Conference Coverage

SEARCH Turns Up More Diabetes in Youth



PHILADELPHIA – The prevalence of type 2 diabetes, once considered an almost exclusively adult-onset disease, increased by 21% from 2001 to 2009 among Americans younger than 20 years.

The prevalence of type 1 diabetes increased by 23% over the same time period, Dr. Dana Dabelea reported at the annual meeting of the American Diabetes Association.

"Every year, we see about 15,000 new cases of type 1 and 3,700 new cases of type 2 diabetes, and the numbers of children living with these diseases are increasing," she said at a press briefing.

Although type 1 diabetes remains "an extremely rare" and very dangerous condition, evidence continues to emerge that type 2 diabetes is anything but benign, said Dr. Dabelea, a professor of epidemiology at the University of Colorado at Denver, Aurora.

"It’s believed that this increase we’re seeing is making type 2 more and more a pediatric condition," she said. "In youth, this disease is associated with early signs and symptoms of chronic complications that may increase lifelong comorbidities, reduce quality life and life expectancy, and increase health care costs."

Dr. Dabelea and her coinvestigators discussed new data from the SEARCH for Diabetes in Youth study. The registry study was launched in 2000, and is expected to continue at least through 2015. It’s being conducted in five centers in the United States.

The primary aim is to track the prevalence of new diabetes cases, providing the first national picture of the rising epidemic. Subanalyses look at the diseases’ complications and comorbidities, associations between diabetes and lifestyle, and the impact of nutrition on the diseases.

The new data suggest that from 2001 to 2009, almost 189,000 U.S. residents aged younger than 20 years had diabetes (about 168,000 with type 1 and about 19,000 with type 2).

The prevalence of both types of diabetes has increased in both boys and girls and across all races and ethnicities. The prevalence of type 1 in the study population rose from 1.55 per 1,000 in 2001 to 2.03 per 1,000 in 2009, a statistically significant difference. The prevalence of type 2 during that period rose significantly from 2.9 per 10,000 to 3.6 per 10,000.

"Although the proportion was highest in Native Americans and blacks, the increase was also observed in whites and Hispanics," Dr. Dabelea said. "This may suggest that pediatric type 2 diabetes is plateauing in the traditionally high-risk groups, but still increasing in other groups."

SEARCH investigators presented a number of substudy findings at the meeting, including the following:

• Young people with either form of the disease may show signs of impending kidney damage. In a group of 5,000 patients with a 4-year diabetes history, up to 17% had albuminuria. The numbers were highest in children with insulin resistance but no diabetes autoantibodies (17%), and lowest (8%) in those with diabetes autoantibodies who were insulin sensitive.

Television time seems directly tied to blood glucose and lipid levels in both types of diabetes. In a cohort of 1,400 SEARCH patients aged younger than 10 years, HbA1c increased as TV time increased. Triglyceride levels were significantly higher in children who watched TV for 3 or more hours each day than in those who watched less.

Peripheral neuropathy strikes children with diabetes at about the same rate as it does adults. "Our findings suggest that children, adolescents, and young adults with diabetes are not only at risk for diabetic peripheral neuropathy, but that many already show measurable signs of it," the authors noted.

• Among a subset of 222 SEARCH subjects, there were early indications that cardiovascular parasympathetic nerves were impaired, perhaps predisposing children with diabetes to future cardiovascular disease.

SEARCH is being sponsored by the Centers for Disease Control and Prevention and the National Institutes of Health. Dr. Dabelea did not have any financial disclosures.

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