This study ascertained cases of type 1 and type 2 diabetes among youths from 2002 through 2012 at five U.S. study centers. After adjustment for age, sex, and race or ethnic group, there were relative ...annual increases in the incidences of type 1 and type 2 diabetes.
Diagnoses of type 1 and type 2 diabetes in youths present a substantial clinical and public health burden owing to the challenges of disease management and the risks of acute and chronic complications.
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The SEARCH for Diabetes in Youth study (hereafter, the SEARCH study) previously showed increases in the prevalences of both diseases in the 2001–2009 period.
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However, data on the trends in incidence are needed to understand the current and potential burden of diabetes more fully.
Previous reports have shown that the incidence of type 1 diabetes has increased worldwide over the past three decades.
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8
Data from Australia . . .
Background
The diagnosis of type 1 diabetes (T1D) in youth is often associated with diabetic ketoacidosis (DKA). We aimed to evaluate if the presence of DKA at diagnosis of T1D is associated with ...less favorable hemoglobin A1c (HbA1c) trajectories over time.
Methods
The SEARCH for Diabetes in Youth study of 1396 youth aged <20 years with newly diagnosed T1D were followed for up to 13 (median 8 interquartile range or IQR 6‐9) years after diagnosis. Of these, 397 (28%) had DKA (bicarbonate level < 15 mmol/L and/or pH < 7.25 (venous) or < 7.30 (arterial or capillary) or mention of DKA in medical records) at diabetes onset. Longitudinal HbA1c levels were measured at each follow‐up visit (average number of HbA1c measures 3.4). A linear piecewise mixed effects model was used to analyze the effect of DKA status at diagnosis of T1D on long‐term glycemic control, adjusting for age at diagnosis, diabetes duration at baseline, sex, race/ethnicity, household income, health insurance status, time‐varying insulin regimen and glucose self‐monitoring, study site, and baseline fasting C‐peptide level.
Results
At baseline, HbA1c levels were significantly higher in youth with T1D diagnosed in DKA vs those who were not (9.9% ± 1.5% vs 8.5% ± 1.4%, respectively). After the first year with diabetes, there was a significant difference in the rate of change in HbA1c levels by DKA status: HbA1c was 0.16% higher each year in youth with DKA compared to those without (interaction P‐value<0.0001), after adjusting for aforementioned covariates.
Conclusions
DKA at T1D diagnosis is associated with worsening glycemic control over time, independent of demographic, socioeconomic, and treatment‐related factors and baseline fasting C‐peptide.
Epidemiology of type 1 diabetes Maahs, David M; West, Nancy A; Lawrence, Jean M ...
Endocrinology and metabolism clinics of North America,
09/2010, Letnik:
39, Številka:
3
Journal Article
Recenzirano
Odprti dostop
This article describes the epidemiology of type 1 diabetes mellitus (T1D) around the world and across the lifespan. Epidemiologic patterns of T1D by demographic, geographic, biologic, cultural, and ...other factors in populations are presented to gain insight about the causes, natural history, risks, and complications of T1D. Data from large epidemiologic studies worldwide indicate that the incidence of T1D has been increasing by 2% to 5% worldwide and that the prevalence of T1D is approximately 1 in 300 in the United States by 18 years of age. Research on risk factors for T1D is an active area of research to identify genetic and environmental triggers that could potentially be targeted for intervention. Although significant advances have been made in the clinical care of T1D with resultant improvements in quality of life and clinical outcomes, much more needs to be done to improve care of, and ultimately find a cure for, T1D. Epidemiologic studies have an important ongoing role to investigate the complex causes, clinical care, prevention, and cure of T1D.
SEARCH for Diabetes in Youth (SEARCH) was initiated in 2000 as a multicenter study to address major gaps in the understanding of childhood diabetes in the United States. An active registry of youth ...diagnosed with diabetes at age <20 years since 2002 assessed prevalence, annual incidence, and trends by age, race/ethnicity, sex, and diabetes type. An observational cohort nested within the population‐based registry was established to assess the natural history and risk factors for acute and chronic diabetes‐related complications, as well as the quality of care and quality of life of children and adolescents with diabetes from diagnosis into young adulthood. SEARCH findings have contributed to a better understanding of the complex and heterogeneous nature of youth‐onset diabetes. Continued surveillance of the burden and risk of type 1 and type 2 diabetes is important to track and monitor incidence and prevalence within the population. SEARCH reported evidence of early diabetes complications highlighting that continuing the long‐term follow‐up of youth with diabetes is necessary to further our understanding of its natural history and to develop the most appropriate approaches to primary, secondary, and tertiary prevention of diabetes and its complications. This review summarizes two decades of research and suggests avenues for further work.
We provide a summary of the design and methods used, and an overview of major findings since the inception of the SEARCH for Diabetes in Youth Study in 2000. These include a summary of the risk, burden, and prognosis of diabetes diagnosed under the age of 20 years, with an emphasis on the disparities that were identified over these years. We also summarize morbidity and mortality information; patterns of, and barriers to, care of diabetes in youth; behavioral and social correlates; issues related to sustainable surveillance; and what the increase in young adults with diabetes who become parents implies.
Aims
Co‐management of weight and glycaemia is critical yet challenging in type 1 diabetes (T1D). We evaluated the effect of a hypocaloric low carbohydrate, hypocaloric moderate low fat, and ...Mediterranean diet without calorie restriction on weight and glycaemia in young adults with T1D and overweight or obesity.
Materials and Methods
We implemented a 9‐month Sequential, Multiple Assignment, Randomized Trial pilot among adults aged 19‐30 years with T1D for ≥1 year and body mass index 27‐39.9 kg/m2. Re‐randomization occurred at 3 and 6 months if the assigned diet was not acceptable or not effective. We report results from the initial 3‐month diet period and re‐randomization statistics before shutdowns due to COVID‐19 for primary weight, haemoglobin A1c (HbA1c), percentage of time below range <70 mg/dl and secondary outcomes body fat percentage, percentage of time in range (70‐180 mg/dl), and percentage of time below range <54 mg/dl. Models adjusted for design, demographic and clinical covariates tested changes in outcomes and diet differences.
Results
Adjusted weight and HbA1c (n = 38) changed by −2.7 kg (95% CI −3.8, −1.5, P < .0001) and −0.91 percentage points (95% CI −1.5, −0.30, P = .005), respectively, while adjusted body fat percentage remained stable, on average (P = .21). Hypoglycaemia indices remained unchanged following adjustment (n = 28, P > .05). Variability in all outcomes, including weight change, was considerable (57.9% were re‐randomized primarily due to loss of <2% body weight). No outcomes varied by diet.
Conclusions
Three months of a diet, irrespective of macronutrient distribution or caloric restriction, resulted in weight loss while improving or maintaining HbA1c levels without increasing hypoglycaemia in adults with T1D.
To estimate the prevalence of diabetes in U.S. youth aged <20 years in 2009 and to estimate the total number of youth with diabetes in the U.S. by age, race/ethnicity, and diabetes type.
To address ...one of its primary aims, the SEARCH for Diabetes in Youth Study identified youth aged <20 years on 31 December 2009 with physician-diagnosed diabetes in selected areas of Colorado, Ohio, South Carolina, and Washington, among health plan members of Kaiser Permanente Southern California and among American Indians living on reservations in Arizona and New Mexico. Diabetes was classified as type 1, type 2, or other. Race/ethnicity was by self-report.
From a population of 3,458,974 youth aged <20 years, 7,695 youth with diabetes were identified (2.22/1,000): 6,668 with type 1 diabetes (1.93/1,000), 837 with type 2 diabetes (0.24/1,000), and 190 (0.05/1,000) with other diabetes types. Prevalence increased with age, was slightly higher in females than males, and was most prevalent in non-Hispanic White and least prevalent in Asian/Pacific Islanders, with Native American and black youth having the highest prevalence of type 2 diabetes. An estimated 191,986 U.S. youth aged <20 years have diabetes; 166,984 type 1 diabetes, 20,262 type 2 diabetes, and 4,740 other types.
Diabetes, one of the leading chronic diseases in childhood, affects >190,000 (1 of 433) youth aged <20 years in the U.S., with racial and ethnic disparities seen in diabetes prevalence, overall and by diabetes type.
Background
There is significant global variation in the prevalence of diabetic ketoacidosis (DKA) at diagnosis among youth with type 1 diabetes (T1D). However, data for youth with type 2 diabetes ...(T2D) are limited, even in developed countries. We compared the prevalence of DKA at diagnosis among individuals with T1D and T2D from the SEARCH for Diabetes in Youth (SEARCH) and the Registry of Youth Onset Diabetes in India (YDR) registries.
Methods
We harmonized the SEARCH and YDR registries to the structure and terminology in the Observational Medical Outcome Partnership Common Data Model. Data used were from youth with T1D and T2D diagnosed before 20 years and newly diagnosed between 2006 and 2012 in YDR and 2009 and 2012 in SEARCH.
Results
There were 5366 US youth (4078 with T1D, 1288 with T2D) and 2335 Indian youth (2108 with T1D, 227 with T2D). More than one third of T1D youth enrolled in SEARCH had DKA at diagnosis which was significantly higher than in YDR (35.3% vs 28.7%, P < .0001). The burden of DKA in youth with T1D was significantly higher among younger age groups; this relationship was similar across registries (P = .4). The prevalence of DKA among T2D in SEARCH and YDR were 5.5% and 6.6% respectively (P = .4).
Conclusions
There is significant burden of DKA at diagnosis with T1D among youth from United States and India, especially among the younger age groups. The reasons for this high prevalence are largely unknown but are critical to developing interventions to prevent DKA at diagnosis.
Aim
Secondary analyses were conducted from a randomized trial of an adaptive behavioural intervention to assess the relationship between protein intake (g and g/kg) consumed within 4 h before ...moderate‐to‐vigorous physical activity (MVPA) bouts and glycaemia during and following MVPA bouts among adolescents with type 1 diabetes (T1D).
Materials and Methods
Adolescents (n = 112) with T1D, 14.5 (13.8, 15.7) years of age and 36.6% overweight/obese, provided measures of glycaemia using continuous glucose monitoring percentage of time above range (>180 mg/dl), time in range (70‐180 mg/dl), time below range (TBR; <70 mg/dl), self‐reported physical activity (previous day physical activity recalls), and 24 h dietary recall data at baseline and 6 months post‐intervention. Mixed effects regression models adjusted for design (randomization assignment, study site), demographic, clinical, anthropometric, dietary, physical activity and timing covariates estimated the association between pre‐exercise protein intake on percentage of time above range, time in range and TBR during and following MVPA.
Results
Pre‐exercise protein intakes of 10‐19.9 g and >20 g were associated with an absolute reduction of −4.41% (p = .04) and −4.83% (p = .02) TBR during physical activity compared with those who did not consume protein before MVPA. Similarly, relative protein intakes of 0.125‐0.249 g/kg and ≥0.25 g/kg were associated with −5.38% (p = .01) and −4.32% (p = .03) absolute reductions in TBR during physical activity. We did not observe a significant association between protein intake and measures of glycaemia following bouts of MVPA.
Conclusions
Among adolescents with T1D, a dose of ≥10 g or ≥0.125 g/kg of protein within 4 h before MVPA may promote reduced time in hypoglycaemia during, but not following, physical activity.
Objective
To compare treatment regimens and glycosylated hemoglobin (A1c) levels in Type 1 (T1D) and Type 2 diabetes (T2D) using diabetes registries from two countries—U.S. SEARCH for Diabetes in ...Youth (SEARCH) and Indian Registry of youth onset diabetes in India (YDR).
Methods
The SEARCH and YDR data were harmonized to the structure and terminology in the Observational Medical Outcomes Partnership Common Data Model. Data used were from T1D and T2D youth diagnosed <20 years between 2006‐2012 for YDR, and 2006, 2008, and 2012 for SEARCH. We compared treatment regimens and A1c levels across the two registries.
Results
There were 4003 T1D (SEARCH = 1899; YDR = 2104) and 611 T2D (SEARCH = 384; YDR = 227) youth. The mean A1c was higher in YDR compared to SEARCH (T1D:11.0% ± 2.9% vs 7.8% ± 1.7%, P < .001; T2D:9.9% ± 2.8% vs 7.2% ± 2.1%, P < .001). Among T1D youth in SEARCH, 65.1% were on a basal/bolus regimen, whereas in YDR, 52.8% were on once/twice daily insulin regimen. Pumps were used by 16.2% of SEARCH and 1.5% of YDR youth with T1D. Among T2D youth, in SEARCH and YDR, a majority were on metformin only (43.0% vs 30.0%), followed by insulin + any oral hypoglycemic agents (26.3% vs 13.7%) and insulin only (12.8% vs 18.9%), respectively.
Conclusion
We found significant differences between SEARCH and YDR in treatment patterns in T1D and T2D. A1c levels were higher in YDR than SEARCH youth, for both T1D and T2D, irrespective of the regimens used. Efforts to achieve better glycemic control for youth are urgently needed to reduce the risk of long‐term complications.
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