Children and Diabetes Children and Diabetes
Center for Diseae Control and Prevention—-Diabetes Public Health Resource

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Diabetes is one of the most common chronic diseases in children and adolescents; about 151,000 people below the age of 20 years have diabetes.

When diabetes strikes during childhood, it is routinely assumed to be type 1, or juvenile-onset diabetes. However, in the last 2 decades, type 2 diabetes (formerly known as adult-onset diabetes) has been reported among U.S. children and adolescents with increasing frequency. Also, studies conducted in Europe showed an increase in the frequency of type 1 diabetes, especially in young children. It is unclear whether the frequency of type 1 diabetes is also increasing among U.S. youth.

Findings Each year, more than 13,000 young people are diagnosed with type 1 diabetes. 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. Health care providers are finding more and more children with type 2 diabetes, a disease usually diagnosed in adults aged 40 years or older. A statistically significant increase in the prevalence of type 2 diabetes among children and adolescents was found only for American Indians. The epidemics of obesity and the low level of physical activity among young people, as well as exposure to diabetes in utero, may be major contributors to the increase in type 2 diabetes during childhood and adolescence. Type 2 diabetes in children and adolescents already appears to be a sizable and growing problem among U.S. children and adolescents. Better physician awareness and monitoring of the disease’s magnitude will be necessary. Standard case definition(s), guidelines for treatment, and approval of oral hypoglycemic agents (to lower blood sugar) are urgently required for children and adolescents.

Children and adolescents diagnosed with type 2 diabetes are generally between 10 and 19 years old, obese, have a strong family history for type 2 diabetes, and have insulin resistance. Generally, children and adolescents with type 2 diabetes have poor glycemic control (A1C = 10% – 12%).

Those affected with type 2 diabetes belong to all ethnic groups, but it is more commonly seen in non-white groups. American Indian youths have the highest prevalence of type 2 diabetes. In the 15-to-19-year age group, the current prevalences were

50.9 per 1000 for Pima Indians from Arizona; 4.5 per 1000 for all U.S. American Indian populations (reported cases from the U.S. Indian Health Service outpatient clinics); 2.3 per 1000 for Canadian First Nation people from Manitoba (reported cases from outpatient clinics).

In comparison, the prevalence per 1000 of type 1 diabetes for U.S. residents aged 0-19 years is 1.7 per 1000.

Population-based prevalence estimates for other ethnic groups were not available. In a retrospective study of such reports, a referral center in Cincinnati, Ohio, found an incidence for type 2 diabetes of 7.2 per 100,000 for African Americans and whites aged 10-19 years in 1994. By comparison, the national incidence of type 1 diabetes among those aged 10-19 years is 19 per 100,000. In most of the U.S. case reports, type 2 diabetes accounted for 8% to 46% of all new cases of diabetes (type 1 and type 2) referred to pediatric centers. The magnitude of type 2 diabetes is probably underestimated.

Why is it hard to detect the prevalence of type 2 diabetes in children?

It is hard to detect type 2 diabetes in children because it can go undiagnosed for a long time; because children may have no symptoms or mild symptoms; and because blood tests are needed for diagnosis. It is difficult to be sure it is type 2, because criteria for differentiating between types of diabetes in children are confusing; that is, children with type 2 can develop ketoacidosis (acid build-up in the blood); children with type 1 can be overweight; and because the overall prevalence of the disease may still be low. This means that scientists will have to sample a very large population of children in order to find a stable estimate of prevalence.