Increase in Both Type 1 and Type 2 Diabetes Seen Among US Youth Over 16-Year Period

Between 2001 and 2017, the estimated prevalence of both type 1 (T1D) and type 2 diabetes (T2D) increased among children and adolescents, according to a study published in JAMA.

These data come from an observational, cross-sectional, multicenter study of a mean of 3.47 million youths from 6 areas in the United States:

• California (Kaiser Permanente Southern California members in 7 counties)
• Colorado (residents of 14 counties)
• Ohio (residents of 8 counties)
• South Carolina (residents of 4 counties)
• Washington State (residents of 5 counties)
• Indian Health Services users in select areas of Arizona and New Mexico (coordinated by the Colorado center)

The study examined individuals aged 19 and younger with physician-diagnosed diabetes at intervals in 2001, 2009, and 2017 to learn if there were differences in observed trends by type of diabetes, race and ethnicity, age, and sex. The youngest participants were less than 4 years old and made up the smallest group in terms of age, but the youngest age was not explicitly stated.

“Case ascertainment was conducted under a Health Insurance Portability and Accountability Act Privacy Rule waiver of consent approved by the institutional review board(s) with jurisdiction for each of the clinical centers and the data coordinating center,” the authors noted.

The methods, incidence rates, prevalence estimates for the SEARCH study were previously published and referenced in the current study, while changes in estimated prevalence between the 3 interval years were described in the current study.

“Youth-onset type 1 and type 2 diabetes are serious chronic health conditions,” the authors said. “Individuals with youth-onset diabetes are at risk for early complications, comorbidities, and excess mortality, particularly those who develop type 2 diabetes and those from racial and ethnic minority groups.”

Analyses found among youth aged 19 or younger with type 1 diabetes (T1D):

• 2001: 4958 of 3.35 million had T1D
• 2009: 6672 of 3.46 million had T1D
• 2017: 7759 of 3.61 million had T1D

Analyses found among those aged 10-19 with type 2 diabetes (T2D):

• 2001: 588 of 1.73 million had T2D
• 2009: 814 of 1.85 million had T2D
• 2017: 1230 of 1.85 million had T2D

The study also found the estimated T1D prevalence per 1000 youths aged 19 or younger increased significantly. The prevalence was 1.48 (95% CI, 1.44-1.52) in 2001, 1.93 (95% CI, 1.88-1.98) in 2009, and 2.15 (95% CI, 2.10-2.20) in 2017. This was an absolute increase of 0.67 per 1000 youths (95% CI, 0.64-0.70) and a 45.1% (95% CI, 40.0%-50.4%) relative increase over 16 years.

The estimated T2D prevalence per 1000 youths aged 10-19 significantly increased from 0.34 (95% CI, 0.31-0.37) in 2001, to 0.46 (95% CI, 0.43-0.49) in 2009, to 0.67 (95% CI, 0.63-0.70) in 2017. Here, the authors saw an absolute increase of 0.32 per 1000 youths (95% CI, 0.30-0.35) and a 95.3% (95% CI, 77.0%-115.4%) relative increase over 16 years.

While other racial and ethnic groups saw greater increases over time, Native American and Black youths aged 10-19 had the highest incidence of T2D overall. Native American, Asian or Pacific Islander, Black, and Hispanic youths had the most significant increases in T2D.

The greatest absolute increases for T1D were noted in non-Hispanic White (0.93 per 1000 youths, 95% CI 0.88-0.98) and non-Hispanic Black (0.89 per 1000 youths, 95% CI, 0.88-0.98) youths. For T2D, the greatest absolute increases were seen in non-Hispanic Black (0.85 per 1000 youths, 95% CI, 0.74-0.97) and Hispanic (0.57 per 1000 youths, 95% CI, 0.51-0.64) youths.

No significant differences were noted between etiologic type and physician’s diagnosis of T1D overall and by age, sex, and race and ethnicity subgroup. The same was true for T2D overall, however the percentage of White participants with T2D who met the criteria for etiologic type in 2002 (50%) was significantly lower than in 2009 and 2017 (85.7% [P = .03] for 2009 and 86.2% [P = .02] for 2017).

Besides White participants in 2002, no significant differences were observed for other race and ethnicity groups. However, there were significant differences seen in participants aged 10-14 in 2002 vs 2008 (P = .03) and in males in 2002 vs 2016 (P = .03). No significant differences were noted for participants aged 15-19 years or for females.

“Translating the difference in estimated type 2 diabetes prevalence from 2001 to 2017 into additional cases indicated that Black and Hispanic females aged 15 to 19 years experienced an estimated increase of more than 1 additional case per 1000 females,” the authors said.

Reference

Lawrence JM, Divers J, Isom S, et al. Trends in prevalence of type 1 and type 2 diabetes in children and adolescents in the US, 2001-2017. JAMA. 2021;326(8):717-727. doi:10.1001/jama.2021.11165