White children account for most of the new cases of diabetes in children, says a new study, but the disease is found in all ethnic groups, and rates of both type 1 and type 2 diabetes are on the rise.
In Wednesday’s Journal of the American Medical Association, Dana Dabelea of the University of Colorado Health Sciences Center reports on the SEARCH for Diabetes in Youth Study, the first study designed to estimate the national incidence of diabetes by race, ethnicity and diabetes type in people under the age of 20.
The study found that estimated rates of type 1 diabetes, which usually strikes in youth, are up 40%-60% for white children and 20%-40% for black and Hispanic children over previous estimates, though she cautions that earlier studies used different methodologies, so direct comparisons can’t be made.
What triggers type 1, a form of the disease in which the body’s immune system destroys its insulin-producing cells, is not known, so the reasons for an increase are not clear, Dabelea says. Theories include a greater genetic susceptibility to autoimmune disease, exposure to something in the environment that has changed over time, or even too much cleanliness, resulting in fewer early-life infections that could train the immune system.
Rates of type 2 diabetes, in which the body produces insulin but doesn’t use it efficiently, are very low, though the disease is more common in minorities than whites. Type 2 usually occurs in middle age and is associated with obesity. Higher rates in minority children may relate to higher obesity in these groups, Dabelea says. “In the past, type 2 diabetes did not occur in children.”
Either form of diabetes is marked by too much sugar in the blood, which over time can damage large and small blood vessels, leading to heart disease, stroke, nerve damage and amputations, blindness and kidney disease.
The study involved 2,435 people under 20 who were newly diagnosed with diabetes in 2002 and 2003. It found:
• Overall incidence of diabetes in children and teens is 24.3 cases per 100,000 per year.
•Diabetes of both types is most common in whites (26.1 per 100,000 per year), blacks (25.4) and American Indian (25.0) youth, and lower in Hispanic (20.2) and Asian/Pacific Islander (16.7) youth.
•Only 19 cases of type 2 were found in 5- to 9-year-olds, and none under 5. In the 10- to 14-year-old group, there were 215 cases and in the 15- to 19-year-old group, 296 cases.
•In teens ages 15 to 19, type 1 is most common in whites and least common in American Indians. For type 2, that is reversed.
“In older kids, the picture is becoming complex,” Dabelea says. Type 1 clearly affects white children most and type 2 is most common in American Indians, but “in African Americans, Asian/Pacific Islanders and Hispanics, they have almost half and half, type 1 and type 2.”
Increases in diabetes and other chronic diseases in children are a concern, says Catherine DeAngelis, editor of the medical association journal. “A chronic condition in a child will become a chronic disease in an adult,” she says. “What we’re talking about for an adult is maybe 10 to 20 years of suffering. With a child, it may be 50 or 60 years of suffering.”
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