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Type 1 to Triple, Type 2 to Quadruple in Youth

Posted: Monday, December 03, 2012

The findings, from the Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, and colleagues, were published in the December issue of Diabetes Care.

The investigators used data from the SEARCH for Diabetes in Youth Study and the US Census Bureau to model 2 scenarios: One in which the diabetes incidence of both diabetes types remains constant at 2002 levels, and the other in which annual incidence rates increase over time at the rates that they were found to have been increasing among youth in a previous trial from Colorado, published in Diabetes Care in 2007.

Assuming incidence rates remain constant, the number of people younger than 20 years who have type 1 diabetes could increase by 23% (from 166,018 in 2010 to 203,385 in 2050), and the number of young people with type 2 diabetes by 49% (from 20,203 in 2010 to 30,111 by 2050).

However, if incidence rates increase, the number of youth with type 1 diabetes could more than triple, and those living with type 2 diabetes could quadruple, particularly among those of minority race or ethnicity.

"Our projections indicate a serious picture of the future national diabetes burden in youth. Even if the incidence remains at 2002 levels, because of the population growth projected by the U.S. Census the future numbers of youth with diabetes is projected to increase, resulting in increased health care needs and costs," the authors write.

According to US Census projections, the proportion of the US population younger than 20 years who are non-Hispanic white will drop from 62% in 2001 to 41% in 2050. Because type 1 diabetes is more common in non-Hispanic whites and type 2 diabetes is higher among minorities, this shift in population is expected to dramatically affect the absolute numbers of people living with type 1 vs type 2 diabetes.

"This makes even more compelling the need for diabetes type-specific projections," the authors write.

For example, although non-Hispanic whites now account for 71% of all youth with type 1 diabetes, if current incidence rates remain the same, that proportion would drop to 55% by 2050 as the absolute number of minority youth in the population rises. Overall, the absolute number of Hispanic youth with type 1 diabetes is projected to increase by 2.5-fold.

In the scenario of rising incidence, with annual increases ranging from 1.8% to 3.5% depending on age (derived by the Colorado trial), the overall prevalence of youth with type 1 diabetes would increase by 3.3-fold overall, from 179,388 in 2010 to 587,488 in 2050. Again, the rise would be greater among Hispanics (6.6-fold), Asian and Pacific Islanders (5.4-fold), American Indian/Alaska Native (4.4-fold), and non-Hispanic blacks (3.0-fold), than among non-Hispanic whites (2.5-fold).

Using a theoretical 2.3% annual increase in type 2 diabetes incidence, the number of youth affected would rise nearly 4-fold, from 22,820 in 2010 to 84,131 in 2050, with Hispanics accounting for 50% and non-Hispanic blacks for 27% of affected youth, the authors write.

In an accompanying commentary, Robert E. Ratner, MD, said that the findings point to an "imperative" to prevent diabetes.

"With diabetes already responsible for over 25% of the Medicare budget, the increase in both type 1 and type 2 diabetes in youth described by Imperatore et al. sends an alarm that the future of the U.S. health delivery system will be overwhelmed unless prevention of diabetes becomes our next major health care goal," said Dr. Ratner, the American Diabetes Association's chief scientific and medical officer, Alexandria, Virginia.

He cited 2007 data (scheduled to be revised in early 2013) of a total $174 billion in healthcare costs for people with diabetes. "Given the increased prevalence of diabetes, there is no reason to believe that the direct medical costs will not continue to increase at this unacceptable rate."

There is currently no information regarding prevention of type 2 diabetes in youth, as there is for adults, Dr. Ratner notes. "If we are to avoid the catastrophic impact on our citizenry, our health care system, and our economy, we must aggressively address the issue of early detection and treatment and prevention."

Source:, Diabetes Care. 2012;35:2515-2520.

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