Rapid Rise in Diabetes Among Children and Teens

Newly diagnosed cases increasing each year, especially in ethnic minorities
 

Scientists are baffled by the rapid rise in diagnoses of type 1 diabetes (T1D) and type 2 diabetes (T2D) among children and teens, with the fastest increase seen in racial/ethnic minority youth.
 

A research study recently published in the New England Journal of Medicine is the first ever to estimate trends in newly diagnosed cases of T1D and T2D in people under age 20 from the five major racial/ethnic minority groups in the United States.
 
The ongoing SEARCH for Diabetes in Youth study (searchfordiabetes.org) shows that from 2002 to 2012, newly diagnosed cases of T1D in youth increased by 1.8% every year. During the same period, the rate of newly diagnosed cases of T2D increased even faster at 4.8% annually.
 
“Because of the early age of onset and longer diabetes duration, youth are at risk for developing diabetes-related complications at a younger age,” explains study researcher, Dr. Giuseppina Imperatore, from the Centers for Disease Control and Prevention (CDC). “This profoundly lessens their quality of life, shortens their life expectancy and increases health care costs.” 
 
The ongoing study, which is designed to assess diabetes trends in youth so experts can identify how the diabetes epidemic is changing over time, also showed:
  • Across all racial/ethnic groups, the rate of newly diagnosed cases of T1D increased more annually from 2003 to 2012 in males (2.2%) than in females (1.4%) ages 0 to 19.
  • Among youth ages 0 to 19, the rate of newly diagnosed cases of T1D diabetes increased most sharply in Hispanic youth – a 4.2% annual increase. In non-Hispanic blacks, the rate of newly diagnosed cases of T1D increased by 2.2% and in non-Hispanic whites, by 1.2% per year.
  • The rate of newly diagnosed cases of T2D rose much more sharply in females (6.2%) than in males (3.7%) ages 10 to 19.
The reason for rising diabetes rates in youth is unclear, according to Dr. Aaron Kowalski, JDRF Chief Mission Officer and Vice-president of Research. However, he notes, rising rates of T2D, which in the past was very rare in young people, are likely tied to the obesity epidemic.

“Although T2D is a genetically inherited disease, it is driven by weight,” says Dr. Kowalski. “It is not the weight itself that causes type 2 diabetes, but increasing weight exacerbates an underlying process and because people are gaining weight around the world, we are seeing more and more of it.” The rise in T1D is additionally difficult to explain. It is important to understand, explains Dr. Kowalski, that T1D is a genetic disease and it is believed to be caused by exposure to an environmental trigger. 

This increased incidence in T1D, he says, demonstrates that environmental triggers are responsible for the autoimmune response. Hence the question: Does the immune system go out of kilter first and then attack and kill the beta cells that make insulin, or do the beta cells go wrong first, triggering the immune system to attack? 

This ‘chicken or the egg’ debate, says Dr. Kowalski, is an important line of scientific investigation and could have implications for treatments, and ultimately, a cure for T1D. 

“If, for example, it’s a beta cell problem there could be drugs that focus on those cells instead of focusing on the immune system,” he says. “Eventually, though, it’s likely that beta cell therapies and immunotherapies are going to go hand-in-hand as a combination therapy.”
 
JDRF is supporting a number of clinical trials looking at the effectiveness of combination therapies – with a cure being the Foundation’s ultimate goal.

Source: Mayer‑Davis EJ, Lawrence JM, Dabelea D, et al. Incidence Trends of Type 1 and Type 2 Diabetes among Youths, 2002–2012. N Engl J Med. 2017;376:1419-29.

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