The incidence rate of type 1 diabetes among non-Hispanic white youth in the United States is one of the highest in the world, according to a major national study coordinated by researchers at Wake Forest University Baptist Medical Center.
SEARCH, a multi-center study of patients diagnosed with diabetes before they were 20 years old, is the largest surveillance effort of youth with diabetes conducted in the United States to-date. The research provides a comprehensive picture of diabetes in children and adolescents from ethnic and racial groups, including non-Hispanic whites, Hispanics, blacks, Asian/Pacific Islanders, and American Indians/Navajo Nation.
The findings, which identify epidemiologic, metabolic, behavioral, and quality of care issues in youth with diabetes, are presented in a supplement of the March issue of Diabetes Care. A series of five articles provide unique information about the burden of type 1 and type 2 diabetes in youth from public health and clinical perspectives.
"One in about 4,200 non-Hispanic white youth develops type 1 diabetes annually," said Ronny A. Bell, Ph.D., an associate professor of epidemiology and prevention at Wake Forest Baptist and the lead author of Diabetes in non-Hispanic White Youth, one of the five articles in publication. "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." Six clinical centers in the U.S. present their SEARCH findings in the journal.
--Jean Lawrence, Sc.D., a research scientist and epidemiologist at Kaiser Permanente Southern California, found that type 1 diabetes is more common than type 2 diabetes in Hispanic-American youth of all ages. In youth between the ages of 15 and 19, the incidence of type 2 diabetes is higher than that of type 1 diabetes in girls but not boys. More than one-third of youth in the older age group with type 1 or type 2 diabetes had poor glycemic control, increasing risk for future diabetes-related complications.
--Elizabeth Mayer-Davis, Ph.D., a professor of nutrition at the University of North Carolina at Chapel Hill School of Public Health, found that type 1diabetes is more common than expected among black youth. Nearly all black youth with diabetes who are under age 10 have type 1 diabetes, and for black girls age 10-14, the incidence of type 1 diabetes is essentially the same as for white girls. About 50 percent of black youth age 15 years or older have poorly controlled blood sugar, a major risk factor for long-term, serious complications including vision-threatening eye disease, kidney disease and heart disease.
--Lenna Liu, M.D., M.P.H., an associate professor in the Department of Pediatrics at Seattle Children's Hospital, found that 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. Rates of type 1 diabetes in American-Asian/Pacific Islander children were higher than rates in Asia and the western Pacific region.
--Dana Dabelea, M.D., Ph.D., an associate professor in the Department of Epidemiology at the University of Colorado Denver, showed that 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. Type 1 diabetes is relatively uncommon. 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," said Barbara Linder, M.D., Ph.D., the senior advisor for Childhood Diabetes Research at the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. "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."
"The need for effective interventions to prevent new cases of diabetes is urgent," said Ann Albright, Ph.D, the director of the Division of Diabetes Translation, part of the Center for Disease Control and Prevention (CDC). "We also must assure that every child with diabetes receives care to prevent the development kidney failure, sight-threatening retinopathy or premature cardiovascular diseases."
"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," said Bell, the lead investigator for the study and director of the Maya Angelou Center for Health Equity at Wake Forest Baptist.
Co-researchers on the Diabetes Care supplements from Wake Forest Baptist were Ralph DiAgostino Jr., Ph.D., and Jennifer Beyer, M.S.
SEARCH was funded by the CDC's Division of Diabetes Translation and by NIDDK.