type 2 diabetes during adolescence have been reported since 1979 among
the Pima Indians, but several clinical reports have been recently published
for other ethnic groups in North America. We reviewed current knowledge
of type 2 diabetes among children and adolescents in North America to
assess the magnitude of the disease and its public health importance.
and adolescents diagnosed with type 2 diabetes were generally between
10 and 19 years old, obese, insulin-resistant, and had a strong family
history for type 2 diabetes and Acanthosis Nigricans. Those affected
belonged to all ethnic groups. Generally, children and adolescents with
type 2 diabetes had poor glycemic control (HbA1c 10% - 12%). Diabetic
complications (for example, microalbuminuria and macroalbuminuria) and
clustering of other cardiovascular risk factors (for example, dyslipidemia,
hypertension) could be observed as early as during teenage years among
Indian youths had the highest prevalence of type 2 diabetes. In the 15-to-19-year
age group, the current prevalence per 1000 was 50.9 for Pima Indians from
Arizona (active population screening by the National Institutes of Health),
4.5 for all U.S. American Indian populations (reported cases from the
U.S. Indian Health Service outpatient clinics), and 2.3 for Canadian First
Nation people from Manitoba (reported cases from outpatient clinics).
In comparison, the prevalence per 1000 of type 1 diabetes for U.S. residents
aged 0-19 years is 1.7 per 1000.
prevalence estimates for other ethnic groups were not available. In a
retrospective study of such reports, a referral center in Cincinnati,
Ohio, found an incidence for type 2 diabetes of 7.2/100,000 for African
Americans and whites aged 10-19 years in 1994. By comparison, the national
incidence of type 1 diabetes among those aged 10-19 years is 19/100,000.
In most of the U.S. case reports, type 2 diabetes accounted for 8% to
46% of all new cases of diabetes (type 1 and type 2) referred to pediatric
centers. Some cases could present with ketoacidosis and be misclassified
as type 1 diabetes, whereas only a few diagnosed cases were asymptomatic.
The magnitude of the disease is therefore probably underestimated.
significant increase in the prevalence of type 2 diabetes among children
and adolescents was found only for American Indians. The epidemics of
obesity and the low level of physical activity among young people, as
well as exposure to diabetes in utero, may be major contributors
to the increase in type 2 diabetes during childhood and adolescence.
type 2 diabetes in children and adolescents already appears to be a sizable
and growing problem among American Indians and an emerging public health
problem among other North American ethnic groups. Better physician awareness
and monitoring of the disease’s magnitude will be necessary. Standard
case definition(s), guidelines for treatment, and approval of oral hypoglycemic
agents are urgently required for children and adolescents.
to a potential emergence of type 2 diabetes among North American children
and adolescents as a public health problem, the Centers for Disease Control
and Prevention (CDC), Division of Diabetes Translation invited a group
of health care providers, epidemiologists, and public health professionals
to review the current knowledge of the disease in North America. A summary
of the workshops was published in the Newsletter of the American Academy
of Pediatrics (AAP) in the Endocrinology Section in the Summer 1999
issue. Search for "Fagot-Campagna" on this AAP Web page: http://www.aap.org/sections/endocrinology/endonews.htm.
workshop in October 1998 focused on the prevalence, incidence, and secular trend of the disease among different ethnic groups. A second workshop
in January 1999 focused on the characteristics, complications, treatment,
and follow-up of children diagnosed with the disease.
As a result of the workshops these four objectives, which will require
strong collaborations with agencies and organizations were formed:
physicians' awareness about the disease
a standard case definition(s)
the magnitude of the problem
and improve the quality of care among children and adolescents diagnosed
with type 2 diabetes
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