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Increasing Incidence of Type 1 Diabetes In Children

Philadelphia youth see rise in diagnosis; especially for African Americans, by 70%.

A study was conducted in all children ages 0-14 years with a diagnosis code of type 1 or type 2 diabetes mellitus in Philadelphia from 2000–2004. The study aimed to describe the increasing incidence of type 1 diabetes in children. Researchers then used these data to compare to the previous three cohorts in the Philadelphia Pediatric Diabetes Registry to determine an increase in incidence over 20 years. In addition, these data describe the first cohort of youth with type 2 diabetes.

The records of all children from 0-14 years old with type 1 or type 2 diabetes were obtained through a retrospective population-based registry. Researchers reviewed inpatient and outpatient records from World Health Organization (WHO) diabetes registry to identify diabetes cases diagnosed from 1 January 2000 to 31 December 2004. In addition, data on length, height, weight, and BMI were collected for children ages 0-14 years. The completeness of validation was ascertained through a survey of nurses who worked for the School District of Philadelphia. The changing pattern of the yearly incidence of type 1 diabetes over 20-year period was evaluated using time series analysis.

The overall incidence rate of type 1 diabetes was 17.2 per 100,000 per year (95% CI 15.2–19.3) and the age-adjusted incidence was 17.0 per 100,000 per year (95% CI 15.8–18.3). The incidence was higher than that of previous cohorts by an average of 1.5% annually and an average 5-year cohort was increased by 7.8% (P = 0.025). The racial/ethnic data showed that the highest age-adjusted rate was in Hispanic children (19.6; 95% CI 15.9–23.3) which had increased 27%, followed by non-Hispanic whites (19.2 [16.8–21.5]) with an increase of 48%, and then African Americans (14.7 [13.1–16.3]). The incidence in children from 0-14 years old increased 70% compared to previous cohort; this increase was most found in young African-American children.

In type 2 diabetes, African-American children accounted for 85.4% of the cases, non-Hispanic white children accounted for 5.2%, Hispanic children comprised 3.1%, and other ethnicity were 4.1%. The overall age-adjusted incidence was 5.8 per 100,000 per year with African-American children having the highest incidence (9.2; 95% CI 7.9–10.2), followed by Hispanic children (1.5 [0.4–2.6]) and non-Hispanic whites (0.94 [0.4–2.0]). Type 1 diabetes was 18 times more common than type 2 diabetes, 10 times more common in Hispanic children, but only 1.6 times more common in African-American children.

There are some limitations to the Philadelphia Pediatric Diabetes Registry. Data were collected from the three pediatric hospitals in Philadelphia. The pediatric hospitals accounted for >98% of children cases with diabetes in the previous cohort and this was verified for this sample. Furthermore, some of the few cases that were diagnosed in a general hospital and subsequently transferred to a pediatric hospital were then identified. Another limitation is that it was impossible to positively confirm the type of diabetes of the cases. Also, data on BMI z scores were not available for cohorts before 1995–1999, making 20-year comparisons impossible.

Practice Pearls:

  • The incidence rate of type 1 diabetes is increased by 29% among children in Philadelphia.
  • In white children, the incidence of type 1 diabetes is 18 times higher than that of type 2 but only 1.6 times higher in African-American children.
  • The rapidly rising risk of diabetes in African-American children ages 0-14 years is particularly a concern in diabetes outcomes and treatment.

Reference:

Terri H. Lipman, Lorraine K, Sarah R, Kathryn M. Increasing Incidence of Type 1 Diabetes in Youth. American Diabetes Association. 2013 Jun; 36(6): 1597-1603.

 

Kay Lynn Tran, PharmD candidate L|E|C|O|M SOP Bradenton ’18