes during childhood, it is routinely assumed to be type 1, or juvenile-onset diabetes. However, in the last 2 decades, type 2 diabetes (formerly known as adult-onset diabetes) has been reported among U.S. children and adolescents with increasing frequency. Also, studies conducted in Europe showed an increase in the frequency of type 1 diabetes, especially in young children. It is unclear whether the frequency of type 1 diabetes is also increasing among U.S. youth.

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  • Each year, more than 13,000 young people are diagnosed with type 1 diabetes.
  • Type 2 diabetes begins when the body develops a resistance to insulin and no longer uses the insulin properly. As the need for insulin rises, the pancreas gradually loses its ability to produce sufficient amounts of insulin to regulate blood sugar.
  • Health care providers are finding more and more children with type 2 diabetes, a disease usually diagnosed in adults aged 40 years or older.
  • A statistically significant increase in the prevalence of type 2 diabetes among children and adolescents was found only for American Indians.
  • The epidemics of obesity and the low level of physical activity among young people, as well as exposure to diabetes in utero, may be major contributors to the increase in type 2 diabetes during childhood and adolescence.
  • Type 2 diabetes in children and adolescents already appears to be a sizable and growing problem among U.S. children and adolescents. Better physician awareness and monitoring of the disease’s magnitude will be necessary.
  • Standard case definition(s), guidelines for treatment, and approval of oral hypoglycemic agents (to lower blood sugar) are urgently required for children and adolescents.

Children and adolescents diagnosed with type 2 diabetes are generally between 10 and 19 years old, obese, have a strong family history for type 2 diabetes, and have insulin resistance. Generally, children and adolescents with type 2 diabetes have poor glycemic control (A1C = 10% - 12%).

Those affected with type 2 diabetes belong to all ethnic groups, but it is more commonly seen in non-white groups. American Indian youths have the highest prevalence of type 2 diabetes. In the 15-to-19-year age group, the current prevalences were

  • 50.9 per 1000 for Pima Indians from Arizona;
  • 4.5 per 1000 for all U.S. American Indian populations (reported cases from the U.S. Indian Health Service outpatient clinics);
  • 2.3 per 1000 for Canadian First Nation people from Manitoba (reported cases from outpatient clinics).

In comparison, the prevalence per 1000 of type 1 diabetes for U.S. residents aged 0-19 years is 1.7 per 1000.

Population-based prevalence estimates for other ethnic groups were not available. In a retrospective study of such reports, a referral center in Cincinnati, Ohio, found an incidence for type 2 diabetes of 7.2 per 100,000 for African Americans and whites aged 10-19 years in 1994. By comparison, the national incidence of type 1 diabetes among those aged 10-19 years is 19 per 100,000. In most of the U.S. case reports, type 2 diabetes accounted for 8% to 46% of all new cases of diabetes (type 1 and type 2) referred to pediatric centers. The magnitude of type 2 diabetes is probably underestimated.

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Why is it hard to detect the prevalence of type 2 diabetes in children?

It is hard to detect type 2 diabetes in children because it can go undiagnosed for a long time; because children may have no symptoms or mild symptoms; and because blood tests are needed for diagnosis. It is difficult to be sure it is type 2, because criteria for differentiating between types of diabetes in children are confusing; that is, children with type 2 can develop ketoacidosis (acid build-up in the blood); children with type 1 can be overweight; and because the overall prevalence of the disease may still be low. This means that scientists will have to sample a very large population of children in order to find a stable estimate of prevalence.

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CDC Initiatives

In response to this growing public health concern, the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) are funding a 5-year, multicenter study, SEARCH for Diabetes in Youth, to examine the current status of diabetes among children and adolescents in the United States.

Cooperative agreements were awarded to six sites to establish a multi-center registry system that will cover over 6 % of the children and adolescents in the United States. The main objectives of the study are to assess the magnitude and burden of diagnosed diabetes and to develop criteria to differentiate between the types of diabetes among young people in the United States.

The study includes a data coordinating center and a central laboratory and has these two phases:

  • to develop a uniform protocol to identify children and adolescents with diabetes
  • to implement the uniform protocol to identify cases of diabetes in children in the areas covered by the six study sites.

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CDC Workshops

To respond to a potential emergence of type 2 diabetes among North American children and adolescents as a public health problem, CDC’s Division of Diabetes Translation invited a group of health care providers, epidemiologists, and public health professionals to review the current knowledge of the disease in North America; see Fagot-Campagna A, Ríos Burrows N, Williamson DF. The Public health epidemiology of type 2 diabetes in children and adolescents: a case study of American Indian adolescents in the southwest United States. Clin Chim Acta 1999;286:81-95.

The first workshop in October 1998 focused on the prevalence, incidence, and secular trend of the disease among different ethnic groups. A second workshop in January 1999 focused on the characteristics, complications, treatment, and follow-up of children diagnosed with the disease.

CDC's Division of Diabetes Translation defined these four objectives, which will require strong collaborations with other agencies and organizations:

  1. Raise physicians' awareness about the disease.
  2. Develop a standard case definition(s).
  3. Determine the magnitude of the problem.
  4. Assess and improve the quality of care among children and adolescents diagnosed with type 2 diabetes.

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For more information, see related links

Appendix: Guidelines for School Health Programs to Promote Lifelong Healthy Eating Among Young People MMWR June 14, 1996 / 45(RR-9);34-41.

Bloomgarden ZT. Type 2 diabetes in the young: the evolving epidemic. Diabetes Care 2004 Apr;27(4):998–1010.

Body Mass Index-for-Age — CDC's Nutrition and Physical Activity.

CDC Growth Charts: United States

CDC National Center for Chronic Disease Prevention and Health Promotion. Diabetes Threat on the Rise Among U.S. Children, Specialists Say. Chronic Disease Notes & Reports 1999 spring/summer 12(2):1,10–12. (Select Spring/Summer 1999.)

CDC's Global Health Spotlight: Children's Health

CDC School Health Index for Physical Activity and Healthy Eating

Diabetes Among Young American Indians — Montana and Wyoming, 2000-2002. MMWR November 21, 2003 / 52(46);1127–1129

Diagnosed Diabetes Among American Indians and Alaska Natives Aged <35 Years — United States, 1994—2004

Fagot-Campagna A, Pettitt DJ, Engelgau MM, Burrows NR, Geiss LS, Valdez R, Beckles GL, Saaddine J, Gregg EW, Williamson DF, Narayan KM. Type 2 diabetes among North American children and adolescents: An epidemiologic review and a public health perspective. J Pediatr 2000;136(5):664–72.

Kaufman F, Schatz D, Silverstein J; American Diabetes Association. Diabetes care at diabetes camps. Diabetes Care 2004 Jan;27 Suppl 1:S129–31.

Klingensmith G, Kaufman F, Schatz D, Clarke W; American Diabetes Association. Diabetes care in the school and day care setting. Diabetes Care. 2004 Jan;27 Suppl 1:S122–8.

Komulainen J, Julmala P, Savola K, et al. Clinical, Autoimmune, and Genetic Characteristics of Very Young Children with Type 1 Diabetes. Diabetes Care 22(12):1950

National Diabetes Education Program Resources on Diabetes in Children and Adolescents

Nutrition — CDC's Division of Adolescent and School Health (DASH)

Physical Activity — CDC's Division of Adolescent and School Health (DASH)

Physical Activity Levels Among Children Aged 9-13 YearsUnited States, 2002 MMWR August 22, 2003 / 52(33);785-788.

Update: Prevalence of Overweight Among Children, Adolescents, and Adults — United States, 1988-1994 MMWR March 07, 1997;46(09):199-202.

2001 Information and Results on Youth Risk Behavior Surveillance System (YRBSS) — CDC's Adolescent and School Health

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