Abstract
OBJECTIVE. Our goal was to estimate the prevalence of diabetes mellitus in youth <20 years of age in 2001 in the United States, according to age, gender, race/ethnicity, and diabetes type.
METHODS. The SEARCH for Diabetes in Youth Study is a 6-center observational study conducting population-based ascertainment of physician-diagnosed diabetes in youth. Census-based denominators for 4 geographically based centers and enrollment data for 2 health plan-based centers were used to calculate prevalence. Age-, gender-, and racial/ethnic group-specific prevalence rates were multiplied by US population counts to estimate the total number of US youth with diabetes.
RESULTS. We identified 6379 US youth with diabetes in 2001, in a population of ∼3.5 million. Crude prevalence was estimated as 1.82 cases per 1000 youth, being much lower for youth 0 to 9 years of age (0.79 cases per 1000 youth) than for those 10 to 19 years of age (2.80 cases per 1000 youth). Non-Hispanic white youth had the highest prevalence (1.06 cases per 1000 youth) in the younger group. Among 10- to 19-year-old youth, black youth (3.22 cases per 1000 youth) and non-Hispanic white youth (3.18 cases per 1000 youth) had the highest rates, followed by American Indian youth (2.28 cases per 1000 youth), Hispanic youth (2.18 cases per 1000 youth), and Asian/Pacific Islander youth (1.34 cases per 1000 youth). Among younger children, type 1 diabetes accounted for ≥80% of diabetes; among older youth, the proportion of type 2 diabetes ranged from 6% (0.19 cases per 1000 youth for non-Hispanic white youth) to 76% (1.74 cases per 1000 youth for American Indian youth). We estimated that 154369 youth had physician-diagnosed diabetes in 2001 in the United States.
CONCLUSIONS. The overall prevalence estimate for diabetes in children and adolescents was ∼0.18%. Type 2 diabetes was found in all racial/ethnic groups but generally was less common than type 1, except in American Indian youth.
Diabetes mellitus is one of the leading chronic diseases of childhood and adolescence.1 Although numerous studies have documented worldwide increases in diabetes,2 few data exist on the population prevalence of diabetes among youth in the United States. Published estimates from studies conducted in the United States on the prevalence of type 1 diabetes ranged from 0.6 to 1.9 cases per 1000 youth <19 years of age,3–6 but those studies were conducted in the 1970s, were limited geographically, and were confined almost exclusively to non-Hispanic white (NHW) youth. In addition, in the past 2 decades, type 2 (nonautoimmune and non-insulin-dependent) diabetes among youth has been reported increasingly in large, clinic-based studies7–9; therefore, estimates of prevalence should now include this type.
Population-based studies of the prevalence of type 2 diabetes among North American youth have been limited to studies involving a small number of select Native American populations in the United States10–12 and Canada.13–15 Estimates have ranged from 0.5 cases per 1000 youth14 among First Nation children living in Manitoba to >53 cases per 1000 youth among Pima Indian youth living in Arizona.11 Several studies have attempted to estimate the prevalence of all types of diabetes, but those reports have been restricted to limited population samples, have rarely included multiple racial and ethnic groups or have been based exclusively on information obtained through telephone surveys.16–21
The SEARCH for Diabetes in Youth Study (SEARCH) is a population-based, observational study of physician-diagnosed diabetes among youth <20 years of age. Initiated in 2000, SEARCH collects data from a total of 6 centers. This report estimates the prevalence of diabetes (among youth <20 years of age) in 2001, both overall and according to age, gender, race/ethnicity, and type of diabetes.
METHODS
Study Design
A detailed description of SEARCH has been published.22 In brief, SEARCH aimed to estimate population prevalence and incidence of diabetes in this group according to age, gender, race or ethnicity, and type of diabetes and to develop practical approaches to classifying diabetes according to type. This article reports the estimates of prevalence of diabetes in youth for the year 2001, the only year in which prevalence was assessed by SEARCH. Methods described here are specific to this aim. The study was reviewed and approved by the institutional review board at each center and complied with the privacy rules established by the Health Insurance Portability and Accountability Act.
SEARCH collected data from 6 centers, located in California, Colorado, Hawaii, Ohio, South Carolina, and Washington. Youth with diabetes mellitus were identified in 4 geographically defined populations in Ohio (8 counties encompassing and surrounding Cincinnati), Washington (5 counties encompassing and surrounding Seattle), South Carolina (4 counties), and Colorado (13 counties); among health plan enrollees in Hawaii (Hawaii Medical Service Association, Med-Quest, and Kaiser Permanente Hawaii) and California (Kaiser Permanente Southern California, excluding San Diego); and from health service beneficiary rolls in several reservation-based, American Indian (AI) populations, as coordinated by the Colorado center.
To identify all youth with diabetes in geographically defined populations, the 4 centers established active surveillance systems based on networks of pediatric and adult endocrinologists, existing pediatric diabetes databases, hospitals, health plan databases, and other health care providers. Membership-based centers used existing diabetes databases in addition to their administrative databases as the sources for case identification. Data sources included reports from pediatric endocrinologists and linked computer data on prescriptions, hospitalizations with diabetes as the discharge diagnosis, and laboratory measurements of hemoglobin A1c. Details of case ascertainment methods were published previously.22 Youth identified by SEARCH completed a short survey that assessed age at diagnosis, treatment history, race/ethnicity, and residence (to establish eligibility).
Validation of Cases, Classification of Diabetes Type, and Enumeration of Cases
Case reports were validated on the basis of physician reports, medical record review, or self-report of a physician diagnosis of diabetes (in a few cases). A physician-diagnosed case of diabetes was established if any of the following criteria were met: medical record review indicated a physician diagnosis of diabetes, the diagnosis of diabetes was verified directly by a physician, the physician referred a youth with diabetes to the study, or the case was included in a clinical database that had a requirement for verification of the diagnosis of diabetes by a physician. The clinical diabetes type assigned by the health care provider was recorded as part of the case validation process and then categorized as follows: type 1 (combining type 1, type 1a, and type 1b), type 2, or other type (including hybrid type, maturity onset of diabetes in youth, secondary diabetes, type unknown by the reporting source, type designated as other, and missing type). Cases were enumerated on the basis of key demographic and diagnostic information (date of birth, gender, race/ethnicity, date of diagnosis, and diabetes type), which was obtained from medical records, physician reports, and self-reports. Case reports were registered anonymously with the coordinating center at Wake Forest University (Winston-Salem, NC). Data collection for prevalent cases commenced in July 2002 and concluded in November 2004.
Study Population
The numerator for the analysis included all cases of nongestational diabetes prevalent in 2001 that met the following criteria: the person was <20 years of age on December 31, 2001, and she or he was a resident of the population in 2001 for a geographically based center or was a member of the participating health plan in 2001 for membership-based centers. Persons who were on active duty in the military or were institutionalized were not eligible. Information on race or ethnicity was based on self-reports or medical record-based data for 93.5% of eligible youth and on geocoding (ie, assignment of a Census 2000 data-derived racial/ethnic proportion) for the 6.5% of youth who had missing data. The most specific geographic level available was used for geocoding, beginning with the block and then using the block group, Census tract, zip code, county, and state as necessary. Age as of December 31, 2001, was determined for each participant.
The denominators for calculation of prevalence included youth <20 years of age who were civilian residents of the study areas covered by the geographic centers or were members of the specific health plans in 2001. Derivation of the appropriate denominators was a multistep process, taking into account racial/ethnicity categorization and the civilian nature of the study population.
For the 4 geographic centers, denominators were collated from a Census-based special tabulation of estimated 2001 counts released by the National Center for Health Statistics (www.cdc.gov/nchs/about/major/dvs/popbridge/popbridge.htm) and pooled across centers. Five racial/ethnic groups were used, namely, Hispanic, NHW, black, Asian/Pacific Islander (API), and AI, by first identifying any residents of Hispanic ethnicity and then applying the race-bridging methods developed by the National Center for Health Statistics23 to multiracial youth and allocating them to 1 of the 4 other racial groups. Therefore, these 4 racial categories exclude persons of Hispanic ethnicity. For Hawaii, the state's distribution of racial/ethnic groups according to 1-year age groups, gender, and county-derived, race-bridged counts from the 2000 Census was applied to the health plan membership counts. For the Kaiser Permanente Southern California population, addresses of all members eligible for inclusion in the study, on the basis of age and geographic location, were geocoded to the Census block level. For each geocoded address, the estimated number of residents of each group living in that block was estimated by using Census file SF1 (Table P8, available at www.census.gov/main/www/cen2000.html). The race- and ethnicity-specific proportions were then applied to the gender-specific denominator estimates in 1-year age increments, to estimate the racial and ethnic distribution of youth according to age and gender.24 As with the geographically based centers, race-bridging methods were used.
To derive civilian population denominators for the centers with military bases within their geographic regions (South Carolina and Washington), we adjusted the denominators for the youth 17 through 19 years of age by subtracting the age-, gender-, racial/ethnic group-, and county-specific number of active duty military personnel, as derived from information from the Military Family Resource Center (www.militaryhomefront.dod.mil) and the Census Bureau. Racial/ethnic group-specific denominator estimates were then pooled across all SEARCH centers.
Statistical Methods
The prevalence of diabetes was expressed as cases per 1000 youth using data pooled across all SEARCH centers. The 95% confidence intervals (CIs) were calculated by using an inverted score test from the binomial distribution.25 To obtain an estimate of the total number of youth <20 years of age with physician-diagnosed diabetes in the US population, we derived age-, gender-, and racial/ethnic group-specific prevalence estimates from SEARCH and applied them to the age-, gender-, and racial/ethnic group-specific US population on the basis of 2001 Census population estimates. For presentation, we show the standardized rates for 2 age groups, namely, 0 to 9 years and 10 to 19 years.
We assessed the completeness of case ascertainment for the 4 geographically based centers by using the capture-recapture method26 and a 2-mode ascertainment model, but we did not conduct capture-recapture analysis for the 2 membership-based centers because the data sources used to ascertain cases within the membership-based centers were not independent. Pooled estimates were produced from a global logarithmic-linear model by using maximal likelihood analysis,27 which accounted for intrasite variation.
RESULTS
SEARCH identified 6379 children or adolescents with diabetes in a population of ∼3.5 million youth (Table 1). The crude prevalence of total diabetes was estimated at 1.82 cases per 1000 youth (95% CI: 1.78–1.87 cases per 1000 youth). As expected, the prevalence of diabetes increased markedly with greater age. Female youth had a slightly higher prevalence than did male youth. NHW youth had the highest prevalence and API youth the lowest. The average age at diagnosis was 8.4 years, varying across racial/ethnic groups (NHW: 7.8 years; Hispanic: 8.8 years; black: 10.0 years; API: 10.2 years; AI: 12.0 years). The average duration of diabetes in this prevalent population was 56 months (∼4.5 years), ranging from 38 to 60 months across racial/ethnic groups. Ascertainment of prevalent cases was estimated to be ∼92% complete across the 4 geographic centers, with the capture-recapture method. Ascertainment was similar for the 0- to 9-year (94%) and 10- to 19-year (92%) age groups, with the latter representing 79% of all cases.
Demographic Characteristics of the Study Population in 2001 and Prevalence of Total Diabetes Mellitus
Less than 1 child per 1000 youth had diabetes in the younger age group (0–9 years) (Table 2); prevalence according to race/ethnicity ranged from 0.23 cases per 1000 youth (AI) to 1.06 cases per 1000 youth (NHW). As expected, type 1 was by far the most prevalent type in this age group (0.76 cases per 1000 youth), with prevalence ranging from 0.18 cases per 1000 youth among AI youth to 1.03 cases per 1000 youth among NHW youth. Among the 1349 cases of diabetes in this younger group, a total of 11 were type 2 and 35 were classified as other/unknown, most of which had no diagnostic information regarding type.
Estimates of Prevalence of Diabetes Mellitus in 2001 According to Diabetes Type, Age Group, and Race/Ethnicity
Among youth 10 to 19 years of age, diabetes prevalence was 2.80 cases per 1000 youth (1 of every 357 youth). Black youth and NHW youth had the highest rates (3.22 and 3.18 cases per 1000 youth, respectively), whereas API youth had the lowest (1.34 cases per 1000 youth). The absolute difference in prevalence between black and API youth was almost 2 cases per 1000 youth. Type 1 was the most prevalent type (average: 2.28 cases per 1000 youth) in all racial/ethnic groups except the AI group, in which type 2 was most prevalent. The type 1 rate was highest among NHW youth and lowest among AI youth. The highest prevalence of type 2 was observed among AI youth (1.74 cases per 1000 youth). Black youth were next (1.05 cases per 1000 youth); NHW youth had the lowest prevalence. Among the 5030 youth with diabetes who were 10 to 19 years of age, 176 (3.5%) had diabetes of other/unknown type, with unknown or missing clinical type in the majority of cases.
In Fig 1, the contributions of the different types of diabetes to the overall prevalence of diabetes within the racial/ethnic groups are shown according to age group. Among children 0 to 9 years of age, type 1 diabetes accounted for ≥80% in all 5 racial/ethnic groups, including the AI group. The proportions of children with a diagnosis of type 2 diabetes were notable for AI children (13%) and API children (7%). Among youth 10 to 19 years of age, type 1 diabetes accounted for >91% of cases among NHW youth, whereas type 2 diabetes accounted for just 6%. In other racial/ethnic groups, the percentages of cases that were type 2 were much higher, that is, 22% for Hispanic youth, 33% for black youth, 40% for API youth, and 76% for AI youth.
Type-specific proportions of prevalent cases of diabetes according to age group (A, 0–9 years; B, 10–19 years) and race/ethnicity. AA indicates black; H, Hispanic.
Gender differences in the prevalence of diabetes were also explored. Among children 0 to 9 years of age, no meaningful differences according to gender were seen in prevalence, either overall or according to type (data not shown). In contrast, among 10- to 19-year-old youth, we found a higher prevalence of total diabetes among female youth in 3 of the racial/ethnic groups (black: 3.83 cases per 1000 youth vs 2.61 cases per 1000 youth; API: 1.48 cases per 1000 youth vs 1.20 cases per 1000 youth; AI: 2.71 cases per 1000 youth vs 1.85 cases per 1000 youth). Among black youth, female youth had higher rates of type 1 diabetes (2.23 cases per 1000 youth vs 1.91 cases per 1000 youth) and type 2 diabetes (1.45 cases per 1000 youth vs 0.66 cases per 1000 youth) than did male youth. Similarly, rates among API youth of type 1 diabetes (0.89 cases per 1000 youth vs 0.68 cases per 1000 youth) and among AI youth of type 2 diabetes (2.18 cases per 1000 youth vs 1.31 cases per 1000 youth) were higher for female youth.
As shown in Table 3, we estimated that, in 2001, there were 154369 youth (95% CI: 150489–158248 youth) in the United States with physician-diagnosed diabetes. The great majority (78.7%; n = 121509) of these youth were 10 to 19 years of age. We estimated that 32860 children <10 years of age had diabetes. Whereas NHW youth accounted for 62% of the US population <20 years of age, they represented 71% of all youth with diabetes. This disparity between the percentage of the population and the share of diabetes cases was more marked among children <10 years of age; NHW children were 60% of that population but represented 77% of all children diagnosed as having diabetes. The same difference existed in the older age group but to a lesser degree.
Estimated Number of Cases of Diabetes Mellitus in the United States in 2001, According to Gender, Age Group, and Race/Ethnicity
DISCUSSION
These population-based estimates are from the largest surveillance effort on diabetes in youth conducted in the United States to date. Using SEARCH data, we estimated that ∼154000 of ∼80.7 million children and adolescents throughout the nation had physician-diagnosed diabetes in 2001 (1 of every 523 youth).
Diabetes is one of the leading chronic diseases in childhood and adolescence,1 affecting 1.82 of 1000 youth according to our estimates. In comparison, 1.24 of 1000 youth are affected by cancer28 and 120 of 1000 youth suffer from asthma.29 Diabetes affects quality of life severely for these youth, has a major impact on their families, and has a significant public health impact. In 2002, the total cost of diabetes in the US population was $132 billion, although much of the cost was generated by adults.30 The development of complications is related to the duration of diabetes, and youth with diabetes represent a population at high risk for developing these complications. Indeed, persons diagnosed with diabetes before 20 years of age have a markedly lower life expectancy than the general population without diabetes.31
Numerous reports have raised concerns about diabetes, particularly type 2 diabetes, in minority populations.32,33 Among AI youth, prevalence estimates varied widely across studies, which typically were conducted in smaller, regionally defined, AI populations.12 SEARCH ascertained 180 AI youth with diabetes from a total AI population of >139000 youth. The SEARCH type 2 diabetes prevalence of 1.74 cases per 1000 youth (95% CI: 1.46–2.07 cases per 1000 youth) among AI youth 10 to 19 years of age is similar in magnitude to results from other studies of unscreened AI populations,12–14 but previous work typically was based on substantially fewer cases. It has been suggested that diabetes among AI individuals is primarily type 2, and this was the case in our study as well. However, 80% of AI children 0 to 9 years of age had type 1 diabetes; among youth 10 to 19 years of age, this proportion was reduced to 21%. Previous work among First Nation youth in Canada (5–14 years of age) revealed that type 1 diabetes accounted for 40% of cases.18
To our knowledge, our prevalence estimates of 1.29 cases per 1000 Hispanic children and adolescents and 0.83 cases per 1000 API youth represent the first population-based prevalence estimates for these US subpopulations based on validated cases of diabetes. For black youth, our estimate of 1.93 cases per 1000 youth was slightly higher than that in a previous report for this group, which was from a geographically small area.19 Our estimates are substantially more conservative than those of the National Survey of Children's Health (2003–2004), which reported prevalence estimates of 2.2 cases per 1000 youth for both black and Hispanic youth 0 to 17 years of age, on the basis of unvalidated parental reports obtained in telephone interviews.21
Information on the contribution of diabetes types in minority populations is also very limited. Among API youth ≥10 years of age, we found 59% of diabetes to be type 1. In contrast, a study among Taiwanese children 6 to 18 years of age reported a type 1/type 2 diabetes ratio of 1:6 for newly diagnosed diabetes cases, on the basis of screening that involved urine and blood testing but not testing for diabetes autoantibodies.34 To our knowledge, there are no population-based data with which to compare our findings that, among 10- to 19-year-old youth, 64% of black youth and 74% of Hispanic youth had type 1 diabetes.
The overall prevalence of diabetes among NHW youth from SEARCH exceeds estimates from previous studies.3,4,20,35 In this study, we found that NHW youth had a greater burden of diabetes than did youth from other racial/ethnic groups, which can be explained by the high prevalence of type 1 diabetes among NHW youth, with its earlier age of onset. Interestingly, the National Survey of Children's Health also reported the highest prevalence of diabetes among NHW youth, albeit at a markedly higher level (3.8 cases per 1000 youth), which might be attributable to the unvalidated nature of the reports.21
Among 10- to 19-year-old youth, we found a higher prevalence among female youth (compared with male youth) in 3 of the 5 racial/ethnic groups (black, API, and AI). A study found an excess prevalence for female youth among black youth but not among NHW youth.19 These results for black youth compared well with those of the present study; we found higher rates for black female youth, compared with black male youth. The difference according to gender we saw for API youth was of a magnitude similar to that seen in a population of Taiwanese youth,34 and the differences found for AI youth were similar to those demonstrated previously in AI populations.11–13,15
In the past, obtaining a comprehensive picture of the burden of diabetes among youth in the United States has been hampered by the lack of a consistent case definition,11,20,36 differences in the types of diabetes studied,18,19,35 different case ascertainment methods,4–6,20,21 and ascertainment periods spanning >5 decades.3,12 SEARCH used a uniform case definition that was applied concurrently in all centers. In addition, case ascertainment approaches were comparable across centers, yielding a validated enumeration of cases. SEARCH generated overall, racial/ethnic group-specific, and type-specific estimates of prevalence by using a surveillance population that was large and included youth from the largest racial/ethnic groups in the US population. However, the SEARCH populations were not selected randomly and were not designed to represent the entire United States geographically.
Completeness of case finding is a prerequisite for any reliable surveillance effort. Given the severity of the disease, undiagnosed type 1 diabetes in children would be a rare occurrence and therefore not a serious threat to our prevalence estimates. Type 2 diabetes among youth, however, could remain undiagnosed for some time. Our reliance on physician diagnoses of diabetes might have led to underestimation of the prevalence of type 2 diabetes. A study conducted recently within the geographic region of a SEARCH center screened >2500 students in grades 5 to 10 (9–20 years of age) for abnormalities of carbohydrate metabolism, by using fasting glucose concentrations and oral glucose tolerance testing.37 No case of undiagnosed type 1 diabetes was found. One case of undiagnosed type 2 diabetes was found, yielding a prevalence of undiagnosed type 2 diabetes of 0.4 cases per 1000 youth. Applying this finding to the SEARCH estimates would yield an upper bound of diabetes prevalence of 2.02 cases per 1000 youth, compared with the 1.82 cases per 1000 youth observed in SEARCH. We think that, although the presence of undiagnosed type 2 diabetes probably led to slight underestimation of that type of diabetes, the order of magnitude would have been small and would not have threatened the validity of our estimate of overall prevalence.
Like previous population-based, prevalence studies,3–6,18,19,35,36 these analyses focused on type 1 or type 2 diabetes and used type assignments made by health care providers. More than 60% of cases from the geographically based centers were reported by pediatric or adult endocrinologists. Among cases for which a full medical record review was completed, 82% were diagnosed by a pediatric or adult endocrinologist. Of the 6379 youth with diabetes, 6168 (96.7%) were identified as having either type 1 or type 2. Of the remaining 211 youth (3.3%), 7 had been diagnosed as having maturity onset of diabetes in youth, 14 hybrid diabetes, 50 secondary diabetes, and 15 “other” type or “not yet specified”; the vast majority, 125 youth, were identified as having “unknown” type or the type information was missing. These groups of other/unknown diabetes types were included in our overall diabetes prevalence estimates but not the type-specific estimates.
CONCLUSIONS
SEARCH provides the most comprehensive data to date on the overall burden of diabetes among youth. By using these data, we estimated the overall prevalence of diabetes among US youth 0 to 19 years of age to be 1.82 cases per 1000 youth. SEARCH observed a lower prevalence of diabetes among youth <10 years of age than among those 10 to 19 years of age. NHW youth accounted for a disproportionately large number of youth with diabetes. As expected, the vast majority of younger children had type 1 diabetes, and type 2 diabetes was extremely rare. Among older youth, the proportion of diabetes accounted for by type 2 varied dramatically across racial/ethnic groups, from just 6% for NHW youth to 76% for AI youth.
Acknowledgments
SEARCH is funded by the Centers for Disease Control and Prevention (program announcement 00097 and grant DP-05-069) and supported by the National Institute of Diabetes and Digestive and Kidney Diseases (site contracts: California: U01 DP000246; Colorado: U01 DP000247; Hawaii: U01 DP000245; Ohio: U01 DP000248; South Carolina: U01 DP000254; Washington: U01 DP000244; coordinating center: U01 DP000250). We acknowledge the involvement of General Clinical Research Centers at the following institutions in SEARCH: Medical University of South Carolina (grant M01 RR01070), Cincinnati Children's Hospital (grant M01 RR08084), Children's Hospital and Regional Medical Center and the University of Washington School of Medicine (grants M01RR00037 and M01RR001271), and Colorado Pediatric General Clinical Research Center (grant M01 RR00069).
The SEARCH writing group was as follows: Angela D. Liese, PhD, MPH (Chair), University of South Carolina (Columbia, SC); Ralph B. D'Agostino, Jr, PhD, Wake Forest University School of Medicine (Winston-Salem, NC); Richard F. Hamman, MD, DrPH, University of Colorado at Denver and Health Sciences Center (Denver, CO); Patrick D. Kilgo, MS, Wake Forest University School of Medicine; Jean M. Lawrence, ScD, MPH, MSSA, Kaiser Permanente Southern California (Pasadena, CA); Lenna L. Liu, MD, MPH, University of Washington Child Health Institute (Seattle, WA); Beth Loots, MPH, MSW, Children's Hospital and Regional Medical Center (Seattle, WA); Barbara Linder, MD, PhD, National Institute of Diabetes and Digestive and Kidney Diseases (Bethesda, MD); Santica Marcovina, PhD, ScD, Department of Medicine, University of Washington (Seattle, WA); Beatriz Rodriguez, MD, MPH, PhD, Pacific Health Research Institute (Honolulu, HI); Debra Standiford, RN, MSN, CNP, Children's Hospital Medical Center (Cincinnati, OH); Desmond E. Williams, MD, PhD, Centers for Disease Control and Prevention (Atlanta, GA).
SEARCH is indebted to the many youth, their families, and their health care providers, whose participation made this study possible. The SEARCH writing group acknowledges the contributions of the following individuals to the work of this study: California: Jean M. Lawrence, ScD, MPH, MSSA, Diana B. Petitti, MD, MPH, Ann K. Kershnar, MD, and Kimberly J. Holmquist, BS, for Kaiser Permanente Southern California and David J. Pettitt, MD, for the Sansum Diabetes Research Institute; Colorado: Dana Dabelea, MD, PhD, Richard F. Hamman, MD, DrPH, Emelin Martinez, MSN, FNP, and Sandra P. Rojas, MA, CCRP, for the Department of Preventive Medicine and Biometrics, University of Colorado at Denver and Health Sciences Center, Georgeanna J. Klingensmith, MD, and Marian J. Rewers, MD, PhD, for the Barbara Davis Center for Childhood Diabetes, Clifford A. Bloch, MD, for Pediatric Endocrine Associates, Jonathan Krakoff, MD, and Peter H. Bennett, MB, FRCP, for the National Institute of Diabetes and Digestive and Kidney Diseases Pima Indian Study, and Joquetta A. DeGroat, BA, for the Navajo Area Indian Health Prevention Program; Hawaii: Beatriz L. Rodriguez, MD, PhD, Beth Waitzfelder, PhD, Wilfred Fujimoto, MD, J. David Curb, MD, Fiona Kennedy, RN, Greg Uramoto, MD, Sorrell Waxman, MD, Teresa Hillier, MD, and Richard Chung, MD, for the Pacific Health Research Institute; Ohio: Lawrence M. Dolan, MD, Debra Standiford, MSN, CNP, Stephen R. Daniels, MD, PhD, and Judith M. Johansen, RN, BSN, for the Cincinnati Children's Hospital Medical Center; South Carolina: Elizabeth J. Mayer-Davis, PhD, Angela D. Liese, PhD, MPH, Robert McKeown, PhD, Robert R. Moran, PhD, John Oeltmann, PhD, Joan Thomas, MS, RD, Deborah Truell, RN, CDE, Gladys Gaillard-McBride, RN, CFNP, Deborah Lawler, MT (ASCP), April Irby, BS, I. David Schwartz, MD, Howard Heinze, MD, for the University of South Carolina, Lynne Hartel, MA, Yaw Appiagyei-Dankah, MD, Lyndon Key, MD, Steve Willi, MD, for the Medical University of South Carolina, James Amrhein, MD, for Greenville Hospital Systems, Pam Clark, MD, for McLeod Pediatric Subspecialists, Andy Muir, MD, for the Medical College of Georgia, and Mark Parker, MD, for Pediatric Endocrinology & Diabetes Specialists. Washington: Catherine Pihoker, MD, Lisa Gilliam, MD, PhD, Irl Hirsch, MD, Lenna L. Liu, MD, MPH, and Carolyn Paris, MD, MPH, for the University of Washington, Beth Loots, MPH, MSW, Jenny Tseng, PhD, and Shirley Vacanti, RN, BSN, for the Seattle Children's Hospital and Regional Medical Center, and Carla Greenbaum, MD, for the Benaroya Research Institute; Centers for Disease Control and Prevention: Giuseppina Imperatore, MD, PhD, Desmond E. Williams, MD, PhD, Michael M. Engelgau, MD, Henry Kahn, MD, and K. M. Venkat Narayan, MD, MPH; National Institute of Diabetes and Digestive and Kidney Diseases: Barbara Linder, MD, PhD; Central Laboratory (University of Washington): Santica Marcovina, PhD, and Greg Strylewicz, MS; coordinating center (Wake Forest University School of Medicine): Ronny Bell, PhD, MS, Ralph D'Agostino, Jr, PhD, Beverly Snively, PhD, Timothy Morgan, PhD, Susan Vestal, BS, and Bharathi Zvara, BS.
Footnotes
- Accepted May 23, 2006.
- Address correspondence to Angela D. Liese, PhD, MPH, University of South Carolina, Department of Epidemiology and Biostatistics, 800 Sumter St, Columbia, SC 29208. E-mail: liese{at}sc.edu
Preliminary results from this analysis were presented at the annual meetings of the American Diabetes Association; June 4–8, 2004; Orlando, FL; and June 10–14, 2005; San Diego, CA; and at the annual meeting of the European Diabetes Epidemiology Group; May 20–23, 2006; Krakow, Poland.
The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention.
The authors have indicated they have no financial relationships relevant to this article to disclose.
REFERENCES
- Copyright © 2006 by the American Academy of Pediatrics
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- Diabetes Care for Emerging Adults: Recommendations for Transition From Pediatric to Adult Diabetes Care Systems: A position statement of the American Diabetes Association, with representation by the American College of Osteopathic Family Physicians, the American Academy of Pediatrics, the American Association of Clinical Endocrinologists, the American Osteopathic Association, the Centers for Disease Control and Prevention, Children with Diabetes, The Endocrine Society, the International Society for Pediatric and Adolescent Diabetes, Juvenile Diabetes Research Foundation International, the National Diabetes Education Program, and the Pediatric Endocrine Society (formerly Lawson Wilkins Pediatric Endocrine Society)
- Depressive Symptoms and Quality of Life in Adolescents With Type 2 Diabetes: Baseline data from the TODAY study
- Familial Aggregation of Autoimmune Disease in Juvenile Dermatomyositis
- Medical Expenditures Associated With Diabetes Among Privately Insured U.S. Youth in 2007
- Validation of a Pediatric Diabetes Case Definition Using Administrative Health Data in Manitoba, Canada
- Heart Disease and Stroke Statistics--2011 Update: A Report From the American Heart Association
- Standards of Medical Care in Diabetes--2011
- Metabolic Risk and Health Behaviors in Minority Youth at Risk for Type 2 Diabetes
- Diabetes and Cancer: A consensus report
- Physical Activity and Electronic Media Use in the SEARCH for Diabetes in Youth Case-Control Study
- Incidence of Treatment for End-Stage Renal Disease Among Individuals With Diabetes in the U.S. Continues to Decline: Response to Villar, McDonald, and Couchoud
- Incorporating Type 1 Diabetes Prevention Into Clinical Practice
- Heart Disease and Stroke Statistics--2010 Update: A Report From the American Heart Association
- Standards of Medical Care in Diabetes--2010
- Association of Type 1 Diabetes With Month of Birth Among U.S. Youth: The SEARCH for Diabetes in Youth Study
- Hospitalization Subsequent to Diagnosis in Young Patients With Diabetes in Chicago, Illinois
- Diabetes in Non-Hispanic White Youth: Prevalence, incidence, and clinical characteristics: the SEARCH for Diabetes in Youth Study
- Diabetes in Hispanic American Youth: Prevalence, incidence, demographics, and clinical characteristics: the SEARCH for Diabetes in Youth Study
- The Many Faces of Diabetes in American Youth: Type 1 and Type 2 Diabetes in Five Race and Ethnic Populations: The SEARCH for Diabetes in Youth Study
- Diabetes in African American Youth: Prevalence, incidence, and clinical characteristics: the SEARCH for Diabetes in Youth Study
- Type 1 and Type 2 Diabetes in Asian and Pacific Islander U.S. Youth: The SEARCH for Diabetes in Youth Study
- Heart Disease and Stroke Statistics--2009 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee
- The Carbohydrate Counting in Adolescents With Type 1 Diabetes (CCAT) Study
- Navigating the Sea of Diabetes
- Standards of Medical Care in Diabetes--2009
- Weight-Loss Practices and Weight-Related Issues Among Youth With Type 1 or Type 2 Diabetes
- Influence of Race, Ethnicity, and Culture on Childhood Obesity: Implications for Prevention and Treatment: A consensus statement of Shaping America's Health and the Obesity Society
- A Medical Home for Children With Insulin-Dependent Diabetes: Comanagement by Primary and Subspecialty Physicians--Convergence and Divergence of Opinions
- Presence of Diabetic Ketoacidosis at Diagnosis of Diabetes Mellitus in Youth: The Search for Diabetes in Youth Study
- Trends in the Prevalence of Preexisting Diabetes and Gestational Diabetes Mellitus Among a Racially/Ethnically Diverse Population of Pregnant Women, 1999-2005
- Self-Management Behaviors, Racial Disparities, and Glycemic Control Among Adolescents With Type 2 Diabetes
- Breast-Feeding and Type 2 Diabetes in the Youth of Three Ethnic Groups: The SEARCH for Diabetes in Youth Case-Control Study
- Heart Disease and Stroke Statistics--2008 Update: A Report From the American Heart Association Statistics Committee and Stroke Statistics Subcommittee
- Standards of Medical Care in Diabetes--2008
- Trends in Hospitalizations for Diabetes Among Children and Young Adults: United States, 1993 2004
- Nonalcoholic Fatty Liver Disease and Insulin Resistance in Youth
- Proportion of Diabetes Type in Early-Onset Diabetes in Japan