New findings from the largest nationwide diabetes surveillance effort show unexpectedly high rates of childhood diabetes in U.S. adolescents across most ethnic and racial groups. Five articles appear in the March supplement of Diabetes Care and provide a comprehensive picture of diabetes in the nation’s youth among five ethnic/racial groups including non-Hispanic whites, Hispanics, African-Americans, Asian/Pacific Islanders, and American Indians/Navajo Nation. The articles stem from the research findings of the national SEARCH study and describe important aspects of the epidemiologic, metabolic, behavioral, and quality of care issues in young diabetics.
SEARCH is a multi-center study of diabetes diagnosed in those under age 20 and is the largest surveillance effort to date around youth with diabetes in the United States. The articles in Diabetes Care this month provide unique information about the burden of type 1 and type 2 diabetes in youth from public health and clinical perspectives. Dana Dabelea, MD, PhD, principal investigator of the SEARCH study at the Colorado School of Public Health, University of Colorado Denver, and national study co-chair is the lead author of one of the five papers in the supplement, Diabetes in Navajo Youth.
“Diabetes is one of the most common chronic diseases in children and adolescents and its occurrence is rising,” says Ann Albright, PhD, director of the Center for Disease Control’s Division of Diabetes Translation. “The need for effective interventions to prevent new cases of type 2 diabetes is urgent. At the same time, we need to ensure that every child with type 1 or type 2 diabetes receives the best available care to prevent them from developing diabetes-related complications such as kidney failure, vision loss, or premature cardiovascular diseases.”
Diabetes in non-Hispanic White Youth
“The incidence rate of type 1 diabetes among U.S. non-Hispanic white youth today is one of the highest in the world—one in about 4,200 youth develops type 1 diabetes annually,” said Ronny Bell, PhD, professor of Epidemiology and Prevention at the Wake Forest University School of Medicine and lead author of Diabetes in non-Hispanic White Youth. “This rate is higher than all previously-reported U.S. studies and many European studies. Type 2 diabetes is relatively rare in non-Hispanic white youth, but incidence rates are still several-fold higher than those reported by European countries.”
Diabetes in Hispanic American Youth
“We found that type 1 diabetes is more common than type 2 diabetes in Hispanic American youth of all ages,” said Jean Lawrence, ScD, research scientist and epidemiologist in the Department of Research and Evaluation at Kaiser Permanente Southern California and lead author of Diabetes in Hispanic American Youth. “However, in youth ages 15 to19 the incidence of type 2 diabetes is higher than that of type 1 diabetes in girls but not boys. We also found that over one-third of the youth in this oldest age group with either type 1 or type 2 diabetes had poor glycemic control, which increases their risk for future diabetes-related complications.”
Diabetes in African American Youth
“In addition to documenting appropriate concerns about type 2 diabetes in African-American youth, we found type 1 diabetes is also more common than we had expected in this population,” said SEARCH study chair Elizabeth Mayer-Davis, PhD, professor in the Department of Nutrition at the University of North Carolina School of Public Health and lead author of Diabetes in African/American Youth. “Nearly all African-American youth with diabetes under age 10 have type 1 diabetes, and for African American girls ages 10 to 14 years old, the incidence of type 1 diabetes is essentially the same as for white girls. Most concerning, about 50 percent of African-American youth age 15 years or older have poorly controlled blood sugar, which is a major risk factor for many long-term, serious complications including vision-threatening eye disease, kidney disease, and heart disease.”
Diabetes in Asian and Pacific Islander Youth
“Asian and Pacific Islander youth, particularly adolescents, have a high risk of obesity and type 2 diabetes—one in about 8,200 youth develops type 2 diabetes annually,” said Lenna Liu, MD, MPH, associate professor in the Department of Pediatrics at the University of Washington and lead author of Diabetes in Asian and Pacific Islander Youth. “We also found that rates of type 1 diabetes in this population were higher than rates in Asia and the western Pacific region. Targeted public health efforts to address obesity and prevent type 2 diabetes among Asian and Pacific Islanders are needed.”
Diabetes in Navajo Youth
“Of all racial and ethnic groups in SEARCH, Navajo youth have the greatest risk of type 2 diabetes—one in 2,542 develop diabetes annually,” said Dana Dabelea, MD, PhD, associate professor in the Department of Epidemiology at the Colorado School of Public Health, University of Colorado Denver, and lead author of Diabetes in Navajo Youth. “In contrast, type 1 diabetes, although present, is relatively uncommon. We also found that many Navajo youth with diabetes have poor glycemic control and evidence of severe depression. Together with high prevalence of smoking, high-fat diets, sedentary lifestyles, and lower socioeconomic status, these findings may translate to an increased prevalence of cardiovascular disease as these youth mature.”
“These findings, which show unexpectedly high rates of childhood diabetes, paint a sobering picture of the heavy burden of diabetes on our young people. The new SEARCH data fill an important gap in our knowledge and will help guide future research and target efforts to improve the prevention and treatment of diabetes and its complications,” said Barbara Linder, MD, PhD, senior advisor for Childhood Diabetes Research at the National Institute of Diabetes and Digestive and Kidney Diseases, a part of the National Institutes of Health.
Those who develop diabetes in childhood are at increased risk for complications due to the longer duration of the disease compared with persons who develop diabetes as adults. “Continuing this surveillance effort is essential to document the future burden of diabetes and its complications on our youth, their families, and the health care system,” added Dabelea.
SEARCH is funded by the Division of Diabetes Translation at the Centers for Disease Control and Prevention (CDC) and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), a part of the National Institutes of Health (NIH). It involves six clinical centers in the states of California (Jean Lawrence, ScD), Colorado (Dana Dabelea, MD, study co-chair), Hawaii (Beatriz Rodriguez, MD), Ohio (Lawrence Dolan, MD), South Carolina (Elizabeth Mayer-Davis, PhD, study chairperson) and Washington (Catherine Pihoker, MD). The central laboratory for the study is the Northwest Lipid Research Laboratories in Seattle (Santica Marcovina, PhD). The coordinating center is at the Division of Public Health Sciences at Wake Forest University School of Medicine (Ronny Bell, PhD).
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