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Back To Vidyya Epidemiology Of Type 2 Diabetes Mellitus Among North American Children And Adolescents

A Review Of Current Knowledge

Cases of 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.


Findings

Children 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 Pima Indians.

American 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.

Population-based 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.

A statistically 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.

In conclusion, 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.


CDC Workshops

To respond 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.

The first 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:

  1. Raise physicians' awareness about the disease
  2. Develop a standard case definition(s)
  3. Determine the magnitude of the problem
  4. Assess and improve the quality of care among children and adolescents diagnosed with type 2 diabetes



Helpful Links

American Diabetes Association. Care of Children with Diabetes in the School and Day Care Setting. Diabetes Care 23, Supplement 1, ADA Clinical Practice Recommendations 2000.

American Diabetes Association. Consensus Statement. Type 2 Diabetes in Children and Adolescents. Diabetes Care 23(3):381.

American Diabetes Association. Management of Diabetes at Diabetes Camps. Diabetes Care 23, Supplement 1, ADA Clinical Practice Recommendations 2000.

Appendix: Guidelines for School Health Programs to Promote Lifelong Healthy Eating Among Young People MMWR June 14, 1996 / 45(RR-9);34-41.

Body Mass Index-for-Age — CDC's Nutrition and Physical Activity.

CDC Growth Charts: United States

CDC National Center for Chronic Disease Prevention and Health Promotion. Diabetes Threat on the Rise Among U.S. Children, Specialists Say. Chronic Disease Notes & Reports 1999 spring/summer 12(2):1,10-12. (Select Spring/Summer 1999.)

Fagot-Campagna A, Pettitt DJ, Engelgau MM, Burrows NR, Geiss LS, Valdez R, Beckles GL, Saaddine J, Gregg EW, Williamson DF, Narayan KM. Type 2 diabetes among North American children and adolescents: An epidemiologic review and a public health perspective. J Pediatr 2000;136(5):664-72.

Fagot-Campagna A, Rios Burrows N, Williamson DF. The public health epidemiology of type 2 diabetes in children and adolescents: a case study of American Indian adolescents in the southwestern United States. Clinica Chimica Acta 1999;286:81-95.

Guidelines for School and Community Programs to Promote Lifelong Healthy Eating Among Young People MMWR March 07, 1997;46(RR-6);1-36.

Komulainen J, Julmala P, Savola K, et al. Clinical, Autoimmune, and Genetic Characteristics of Very Young Children with Type 1 Diabetes. Diabetes Care 22(12):1950

Nutrition and the Health of Young People Fact Sheet — CDC's Adolescent and School Health

Promote Lifelong Healthy Eating Among Young People -- How You Can Help — CDC's Adolescent and School Health

Update: Prevalence of Overweight Among Children, Adolescents, and Adults -- United States, 1988-1994 MMWR March 07, 1997;46(09):199-202.

1997 Youth Risk Behavior Surveillance System (YRBSS) — Summary — CDC's Adolescent and School Health


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