Trends in Prevalence of Type 1 and Type 2 Diabetes in Children and Adolescents in the US, 2001-2017

Abstract

IMPORTANCEChanges in the prevalence of youth-onset diabetes have previously been observed.OBJECTIVE To estimate changes in prevalence of type 1 and type 2 diabetes in youths in the US from 2001 to 2017. DESIGN, SETTING, AND PARTICIPANTSIn this cross-sectional observational study, individuals younger than 20 years with physician-diagnosed diabetes were enumerated from 6 areas in the US (4 geographic areas, 1 health plan, and select American Indian reservations) for 2001, 2009, and 2017. EXPOSURES Calendar year. MAIN OUTCOMES AND MEASURES Estimated prevalence of physician-diagnosed type 1 and type 2 diabetes overall and by race and ethnicity, age, and sex. RESULTS Among youths 19 years or younger, 4958 of 3.35 million had type 1 diabetes in 2001, 6672 of 3.46 million had type 1 diabetes in 2009, and 7759 of 3.61 million had type 1 diabetes in 2017; among those aged 10 to 19 years, 588 of 1.73 million had type 2 diabetes in 2001, 814 of 1.85 million had type 2 diabetes in 2009, and 1230 of 1.85 million had type 2 diabetes in 2017. The estimated type 1 diabetes prevalence per 1000 youths for those 19 years or younger increased significantly from 1.48 (95% CI, 1.44-1.52) in 2001 to 1.93 (95% CI, 1.88-1.98) in 2009 to 2.15 (95% CI, 2.10-2.20) in 2017, an absolute increase of 0.67 per 1000 youths (95%, CI, 0.64-0.70) and a 45.1% (95% CI, 40.0%-50.4%) relative increase over 16 years. The greatest absolute increases were observed among non-Hispanic White (0.93 per 1000 youths [95% CI, 0.88-0.98]) and non-Hispanic Black (0.89 per 1000 youths [95% CI, 0.88-0.98]) youths. The estimated type 2 diabetes prevalence per 1000 youths aged 10 to 19 years increased significantly from 0.34 (95% CI, 0.31-0.37) in 2001 to 0.46 (95% CI, 0.43-0.49) in 2009 to 0.67 (95% CI, 0.63-0.70) in 2017, an absolute increase of 0.32 per 1000 youths (95% CI, 0.30-0.35) and a 95.3% (95% CI, 77.0%-115.4%) relative increase over 16 years. The greatest absolute increases were observed among non-Hispanic Black (0.85 per 1000 youths [95% CI, 0.74-0.97]) and Hispanic (0.57 per 1000 youths [95% CI, 0.51-0.64]) youths. CONCLUSIONS AND RELEVANCEIn 6 areas of the US from 2001 to 2017, the estimated prevalence of diabetes among children and adolescents increased for both type 1 and type 2 diabetes.

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“…However, the observed association of increased risk for diabetes diagnosis following SARS-CoV-2 infection would not be explained solely by delayed care. COVID-19 has disproportionately affected racial/ethnic minority groups, and those aged <18 years in these groups are also at increased risk for type 2 diabetes ( 10 ). An association between COVID-19 and new pediatric diabetes diagnoses might disproportionately affect racial/ethnic minority groups.…”

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“…Islet beta cell stress leads to activation of beta cell neoantigen production and stimulation of HLA class I expression on the cell surface [3][4][5]. This could underlie, at least in part, the increasing incidence of type 1 diabetes within older children and adolescents [6,7]. Accordingly, approaches to limit islet beta cell metabolic stress through pharmacological means, such as by using metformin, or reducing availability of nutrient secretagogues, could prevent type 1 diabetes [8,9].…”

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