American Diabetes Month: Both type 1 and type 2 diabetes on the rise among Americans aged below 20
The onset of diabetes in childhood and adolescence is associated with multiple complications, including diabetic kidney disease, retinopathy (when blood vessels of the retina are damaged), and peripheral neuropathy (a result of damage to the nerves outside of the brain and spinal cord), and has a substantial impact on public health resources. Despite awareness, the incidence or the rate of new diagnosed cases of both type 1 and type 2 diabetes in US youths (persons aged below 20 years) has continued to rise. Among all youths, the rates of new diagnosed cases of type 1 diabetes increased by 1.9% from 19.5 per 100,000 in 2002-2003 to 22.3 in 2014-2015. Among persons aged 10-19 years, type 2 diabetes incidence went up by 4.8%, from 9.0 per 100,000 in 2002-2003 to 13.8 in 2014-2015, according to an analysis conducted this year.
Since diabetes is a chronic disease that requires lifelong treatment and management, the authors from multiple universities as well the Centers for Disease Control and Prevention (CDC) emphasize that a better understanding of the number of new cases of diabetes among youths helps in planning for healthcare needs and resources. “Ongoing surveillance to monitor trends in type 1 and type 2 diabetes incidence can help identify population subgroups at increased risk for diabetes to aid prevention efforts and planning for future health care needs,” they add. The findings have been published in the Morbidity and Mortality Weekly Report (MMWR) of the CDC.
To assess recent trends in the incidence of diabetes in youths, the research team analyzed 2002-2015 data from the SEARCH for Diabetes in Youth Study, a US population-based registry of clinical sites located in five states. SEARCH is supported by the CDC and the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), which is part of the National Institutes of Health (NIH). Case reports were obtained from medical records and validated based on physician diagnosis of diabetes.
During 2002-2015, among the 69,457,475 youths at risk for diabetes, SEARCH identified 14,638 youths with type 1 diabetes and 3,916 with type 2 diabetes. The incidence of type 1 diabetes increased during 2002-2015 in all demographic groups except those who received a diagnosis at age less than 5 years and American Indians. Incidence of type 1 diabetes differed by age at diagnosis, sex, and race/ethnicity, with higher rates observed among persons aged 10-14 years, males, and whites.
Steeper increases in the age-adjusted and sex-adjusted incidence of type 1 diabetes were seen among blacks (2.7% per year), Hispanics (4.0% per year), and Asians and Pacific Islanders (4.4% per year) than among Whites (0.7% per year). Incidence among Asians and Pacific Islanders did not change significantly during 2002-2010, then steeply increased during 2011-2015 (8.5% per year). “The incidence of type 1 diabetes continues to increase in US youths, with steeper increases observed in black and Hispanic youths. Since 2011, the incidence of type 1 diabetes has also significantly increased among Asians and Pacific Islanders. Reasons for this recent increase are unknown,” say investigators.
During 2002-2015, the incidence of type 2 diabetes increased among youths aged 10-19 years in all age, sex, and race/ethnicity groups except Whites. During 2014-2015, type 2 diabetes incidence differed by race/ethnicity, with the lowest rates observed among Whites (0.77) and higher rates among American Indians (3.69), Blacks (5.97), and Hispanics (6.45). The steepest increase was among Asians and Pacific Islanders (7.7% per year) followed by Hispanics (6.5% per year), blacks (6.0% per year), and American Indians (3.7% per year).
“In parallel with increased obesity prevalence in US youths, the incidence of type 2 diabetes among adolescents has increased at a higher rate than that of type 1 diabetes, especially among racial/ethnic minority youths. There are no known prevention interventions for type 1 diabetes; in adults, the onset of type 2 diabetes can be prevented or delayed with lifestyle changes programs,” the findings state.
One such program is the National Diabetes Prevention Program, which can help prevent or delay type 2 diabetes in those at high risk. The program, available to those aged 18 and older, is taught by trained lifestyle coaches and encourages healthy life changes to help participants address barriers to improved nutrition, increased physical activity, and coping mechanisms for stress reduction.
While the effectiveness of these programs among youths is unknown, the researchers stress that promoting healthy eating and lifestyles provide many health benefits.
Prediabetes is an emerging health threat among the youth
Nearly one in five adolescents aged 12-18 years, and one in four young adults aged 19-34 years, are living with prediabetes, which can increase the risk of developing type 2 diabetes. It is a health condition in which blood sugar levels are higher than normal, but not yet high enough to be diagnosed as type 2 diabetes.
The percentage of adolescents and young adults living with prediabetes was higher in males (22.5% versus 13.4%) and participants with obesity (25.7% versus 16.4%). Hispanic young adults had higher rates of prediabetes compared to white young adults.
“We’re already seeing increased rates of type 2 diabetes and diabetes-related complications in youth and young adults, and these new findings are evidence of a growing epidemic and a tremendously worrisome threat to the future of our nation’s health. Additional research is needed to support the development of interventions for youth and increasing access to programs that we know work for young adults, like the CDC-led National Diabetes Prevention Program,” suggests Dr Ann Albright, director of CDC’s Division of Diabetes Translation.
Parents can also help turn the tide on prediabetes by encouraging healthy eating and increased physical activity. They can aim for their children to get 60 minutes of physical activity a day, recommends the agency.