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Incidence Trends of Type 1 and Type 2 Diabetes among Youths, 2002–2012

New England Journal of Medicine, Volume 376, Issue 15, Page 1419-1429, April 2017. <br/>

Background

Diagnoses of type 1 and type 2 diabetes in youths present a substantial clinical and public health burden. The prevalence of these diseases increased in the 2001–2009 period, but data on recent incidence trends are lacking.

Methods

We ascertained cases of type 1 and type 2 diabetes mellitus at five study centers in the United States. Denominators (4.9 million youths annually) were obtained from the U.S. Census or health-plan member counts. After the calculation of annual incidence rates for the 2002–2012 period, we analyzed trends using generalized autoregressive moving-average models with 2-year moving averages.

Results

A total of 11,245 youths with type 1 diabetes (0 to 19 years of age) and 2846 with type 2 diabetes (10 to 19 years of age) were identified. Overall unadjusted estimated incidence rates of type 1 diabetes increased by 1.4% annually (from 19.5 cases per 100,000 youths per year in 2002–2003 to 21.7 cases per 100,000 youths per year in 2011–2012, P=0.03). In adjusted pairwise comparisons, the annual rate of increase was greater among Hispanics than among non-Hispanic whites (4.2% vs. 1.2%, P<0.001). Overall unadjusted incidence rates of type 2 diabetes increased by 7.1% annually (from 9.0 cases per 100,000 youths per year in 2002–2003 to 12.5 cases per 100,000 youths per year in 2011–2012, P<0.001 for trend across race or ethnic group, sex, and age subgroups). Adjusted pairwise comparisons showed that the relative annual increase in the incidence of type 2 diabetes among non-Hispanic whites (0.6%) was lower than that among non-Hispanic blacks, Asians or Pacific Islanders, and Native Americans (P<0.05 for all comparisons) and that the annual rate of increase among Hispanics differed significantly from that among Native Americans (3.1% vs. 8.9%, P=0.01). After adjustment for age, sex, and race or ethnic group, the relative annual increase in the incidence of type 1 diabetes was 1.8% (P<0.001) and that of type 2 diabetes was 4.8% (P<0.001).

Conclusions

The incidences of both type 1 and type 2 diabetes among youths increased significantly in the 2002–2012 period, particularly among youths of minority racial and ethnic groups. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and the Centers for Disease Control and Prevention.)

Supported by a grant (1UC4DK108173-01) from the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, and by the CDC. The Population Based Registry of Diabetes in Youth Study (RFP DP15-002) is funded by the CDC and supported by grants at the National Institute of Diabetes and Digestive and Kidney Diseases sites at Kaiser Permanente Southern California (U18DP006133, U48/CCU919219, U01 DP000246, and U18DP002714), University of Colorado Denver (U18DP006139, U48/CCU819241-3, U01 DP000247, and U18DP000247-06A1), Cincinnati’s Children’s Hospital Medical Center (U18DP006134, U48/CCU519239, U01 DP000248, and 1U18DP002709), University of North Carolina at Chapel Hill (U18DP006138, U48/CCU419249, U01 DP000254, and U18DP002708), Seattle Children’s Hospital (U18DP006136, U58/CCU019235-4, U01 DP000244, and U18DP002710-01), and Wake Forest University School of Medicine (U18DP006131, U48/CCU919219, U01 DP000250, and 200-2010-35171).

Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.

Dr. Marcovina reports receiving consulting fees from Denka-Saiken and MedTest DX. No other potential conflict of interest relevant to this article was reported.

The views expressed in this article are those of the authors and do not necessarily represent the official positions of the National Institute of Diabetes and Digestive and Kidney Diseases or the Centers for Disease Control and Prevention (CDC).

We thank the many youths and their families and the health care providers, whose participation made this study possible.

Source Information

From the Departments of Nutrition and Medicine, University of North Carolina, Chapel Hill (E.J.M.-D.), and the Department of Biostatistical Sciences (J.D., S.I.) and the Division of Public Health Sciences (L.W.), Wake Forest School of Medicine, Winston-Salem — both in North Carolina; the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (J.M.L.), and Santa Barbara (D.J.P.) — both in California; the Department of Epidemiology, Colorado School of Public Health, Aurora (D.D.); the Department of Endocrinology, Children’s Hospital Medical Center, Cincinnati (L.D.); the Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta (G.I., S.S.); the Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (B.L.); and the Northwest Lipid Research Laboratory (S.M.) and the Department of Pediatrics, University of Washington (C.P.) — both in Seattle.

Address reprint requests to Dr. Mayer-Davis at the University of North Carolina, 245 Rosenau Hall, Campus Box 7461, Chapel Hill, NC 27599, or at .

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