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Diabetes Projects
Children and Diabetes
SEARCH for Diabetes in Youth
Diabetes is one of the most common chronic diseases among children in
the United States.
When diabetes strikes during childhood, it is routinely assumed to be
type 1, or juvenile-onset, diabetes. Type 1 diabetes develops when the
body's immune system destroys pancreatic cells that make the hormone insulin
that regulates blood sugar. It normally strikes children and young adults.
People with type 1 diabetes must have daily insulin injections to survive.
In the last two decades, type 2 diabetes, formerly known as adult-onset
diabetes, has been reported among U.S. children and adolescents with
increasing frequency. Type 2 diabetes begins when the body develops a
resistance to insulin and no longer uses the insulin properly. As the need
for insulin rises, the pancreas gradually loses its ability to produce
sufficient amounts of insulin to regulate blood sugar.
Reports of increasing frequency of both type 1 and type 2 diabetes in
youth has been among the most concerning aspects of the evolving diabetes
epidemic. Unfortunately, reliable data on changes over time in the U.S., or
even how many children in the U.S. had type 1 or type 2 diabetes, were
lacking. In response to this growing public health concern, the Centers for
Disease Control and Prevention (CDC) and the National Institutes of Health (NIH)
in 2000 funded the SEARCH for Diabetes in Youth Study
www.searchfordiabetes.org* .
SEARCH is a multicenter, epidemiological study, conducted in six
geographically dispersed populations that encompass the racial/ethnic
diversity of the U.S. It is designed to characterize the burden of both type 1 and
type 2 diabetes, along with the associated complications, the levels of
care, and impact on the daily lives of children and youth in the U.S.
SEARCH Facts
In the year 2001, approximately 3.5 million children less than 20 years
of age were under surveillance at the six SEARCH centers to estimate how
many children or young people had DM (prevalent cases);
- SEARCH provides
estimates of 2001 DM prevalence
(1.8 per 1,000) (Link to directly to PUB MED; Pediatrics, 2006
118(4):1510-8).
- SEARCH prevalence data indicate that in the U.S., at least 154,000
children/youth have DM. DM prevalence varies across major racial/ethnic
groups:
- In children 0–9 years of age non-Hispanic whites have the
highest prevalence (about 1/1,000). In this age group across all
race/ethnic groups, type 1 DM is the most common form of diabetes.
The study found that type 2 DM is extremely rare in children of all
races younger than 10 years of age.
- Among adolescents and young adults (age 10–19 years), African
American and non-Hispanic white youth have the highest burden of DM
(about 1 of 315) and Asian/Pacific Islanders have the lowest
(about 1 of 746).Type 1 DM prevalence is 2.3/1,000 and it is the
most common form of DM in all racial/ethnic groups except in
American Indian youth. Type 2 prevalence is 0.4/1,000 and it
represented 6% of the cases of diabetes in Non-Hispanic White, 33%
in African American, 40% in Asian/Pacific Islander, and 76% among American Indian youth.
Since 2002, approximately 5.5 million children less than 20 years of age
(approximately 6 percent), each year
have been under surveillance at the SEARCH research centers to estimate how
many children/youth develop diabetes (incidence cases) per year;
- Based on
2002 and 2003 data,
the overall incidence is estimated to be 24.3 per 100,000 per year.
Annually, an estimated 15,000 youth are diagnosed with type 1diabetes,
and about 3,700 youth are diagnosed with type 2.
- Among youth aged <10 years, most diabetes cases are type 1,
regardless of race/ethnicity. In this age group the highest
incidence of type 1 diabetes is observed in non-Hispanic whites
(19/100,000 for 0– to 4– years-old and 28/100,000 for 5– to 9– years-old)
- Among older youth (ages 10–14 and 15–19 years), the highest
incidence of type 1 diabetes is in non-Hispanic white youth
(33/100,000 per year for 10– to 14– years-old and 15/100,000 for 15– to 19– year olds),
followed by African American (19.2 and 11.1) and Hispanic (17.6 and
12.1), and lowest among American Indian (7.1 and 4.8) and
Asian/Pacific Islanders (8.3 and 6.8).
- The incidence of type 2 DM is the highest among American Indians
(25.3 and 49.4 for ages 10–14 and 15–19 years, respectively),
followed by African Americans (22.3 and 19.4), Asian/Pacific
Islanders (11.8 and 22.7) and Hispanics (8.9 and 17.0), and is low
(3.0 and 5.6) among non-Hispanic whites.
SEARCH has shown that
nutritional intake in adolescents with DM
is poor and does not follow current recommendations. Recommendations for
total dietary fat intake are met by only 10 percent of youth with DM and
recommendations for saturated fat intake by only 7 percent.
SEARCH found that about 9 percent of adolescents with DM have moderate or
severely depressed mood symptoms, with more girls than boys being affected.
Depressed mood is associated with poor glycemic control and a higher
likelihood of emergency room visits. (Pediatrics, 2006; 117:1348–58);
About half of the SEARCH participants had an LDL-C concentration above
the optimal level of 100 mg/dL. In older youth (≥ 10 yrs of age), the
prevalence of abnormal lipids was higher in those with type 2 (33%) than in
those with type 1 diabetes (19%). (J Pediatr, 2006; 149(3); 314-9).
Moreover, worse glycemic control was associated with a worse lipid profile,
regardless of diabetes type (Arch Pediat Adoles Med 2007;161:159–165)
The prevalence of multiple cardiovascular disease (CVD) risk factors is
high in children and adolescents with DM. CVD risk factors are present in
both youth with T1 or T2 DM, but were more common in adolescents with T2 DM
(Diab Care 2006; 29:1891-1896).
Higher Body Mass Index (BMI) is associated with younger age at diagnosis of
T1 DM but, only in children with reduced beta cell function. These data
suggest that, only among individuals with already compromised beta-cell
function or high rate of beta cell loss, obesity accelerates T1 DM
onset. In addition, low birth weight may be a factor in accelerating the
onset of T1 DM. These data suggest that the intrauterine environment may be
an important determinant of age of onset for T1 DM (Diabetes Care, 2006; 29:
290–4).
Implications
SEARCH provides the foundation for childhood diabetes surveillance
efforts in public health, clinic, and research settings. SEARCH data is
important to ultimately design and implement public health efforts
to prevent type 1, once prevention strategies are identified, and type 2
diabetes in youth.
The data that are acquired by SEARCH regarding the natural history, risk
factors of diabetes complications, quality of care and quality of life will
also help design and implement interventions
that can reduce the risk for both acute and chronic diabetes complications.
SEARCH Research Centers
Kaiser Permanente Southern California, Pasadena CA
University of Colorado Health Sciences Center, Denver CO
Pacific Health Research Institute, Honolulu HI
Children抯 Hospital Medical Center, Cincinnati OH
University of South Carolina School of Public Health, Columbia SC
Children抯 Hospital and Regional Medical Center, Seattle WA
Coordinating Center: Wake Forest University School of Medicine,
Winston-Salem NC
Central Laboratory: Northwest Lipid Research Laboratories, University of
Washington, Seattle, WA
For more information
SEARCH Publications
The SEARCH Writing Group. SEARCH for Diabetes in Youth: a Multi-Center
Study of the Prevalence, Incidence and Classification of Diabetes Mellitus
in Youth. Controlled Clinical Trials 2004;25:458–471.
Dabelea D, D'Agostino RB Jr, Mayer-Davis EJ, Pettitt DJ, Imperatore G,
Dolan LM, Pihoker C, Hillier TA, Marcovina SM, Linder B, Ruggiero AM, Hamman
RF. Testing the accelerator Hypothesis: Body size, beta-cell function, and
age at onset of T1 (autoimmune) diabetes. Diabetes Care 2006;29:290�4.
Lawrence JM, Standiford DA, Loots B, Klingensmith GJ, Williams DE,
Ruggiero A, Liese AD, Bell RA, Waitzfelder BE, McKeown RE, the SEARCH
for Diabetes in Youth Study. Prevalence and correlates of depressed mood
among youth with diabetes: The SEARCH for Diabetes in Youth Study.
Pediatrics 2006;117:1348�58.
Mayer-Davis EJ, Nichols M, Liese A, Bell R, Dabelea D, Johansen J,
Pihoker C, Rodriguez B, Thomas J, Williams DE For the SEARCH for Diabetes in
Youth Study Group. Dietary intake among youth with diabetes: the SEARCH for
Diabetes in Youth Study. Journal of the American Dietetic Association
2006;106:689�7.
Rodriguez BL, Mayer-Davis EJ, Imperatore G, Williams DE, Bell RA, Pihoker
C, Wadwa RP, Palla SL, Liese AD, Liu LL, Kershnar A, Daniels SR, Linder B,
FujimotoWY 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. Diabetes Care 2006;
29:1891�96.
Kershnar AK, Daniels SR, Imperatore G, Palla SL, Petitti DB, Pettitt DJ,
Marcovina S, Dolan LM, Hamman RF, Liese AD, Pihoker C, Rodriguez BL. Lipid
abnormalities are prevalent in youth with T1 and T2 diabetes: the SEARCH for
Diabetes in Youth Study. Journal of Pediatrics 2006;149:314�9.
The SEARCH for Diabetes in Youth Study Group. The burden of diabetes
among U.S. youth: prevalence estimates from the SEARCH for Diabetes in Youth
Study. Pediatrics 2006;118:1510�18.
Petitti DB, Imperatore G, Palla SL, Daniels SR, Dolan LM, Kershnar AK, Marcovina S, Pettitt DJ, Pihoker C the SEARCH for Diabetes in Youth
Study Group. Serum lipids and glucose control: the SEARCH for Diabetes in
Youth Study. Archives of Pediatrics and Adolescent Medicine 2007;161:159�5
The SEARCH for Diabetes in Youth Study Group. Incidence on diabetes in
youth in the United States: the SEARCH for Diabetes in Youth Study. JAMA
2007; 297:2716�).
* Links to non-Federal organizations found at this site are provided solely
as a service to our users. These links do not constitute an endorsement
of these organizations or their programs by CDC or the Federal Government,
and none should be inferred. The CDC is not responsible for the content
of the individual organization Web pages found at these links.
Page last reviewed: December 3, 2007
Page last modified: December 3, 2007
Content Source: National Center for Chronic Disease Prevention and Health Promotion
Division of Diabetes Translation
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