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Prevalence of Type 1 and Type 2 Diabetes Among Children and Adolescents From 2001 to 2009- JAMA

16 Ene. 2015 Posted by SAOTA

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.

Information on recent trends in the prevalence of type 1 and type 2 diabetes in the United States is limited. Imperatore et al1 reported that the predicted increase in the number of youth living with type 1 and type 2 diabetes by the year 2050 would be primarily among youth of minority race/ethnic groups. Worldwide, from 1990 to 2008, the incidence of type 1 diabetes has been increasing by 2.8% to 4.0% per year,2 similar to that observed in the United States3 for both non-Hispanic white (hereafter called white) and Hispanic youth. However, a recent report from Finland, with the world’s highest incidence, suggested a possible leveling off of the increase from 2005-2011.4 Due to the very low mortality among youth with type 1 diabetes in the United States,5 an increase in the incidence of type 1 diabetes will likely result in an increase in prevalence.

Type 2 diabetes is increasingly diagnosed in youth and now accounts for 20% to 50% of new-onset diabetes case patients,6 disproportionately affecting minority race/ethnic groups.7- 9 Although few longitudinal studies have been conducted, it has been suggested that the increase in type 2 diabetes in youth is a result of an increase in the frequency of obesity in pediatric populations.10 Obesity in youth has been increasing since the 1960s though recent data suggest a plateau.11

There are a limited number of population-based studies of youth-onset type 2 diabetes. Most have involved American Indians and Native Canadians and showed high prevalence.7,12,13 Similarly, type 2 diabetes incidence rates rose among non-Hispanic black (hereafter called black), Hispanic, and white children with insulin-treated, non–type 1 diabetes in Chicago from 1994 to 2003.14

We explored whether overall prevalence of type 1 and type 2 diabetes among US youth changed from 200115 to 200913 and whether it changed by sex, age, and race/ethnicity. Understanding changes in prevalence according to population subgroups is important to inform clinicians about care that will be needed for the pediatric population living with diabetes and may provide direction for other studies designed to determine the causes of the observed changes.