National Surveillance for Type 2 Diabetes Mellitus in Taiwanese Children

Abstract

Context Despite a disturbing trend of increasing prevalence of type 2 diabetes mellitus (DM) in childhood, little is known about the epidemiology of childhood type 2 DM, especially in the Taiwanese population.Objective To study the rate and risk factors for childhood type 2 DM based on a nationwide screening program in Taiwan.Design, Setting, and Participants Screening in 1999 for type 2 DM using urine and blood testing and confirmed by follow-up telephone survey among schoolchildren aged 6 to 18 years in Taiwan, followed by a nested case-control study conducted in 2002 comparing 137 children with type 2 DM with 1000 randomly selected children without diabetes chosen to represent the age and sex distribution of the whole student population.Main Outcome Measures Rate and identification of risk factors associated with childhood type 2 DM. ResultsThe rate of newly identified diabetes was 9.0 per 100000 for boys and 15.3 per 100000 for girls. Follow-up at 3 years revealed that, of 253 children with newly diagnosed diabetes, 24 (9.5%) had type 1 DM, 137 (54.2%) had type 2 DM, and 22 (8.7%) had secondary diabetes. Compared with children aged 6 to 9 years, the odds ratios (ORs) and 95% confidence intervals (CIs) of type 2 DM increased to 6.59 (3.23-13.4) for those aged 13 to 15 years and to 4.59 (2.07-10.2) for those aged 16 to 18 years. The OR (95% CI) of type 2 DM in children with a body mass index in the 95th percentile or higher (obesity) was 18.8 (9.22-38.5) compared with those with a body mass index in less than the 50th percentile. Other factors significantly associated with type 2 DM were hypercholesterolemia (OR, 1.80; 95% CI, 1.04-3.23), blood pressure greater than the 85th percentile (OR, 1.70; 95% CI, 1.07-2.70), and positive family history of diabetes (OR, 3.95; 95% CI, 2.01-7.78). ConclusionsOur mass screening program showed that type 2 DM is the leading cause of childhood DM in Taiwan. Obesity is a major risk factor for the development of type 2 DM in children.

Global trends in the incidence and prevalence of type 2 diabetes in children and adolescents: a systematic review and evaluation of methodological approaches

“…Although the Princeton study recently showed that undiagnosed type 2 diabetes is very uncommon in adolescents and that this has not changed over the last decades [49], the findings from the Princeton study probably cannot be extrapolated to countries in which patients have only limited access to healthcare and/or the healthcare system has a suboptimal quality. Second, the quality of detection and classification of type 2 diabetes might differ between healthcare providers [29,32,35,36]. The Netherlands (1998) [37] Turkey, Ankara (not specified) [18] UK (2000) [27] UK (1998) [41]Fig.…”

“…Also, just as in the other methods, the sensitivity and specificity of the diagnostic tests, with the potential risks of under-or over-diagnosis, respectively, can be a problem. Wei et al reported that the sensitivity of the glycosuria test used in the screening for diabetes ranged from 20% to more than 80% [32]. Finally, the performance of a population-based screening is probably more costly than the other methods.…”

“…In almost all studies, the healthcare providers or investigators confirmed the type of diabetes, except in two studies in which the type of diabetes was reported by parents or children themselves via questionnaire or telephone survey [32,39].…”

Confronting the Epidemic: The Need for Global Solutions

“…A mass screening program of Taiwanese children identified a 6:1 ratio of type 2 to type 1 diabetes, with obesity as the major risk factor for the development of type 2 diabetes. The likelihood of having type 2 diabetes in obese children (above the 95th percentile ranking for their age and sex) was 18.8 times greater than those on the median or 50th percentile (19).…”

Perspectives on the Nutritional Management of Metabolic Syndrome in Asia: People, Practice and Programmes

“…On the other hand, according to a 1999 survey in Taiwan, the rate of newly diagnosed diabetes was 9 per 100,000 for males and 15 per 100,000 for females. Family history, high blood pressure, obesity and high blood cholesterol were the major risk factors [11].…”