Many Faces of Diabetes in American Youth

New findings from the nation’s largest study of diabetes in youth paint an alarming picture of disease on the rise among every racial and ethnic group studied. Five articles appearing in the March supplement of Diabetes Care provide a comprehensive picture of diabetes in children and adolescents from five ethnic and racial groups in the United States, including non-Hispanic whites, Hispanics, blacks, Asian/Pacific Islanders and American Indians/Navajo Nation. The articles describe important aspects of the epidemiologic, metabolic, behavioral and quality of care issues in youth with diabetes.

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 articles provide unique information about the burden of type 1 and type 2 diabetes in youth from public health and clinical perspectives.

“The incidence rate of type 1 diabetes among U.S. non-Hispanic white youth is today one of the highest in the world: one in about 4,200 youth develops type 1 diabetes annually,” said Ronny A. Bell, Ph.D., an associate professor of epidemiology and prevention at Wake Forest University Baptist Medical Center and 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.”

“We found that type 1 diabetes is more common than type 2 diabetes in Hispanic American youth of all ages” said Jean Lawrence, Sc.D., a 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 age 15-19 the incidence of type 2 diabetes is higher than that of type 1 diabetes in girls but not boys. We also found that over a 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.”

“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,” said SEARCH study chair Elizabeth Mayer-Davis, Ph.D., a 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 black youth with diabetes under age 10 have type 1 diabetes, and for black girls age 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 black 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.”