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Children and Diabetes

SEARCH for Diabetes in Youth

Diabetes is one of the most common chronic diseases among children in the United States.

When diabetes strikes during childhood, it is routinely assumed to be type 1. Type 1 diabetes develops when the body's immune system destroys pancreatic cells that make the hormone insulin that regulates blood sugar. It normally strikes children and young adults, but it can occur at any age. People with type 1 diabetes must have daily insulin injections or be on an insulin pump to survive.

In the last two decades, type 2 diabetes, has been reported among U.S. children and adolescents with increasing frequency. 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.

Reports of increasing frequency of both type 1 and type 2 diabetes in youth has been among the most concerning aspects of the evolving diabetes epidemic. Unfortunately, reliable data on changes over time in the U.S., or even how many children in the U.S. had type 1 or type 2 diabetes, were lacking. In response to this growing public health concern, the Centers for Disease Control and Prevention (CDC) and the National Institutes of Health (NIH) in 2000 funded the SEARCH for Diabetes in Youth Study www.searchfordiabetes.org . SEARCH is a multicenter, epidemiological study, conducted in five geographically dispersed populations that encompass the racial/ethnic diversity of the U.S. It is designed to characterize the burden of both type 1 and type 2 diabetes, along with the associated complications, the levels of care, and impact on the daily lives of children and youth in the U.S.

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SEARCH Facts

In the year 2009, approximately 3.5 million children and youth less than 20 years of age were under surveillance at the five SEARCH centers to estimate how many children or young people had DM (prevalent cases);

  • SEARCH provides estimates of 2009 DM prevalence (2.2 per 1,000) (Diabetes Care. 2014 Feb;37(2):402-8.).
  • SEARCH prevalence data indicate that in the U.S., at least 191,986 youth have DM. DM prevalence varies across major racial/ethnic groups:
    • Non-Hispanic white youth less than 20 years have the highest burden of DM (about 1 of 370), followed by non-Hispanic Black youth (about 1 in 438).  Asian/Pacific Islanders have the lowest burden of DM (about 1 in 1,250)
    • In children 0–9 years of age non-Hispanic whites have the highest prevalence (about 2/1,000). In this age group across all race/ethnic groups, type 1 DM is the most common form of diabetes. The study found that type 2 DM is extremely rare in children of all races younger than 10 years of age.
    • Type 1 DM prevalence is 1.93/1,000 and it is the most common form of DM in all racial/ethnic groups except in American Indian youth.
    • Type 2 prevalence is 0.24/1,000 and it represented 5.5% of the cases of diabetes in Non-Hispanic White, 37.6% in Non-Hispanic Black, 35.2% in Hispanic, 34.2% in Asian/Pacific Islander, and 80% among American Indian youth.

Since 2002, approximately 4.9 million children less than 20 years of age (approximately 6 percent), each year have been under surveillance at the SEARCH research centers to estimate how many children/youth develop diabetes (incidence cases) per year;

  • Based on 2008 and 2009 data, the overall incidence is estimated to be 28.1 per 100,000 per year. Annually, an estimated 18,436 youth are diagnosed with type 1 diabetes, and 5,089 youth are diagnosed with type 2.
    • Among youth aged <10 years, most diabetes cases are type 1, regardless of race/ethnicity. In this age group the highest incidence of type 1 diabetes is observed in non-Hispanic whites (28.9/100,000 per year; 19.1/100,000 for 0– to 4– years-old and 38.4/100,000 for 5– to 9– years-old).
    • Among older youth (ages 10–19 years), the highest incidence of type 1 diabetes is in non-Hispanic white youth (26.2/100,000 per year), followed by Hispanics (18.9/100,000) and African American (17.7/100,000), and lowest among American Indian (6.1/100,000) and Asian/Pacific Islanders (5.8/100,000).
    • The incidence of type 2 DM among those aged 10–19 years is the highest among American Indians (28.9/100,000), followed by African Americans (26.7/100,000), Hispanics (17.2/100,000), and Asian/Pacific Islanders (8.9/100,000) and is low among non-Hispanic whites (4.5/100,000).

SEARCH has shown that nutritional intake in adolescents with DM is poor and does not follow current recommendations. Recommendations for total dietary fat intake are met by only 10 percent of youth with DM and recommendations for saturated fat intake by only 7 percent.

SEARCH found that about 9 percent of adolescents with DM have moderate or severely depressed mood symptoms, with more girls than boys being affected. Depressed mood is associated with poor glycemic control and a higher likelihood of emergency room visits. (Pediatrics, 2006; 117:1348–58);

About half of the SEARCH participants had an LDL-C concentration above the optimal level of 100 mg/dL. In older youth (≥ 10 yrs of age), the prevalence of abnormal lipids was higher in those with type 2 (33%) than in those with type 1 diabetes (19%). (J Pediatr, 2006; 149(3); 314-9). Moreover, worse glycemic control was associated with a worse lipid profile, regardless of diabetes type (Arch Pediat Adoles Med 2007;161:159–165)

The prevalence of multiple cardiovascular disease (CVD) risk factors is high in children and adolescents with DM. CVD risk factors are present in both youth with type 1 or type 2 diabetes, but were more common in adolescents with type 2 diabetes (Diab Care 2006; 29:1891-1896).
 

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Implications

SEARCH provides the foundation for childhood diabetes surveillance efforts in public health, clinic, and research settings. SEARCH data is important to ultimately design and implement public health efforts to prevent type 1, once prevention strategies are identified, and type 2 diabetes in youth.

The data that are acquired by SEARCH regarding the natural history, risk factors of diabetes complications, quality of care and quality of life will also help design and implement interventions that can reduce the risk for both acute and chronic diabetes complications.
 

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SEARCH Research Centers

Kaiser Permanente Southern California, Pasadena CA
University of Colorado, School of Public Health, Aurora CO
Children’s Hospital Medical Center, Cincinnati OH
University of North Carolina, Chapel Hill NC
Children’s Hospital and Regional Medical Center, Seattle WA
Coordinating Center: Wake Forest University School of Medicine, Winston-Salem NC
 

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For more information

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SEARCH Publications

A complete listing of SEARCH Publications can be found at: https://www.searchfordiabetes.org/public/dspPubs.cfm.

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