Lenna L. Liu

The Burden of Diabetes Mellitus Among US Youth: Prevalence Estimates From the SEARCH for Diabetes in Youth Study

OBJECTIVE. Our goal was to estimate the prevalence of diabetes mellitus in youth <20 years of age in 2001 in the United States, according to age, gender, race/ethnicity, and diabetes type. METHODS. The SEARCH for Diabetes in Youth Study is a 6-center observational study conducting population-based ascertainment of physician-diagnosed diabetes in youth. Census-based denominators for 4 geographically based centers and enrollment data for 2 health plan-based centers were used to calculate prevalence. Age-, gender-, and racial/ethnic group-specific prevalence rates were multiplied by US population counts to estimate the total number of US youth with diabetes. RESULTS. We identified 6379 US youth with diabetes in 2001, in a population of ∼3.5 million. Crude prevalence was estimated as 1.82 cases per 1000 youth, being much lower for youth 0 to 9 years of age (0.79 cases per 1000 youth) than for those 10 to 19 years of age (2.80 cases per 1000 youth). Non-Hispanic white youth had the highest prevalence (1.06 cases per 1000 youth) in the younger group. Among 10- to 19-year-old youth, black youth (3.22 cases per 1000 youth) and non-Hispanic white youth (3.18 cases per 1000 youth) had the highest rates, followed by American Indian youth (2.28 cases per 1000 youth), Hispanic youth (2.18 cases per 1000 youth), and Asian/Pacific Islander youth (1.34 cases per 1000 youth). Among younger children, type 1 diabetes accounted for ≥80% of diabetes; among older youth, the proportion of type 2 diabetes ranged from 6% (0.19 cases per 1000 youth for non-Hispanic white youth) to 76% (1.74 cases per 1000 youth for American Indian youth). We estimated that 154369 youth had physician-diagnosed diabetes in 2001 in the United States. CONCLUSIONS. The overall prevalence estimate for diabetes in children and adolescents was ∼0.18%. Type 2 diabetes was found in all racial/ethnic groups but generally was less common than type 1, except in American Indian youth.

Projections of type 1 and type 2 diabetes burden in the U.S. population aged <20 years through 2050: dynamic modeling of incidence, mortality, and population growth.

OBJECTIVE To forecast the number of U.S. individuals aged <20 years with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) through 2050, accounting for changing demography and diabetes incidence. RESEARCH DESIGN AND METHODS We used Markov modeling framework to generate yearly forecasts of the number of individuals in each of three states (diabetes, no diabetes, and death). We used 2001 prevalence and 2002 incidence of T1DM and T2DM from the SEARCH for Diabetes in Youth study and U.S. Census Bureau population demographic projections. Two scenarios were considered for T1DM and T2DM incidence: 1) constant incidence over time; 2) for T1DM yearly percentage increases of 3.5, 2.2, 1.8, and 2.1% by age-groups 0–4 years, 5–9 years, 10–14 years, and 15–19 years, respectively, and for T2DM a yearly 2.3% increase across all ages. RESULTS Under scenario 1, the projected number of youth with T1DM rises from 166,018 to 203,382 and with T2DM from 20,203 to 30,111, respectively, in 2010 and 2050. Under scenario 2, the number of youth with T1DM nearly triples from 179,388 in 2010 to 587,488 in 2050 (prevalence 2.13/1,000 and 5.20/1,000 [+144% increase]), with the greatest increase in youth of minority racial/ethnic groups. The number of youth with T2DM almost quadruples from 22,820 in 2010 to 84,131 in 2050; prevalence increases from 0.27/1,000 to 0.75/1,000 (+178% increase). CONCLUSIONS A linear increase in diabetes incidence could result in a substantial increase in the number of youth with T1DM and T2DM over the next 40 years, especially those of minority race/ethnicity.

Prevalence of overweight and obesity in youth with diabetes in USA: the SEARCH for Diabetes in Youth study.

Liu LL, Lawrence JM, Davis C, Liese AD, Pettitt DJ, Pihoker C, Dabelea D, Hamman R, Waitzfelder B, Kahn HS. Prevalence of overweight and obesity in youth with diabetes in USA: the SEARCH for Diabetes in Youth Study.

Prevalence of Cardiovascular Disease Risk Factors in U.S. Children and Adolescents With Diabetes The SEARCH for Diabetes in Youth Study

OBJECTIVE—The purpose of this study was to determine the prevalence and correlates of selected cardiovascular disease (CVD) risk factors among youth aged <20 years with diabetes. RESEARCH DESIGN AND METHODS—The analysis included 1,083 girls and 1,013 boys examined as part of the SEARCH for Diabetes in Youth study, a multicenter, population-based study of youth 0–19 years of age with diabetes. Diabetes type was determined by a biochemical algorithm based on diabetes antibodies and fasting C-peptide level. CVD risk factors were defined as follows: HDL cholesterol <40 mg/dl; age- and sex-specific waist circumference >90th percentile; systolic or diastolic blood pressure >90th percentile for age, sex, and height or taking medication for high blood pressure; and triglycerides >110 mg/dl. RESULTS—The prevalence of having at least two CVD risk factors was 21%. The prevalence was 7% among children aged 3–9 years and 25% in youth aged 10–19 years (P < 0.0001), 23% among girls and 19% in boys (P = 0.04), 68% in American Indians, 37% in Asian/Pacific Islanders, 32% in African Americans, 35% in Hispanics, and 16% in non-Hispanic whites (P < 0.0001). At least two CVD risk factors were present in 92% of youth with type 2 and 14% of those with type 1A diabetes (P < 0.0001). In multivariate analyses, age, race/ethnicity, and diabetes type were independently associated with the odds of having at least two CVD risk factors (P < 0.0001). CONCLUSIONS—Many youth with diabetes have multiple CVD risk factors. Recommendations for weight, lipid, and blood pressure control in youth with diabetes need to be followed to prevent or delay the development of CVD as these youngsters mature.

Diabetes in Non-Hispanic White Youth Prevalence, incidence, and clinical characteristics: the SEARCH for Diabetes in Youth Study

OBJECTIVE—To investigate the incidence, prevalence, and clinical characteristics of diabetes among U.S. non-Hispanic white (NHW) youth. RESEARCH DESIGN AND METHODS—Data from the SEARCH for Diabetes in Youth Study (SEARCH study), a multicenter study of diabetes among youth aged 0–19 years, were examined. Incidence rates were calculated per 100,000 person-years across 4 incident years (2002–2005), and prevalence in 2001 was calculated per 1,000 youths. Information obtained by questionnaire, physical examination, and blood and urine collection was analyzed to describe the characteristics of youth who completed an in-person visit. RESULTS—The prevalence of type 1 diabetes (at ages 0–19 years) was 2.00/1,000, which was similar for male (2.02/1,000) and female (1.97/1,000) subjects. The incidence of type 1 diabetes was 23.6/100,000, slightly higher for male compared with female subjects (24.5 vs. 22.7 per 100,000, respectively, P = 0.04). Incidence rates of type 1 diabetes among youth aged 0–14 years in the SEARCH study are higher than all previously reported U.S. studies and many European studies. Few cases of type 2 diabetes in youth aged <10 years were found. The prevalence of type 2 diabetes (at ages 10–19 years) was 0.18/1,000, which is significantly higher for female compared with male subjects (0.22 vs. 0.15 per 1,000, P = 0.01). Incidence of type 2 diabetes was 3.7/100,000, with similar rates for female and male subjects (3.9 vs. 3.4 per 1,000, respectively, P = 0.3). High levels of abnormal cardiometabolic and behavioral risk factor profiles were common among youth with both type 1 and type 2 diabetes. For example, within each of four age-groups for youth with type 1 diabetes and two age-groups for youth with type 2 diabetes, >40% had elevated LDL cholesterol, and <3% of youth aged >10 years met current recommendations for intake of saturated fat. Among youth aged ≥15 years, 18% with type 1 and 26% with type 2 diabetes were current smokers. CONCLUSIONS—The SEARCH study is one of the most comprehensive studies of diabetes in NHW youth. The incidence of type 1 diabetes in NHW youth in the U.S. is one of the highest in the world. While type 2 diabetes is still relatively rare, rates are several-fold higher than those reported by European countries. We believe efforts directed at improving the cardiometabolic and behavioral risk factor profiles in this population are warranted.

Diabetes in African American Youth: Prevalence, incidence, and clinical characteristics: the SEARCH for Diabetes in Youth Study

OBJECTIVE—To report the prevalence and incidence of type 1 and type 2 diabetes among African American youth and to describe demographic, clinical, and behavioral characteristics. RESEARCH DESIGN AND METHODS—Data from the SEARCH for Diabetes in Youth Study, a population-based, multicenter observational study of youth with clinically diagnosed diabetes aged 0–19 years, were used to estimate the prevalence for calendar year 2001 (692 cases) and incidence based on 748 African American case subjects diagnosed in 2002–2005. Characteristics of these youth were obtained during a research visit for 436 African American youth with type 1 diabetes and 212 African American youth with type 2 diabetes. RESULTS—Among African American youth aged 0–9 years, prevalence (per 1,000) of type 1 diabetes was 0.57 (95% CI 0.47–0.69) and for those aged 10–19 years 2.04 (1.85–2.26). Among African American youth aged 0–9 years, annual type 1 diabetes incidence (per 100,000) was 15.7 (13.7–17.9) and for those aged 10–19 years 15.7 (13.8–17.8). A1C was ≥9.5% among 50% of youth with type 1 diabetes aged ≥15 years. Across age-groups and sex, 44.7% of African American youth with type 1 diabetes were overweight or obese. Among African American youth aged 10–19 years, prevalence (per 1,000) of type 2 diabetes was 1.06 (0.93–1.22) and annual incidence (per 100,000) was 19.0 (16.9–21.3). About 60% of African American youth with type 2 diabetes had an annual household income of <

The Many Faces of Diabetes in American Youth: Type 1 and Type 2 Diabetes in Five Race and Ethnic Populations: The SEARCH for Diabetes in Youth Study

25,000. Among those aged ≥15 years, 27.5% had an A1C ≥9.5%, 22.5% had high blood pressure, and, across subgroups of age and sex, >90% were overweight or obese. CONCLUSIONS—Type 1 diabetes presents a serious burden among African American youth aged <10 years, and African American adolescents are impacted substantially by both type 1 and type 2 diabetes.

Type 1 and Type 2 Diabetes in Asian and Pacific Islander U.S. Youth: The SEARCH for Diabetes in Youth Study

Diabetes, a leading cause of nephropathy, retinopathy, neuropathy, and coronary and peripheral vascular disease, is the third most prevalent severe chronic disease of childhood in the U.S. (1). People with diabetes diagnosed before the age of 20 years have a life expectancy that is 15–27 years shorter than people without diabetes (1), although prospective data show improvements in mortality for those diagnosed in more recent years (2). Until only a decade ago, diabetes diagnosed in children and adolescents was almost entirely considered to be type 1 diabetes, most often due to the autoimmune destruction of the β-cells of the pancreas leading to an absolute deficiency of insulin. Diabetes in children and adolescents is now viewed as a complex disorder with heterogeneity in its pathogenesis, clinical presentation, and clinical outcome. The occurrence of what appears clinically to be type 2 diabetes in youth, particularly overweight minority youth, has been documented in several studies. The SEARCH for Diabetes in Youth Study, funded by the Centers for Disease Control and Prevention, Division of Diabetes Translation, with support from the National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, began in 2000 with an overarching objective to describe childhood diabetes as it occurs among the five major race and ethnic groups in the U.S. These groups include non-Hispanic white, Hispanic, Asian/Pacific Islander, African American, and American Indian. Key aims of the study with a focus on race and ethnicity are the following: As previously published by the SEARCH study, both type 1 and type 2 diabetes occur in each of the five major race/ethnic …

Prevalence and Correlates of Elevated Blood Pressure in Youth with Diabetes Mellitus: The Search for Diabetes in Youth Study

OBJECTIVE—Given limited reports on diabetes among U.S. Asian and Pacific Islander youth, we describe the clinical characteristics, incidence, and prevalence of diabetes among Asian, Pacific Islander, and mixed Asian–Pacific Islander youth. RESEARCH DESIGN AND METHODS—Data were collected from 245 Asian, Pacific Islander, and Asian–Pacific Islander participants in the SEARCH for Diabetes in Youth Study, a population-based study of diabetes in youth (aged <20 years). Additionally, we estimated the incidence and prevalence of type 1 and type 2 diabetes for Asian, Pacific Islander, and Asian–Pacific Islander youth combined. RESULTS—Most participants with type 2 diabetes were obese (range Asian 71% to Pacific Islander 100%) with mean BMI >33 kg/m2. In those with type 1 diabetes, Pacific Islanders were more likely to be obese, with a mean BMI of 26 vs. 20 kg/m2 for Asian and Asian–Pacific Islander youth (P < 0.0001). The incidence of type 1 diabetes for youth aged 0–9 years was 6.4 per 100,000 person-years and 7.4 per 100,000 person-years for youth aged 10–19 years. The incidence of type 2 diabetes was 12.1 per 100,000 person-years for youth aged 10–19 years. CONCLUSIONS—While Asian and Asian–Pacific Islanders with type 1 and type 2 diabetes had lower mean BMIs than Pacific Islanders, all Asian, Pacific Islander, and Asian–Pacific Islanders with type 2 diabetes had mean BMIs above adult ethnicity-specific definitions of obesity. While the majority of Asian, Pacific Islander, and Asian–Pacific Islander youth had type 1 diabetes, older Asian, Pacific Islander, and Asian–Pacific Islander youth (aged 10–19 years) have an incidence of type 2 diabetes almost double that of type 1 diabetes. Public health efforts to prevent type 2 diabetes and obesity in Asian, Pacific Islander, and Asian–Pacific Islander adolescents are needed.

Understanding and Addressing Unique Needs of Diabetes in Asian Americans, Native Hawaiians, and Pacific Islanders

OBJECTIVE To determine the prevalence and correlates of elevated blood pressure (BP) in youth with type 1 or type 2 diabetes mellitus by using data from the SEARCH Study. STUDY DESIGN The analysis included youth aged 3 to 17 years with type 1 (n = 3691) and type 2 diabetes mellitus (n = 410) who attended a research visit. Elevated BP was defined as systolic or diastolic values >or=95 percentile, regardless of drug use. In youth with elevated BP, awareness was defined as self-report of an earlier diagnosis. Control was defined as BP values <90th percentile and <120/90 mm Hg in youth with an earlier diagnosis who were taking BP medications. RESULTS The prevalence of elevated BP in youth with type 1 diabetes mellitus was 5.9%; minority ethnic groups, obese adolescents, and youth with poor glycemic control were disproportionately affected. In contrast, 23.7% of adolescents with type 2 diabetes mellitus had elevated BP (P < .0001), Similarly, 31.9% of youth with type 2 diabetes mellitus and elevated BP were aware, compared with only 7.4% of youth with type 1 diabetes mellitus (P < .0001). Once BP was diagnosed and treated, control was similar in type 1 (57.1%) and type 2 diabetes mellitus (40.6%). CONCLUSIONS Our findings identify high-risk groups of youth with diabetes mellitus at which screening and treatment efforts should be directed.