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Original Investigation |

Prevalence of Type 1 and Type 2 Diabetes Among Children and Adolescents From 2001 to 2009

Dana Dabelea, MD, PhD1; Elizabeth J. Mayer-Davis, PhD2; Sharon Saydah, PhD3; Giuseppina Imperatore, MD3; Barbara Linder, MD, PhD4; Jasmin Divers, PhD5; Ronny Bell, PhD 6; Angela Badaru, MD7; Jennifer W. Talton, MS5; Tessa Crume, PhD1; Angela D. Liese, PhD8; Anwar T. Merchant, DMD, ScD8; Jean M. Lawrence, ScD, MPH, MSSA9; Kristi Reynolds, PhD9; Lawrence Dolan, MD10; Lenna L. Liu, MD, MPH11; Richard F. Hamman, MD, DrPH1 ; for the SEARCH for Diabetes in Youth Study
[+] Author Affiliations
1Department of Epidemiology, Colorado School of Public Health, Aurora
2Department of Nutrition, University of North Carolina, Chapel Hill
3Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
4Childhood Diabetes Research Division of Diabetes, Endocrinology and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
5Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
6Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
7Department of Pediatric Endocrinology and Diabetes, Children’s Hospital and Regional Medical Center, Seattle, Washington
8Department of Epidemiology and Biostatistics, Arnold School of Public Health, Columbia, South Carolina
9Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
10Department of Endocrinology, Children's Hospital Medical Center, Cincinnati, Ohio
11Department of Pediatrics, University of Washington, and Seattle Children’s Hospital, Seattle
JAMA. 2014;311(17):1778-1786. doi:10.1001/jama.2014.3201.
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Importance  Despite concern about an “epidemic,” there are limited data on trends in prevalence of either type 1 or type 2 diabetes across US race and ethnic groups.

Objective  To estimate changes in the prevalence of type 1 and type 2 diabetes in US youth, by sex, age, and race/ethnicity between 2001 and 2009.

Design, Setting, and Participants  Case patients were ascertained in 4 geographic areas and 1 managed health care plan. The study population was determined by the 2001 and 2009 bridged-race intercensal population estimates for geographic sites and membership counts for the health plan.

Main Outcomes and Measures  Prevalence (per 1000) of physician-diagnosed type 1 diabetes in youth aged 0 through 19 years and type 2 diabetes in youth aged 10 through 19 years.

Results  In 2001, 4958 of 3.3 million youth were diagnosed with type 1 diabetes for a prevalence of 1.48 per 1000 (95% CI, 1.44-1.52). In 2009, 6666 of 3.4 million youth were diagnosed with type 1 diabetes for a prevalence of 1.93 per 1000 (95% CI, 1.88-1.97). In 2009, the highest prevalence of type 1 diabetes was 2.55 per 1000 among white youth (95% CI, 2.48-2.62) and the lowest was 0.35 per 1000 in American Indian youth (95% CI, 0.26-0.47) and type 1 diabetes increased between 2001 and 2009 in all sex, age, and race/ethnic subgroups except for those with the lowest prevalence (age 0-4 years and American Indians). Adjusted for completeness of ascertainment, there was a 21.1% (95% CI, 15.6%-27.0%) increase in type 1 diabetes over 8 years. In 2001, 588 of 1.7 million youth were diagnosed with type 2 diabetes for a prevalence of 0.34 per 1000 (95% CI, 0.31-0.37). In 2009, 819 of 1.8 million were diagnosed with type 2 diabetes for a prevalence of 0.46 per 1000 (95% CI, 0.43-0.49). In 2009, the prevalence of type 2 diabetes was 1.20 per 1000 among American Indian youth (95% CI, 0.96-1.51); 1.06 per 1000 among black youth (95% CI, 0.93-1.22); 0.79 per 1000 among Hispanic youth (95% CI, 0.70-0.88); and 0.17 per 1000 among white youth (95% CI, 0.15-0.20). Significant increases occurred between 2001 and 2009 in both sexes, all age-groups, and in white, Hispanic, and black youth, with no significant changes for Asian Pacific Islanders and American Indians. Adjusted for completeness of ascertainment, there was a 30.5% (95% CI, 17.3%-45.1%) overall increase in type 2 diabetes.

Conclusions and Relevance  Between 2001 and 2009 in 5 areas of the United States, the prevalence of both type 1 and type 2 diabetes among children and adolescents increased. Further studies are required to determine the causes of these increases.

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