Commentary by Lin Li, MD, PhD
The prevalence of diabetes (type 1 and type 2) rose among commercially-insured children and adolescents between 2002 to 2013, according to a study published online ahead of print in Diabetes Care. The study also showed that while diabetic nephropathy is relatively uncommon in youth, the prevalence also is on the rise.
The study authors reviewed a large U.S.-based claims database (Market-Scan Commercial Claims and Encounters Database of Truven Health Analytics) and identified 96,171 pediatric patients (aged <18 years) first diagnosed with diabetes between 2002 and 2013 who met the inclusion criteria. The majority of these patients (79%) had type 1 diabetes. Of this subgroup, 53% were male, and 53% were aged 12 to <18 years at diagnosis. In the type 2 diabetes subgroup, 60% were female and 79% were aged 12 to <18 years at diagnosis.
Prevalence of Diabetes
The prevalence of type 1 diabetes increased from 1.48 to 2.32 per 1,000 patients between 2002 and 2013. The average increase was 8.5% per year from 2002 to 2006 and 1.4% thereafter (P<0.05 for both values).
“Type 1 diabetes is an autoimmune disease and accounts for a majority of childhood and adolescent diabetes. The findings that the prevalence of type 1 diabetes among U.S. young people (ages 0-17 years) increased from 2002 to 2013 warrant further studies to determine the causes for the increase,” said lead author Lin Li, MD, PhD, who is Epidemiologist and Research Assistant Professor of Epidemiology at Boston University School of Public Health in Massachusetts.
The prevalence of type 2 diabetes increased from 0.38 to 0.67 per 1,000 patients (average increase 13.3% per year; P<0.05) between 2002-2006 and then ranged from 0.56 to 0.49 per 1,000 thereafter (average decrease 2.7% per year: P<0.05).
For both types of diabetes, the highest prevalence was found in patients aged 12 to <18 years. In terms of gender, the prevalence of type 1 diabetes was higher in boys than girls and the prevalence of type 2 diabetes was higher in girls than boys.
Link Between Type 2 Diabetes and Obesity Prevalence
“Obesity is the most important risk factor for type 2 diabetes in youth, and the rise in pediatric obesity was accompanied by an increased prevalence of type 2 diabetes in children,” Dr. Li said. “Ogden et al recently reported that there were no significant changes in obesity prevalence in U.S. youth under the age of 20 years between 2003 to 2004 and 2011 to 2012, but there was a significant decrease in obesity among 2- to 5-year-old children.”
“The findings by Ogden et al may at least partially explain our findings on the prevalence of type 2 diabetes (rose from 0.38 per 1000 to 0.67 per 1000 from 2002-2006, then dropped from 0.56 to 0.49 per 1000 thereafter),” Dr. Li noted. “The slight decline in prevalence of type 2 diabetes in the later years of the study was encouraging.”
Prevalence of Diabetic Nephropathy Also on the Rise
“During the same time period, the prevalence of diabetic nephropathy rose as well, from 1.16 percent of all pediatric diabetes cases to 3.44%,” Dr. Li said.
The average increase was 25.7% per year from 2002 to 2005 and then 4.6% thereafter (P<0.05 for both values). There were no differences in the prevalence of diabetic nephropathy by diabetes type. As with diabetes, the prevalence of diabetic nephropathy was highest among youth ages 12 to <18 years. The prevalence of diabetic nephropathy was slightly higher in girls than boys.
“Diabetic nephropathy is the leading cause of end-stage renal disease (ESRD) in adults; this finding is important because such youth with diabetic nephropathy will enter adulthood with the potential for progression to ESRD. Thus, it is imperative for health care professionals to identify and treat diabetic nephropathy early in its course.”
Li L, Jick S, Breitenstein S, Michel A. Prevalence of diabetes and diabetic nephropathy in a large U.S. commercially insured pediatric population, 2002-2013. Diabetes Care. 2015 Dec 17. pii: dc151710. [Epub ahead of print]
Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA. 2014;311(8):806-814.