CE/CME

Pediatric T2DM: A Growing Threat to US Health


 

References

The increasing prevalence of type 2 diabetes mellitus (T2DM) in children and adolescents is a serious health threat that urgently requires effective lifestyle intervention in at-risk patients, vigilant disease management for those diagnosed, and further research to support treatment decisions in the pediatric population.

Over the past several decades, National Health and Nutrition Examination Survey (NHANES) data have documented a sharp rise in the prevalence of obesity in children and adolescents ages 2 to 19: from 5.5% during 1976-1980 to 16.9% in 2009-2010.1 Cardiovascular damage once seen only in adults is occurring in obese children, along with other obesity-related comorbidities such as dyslipidemia and insulin resistance.2 Similarly, type 2 diabetes mellitus (T2DM), once a disease of middle-aged or older adults, is being diagnosed with growing frequency in the pediatric population.3

While much is known about adult T2DM, less has been established about pediatric T2DM because of its relatively recent emergence. Areas requiring further study in the pediatric population include the determination of optimal target A1C levels; the most effective treatments for both T2DM and coexisting conditions; and the long-term impact on morbidity and mortality when T2DM is diagnosed so early in life. Increasing evidence suggests that T2DM in young people is an “aggressive” form of diabetes,4 with significant comorbidities that may already be present at diagnosis.5

In an effort to document long-term outcomes for patients diagnosed with “young-onset type 2 diabetes mellitus” (defined as T2DM diagnosed between ages 15 and 30), researchers reviewed records from the Royal Prince Alfred Hospital’s Diabetes Clinical Database, established in 1986, that were matched against the Australian National Death Index through June 2011. They identified 470 cases of type 1 diabetes mellitus (T1DM) and 354 cases of T2DM, with a median observation period of more than 20 years for patients in both groups, and compared morbidity and mortality outcomes.6 The authors found that unfavorable cardiovascular risk factors were more prevalent in the T2DM group and developed earlier in the disease process—in some cases, as early as two years after diagnosis—than in patients with T1DM. Diabetic complications (eg, albuminuria and neuropathy) were more prevalent in the T2DM group, but the rates of retinopathy were about the same in both groups.6

In terms of mortality, 11% of the patients with T2DM and 6.8% of those with T1DM had died, and the deaths in the T2DM group occurred after a significantly shorter duration of ­disease (26.9 v 36.5 y). Cardiovascular causes of death ­predominated in both groups but were more ­common in patients with T2DM (50.0%) than with T1DM (30.3%). The authors concluded that T2DM is “the more lethal phenotype” of diabetes in young people and requires intensive intervention directed at both glycemic control and cardiovascular risk management.6

EPIDEMIOLOGY
In 2012, an estimated 208,000 Americans younger than 20 were diagnosed with diabetes7; approximately 10.5% of them (21,000) were diagnosed with T2DM.8 While these numbers are a small fraction of the 29.1 million Americans living with diabetes,7 researchers note that both the incidence and prevalence of T2DM in young people are increasing.

For the years 2002-2003, the SEARCH for Diabetes in Youth Study Group estimated the annual incidence of new cases of diabetes in persons younger than 20 to be 15,000 for T1DM and 3,700 for T2DM.3 By 2008-2009, those estimates had grown to 18,436 per year for T1DM and 5,089 per year for T2DM.7

It has been projected that, if incidence rates remain constant, the number of young people diagnosed with T2DM in the United States will increase by 49% by 2050. If incidence grows by 2.3% annually, however, the increase could be fourfold by 2050.9

Prevalence has also increased. The number of persons age 19 or younger living with T1DM increased by 21.1% between 2001 and 2009; prevalence of T2DM in this age-group grew by 30.5% during the same period.10 T2DM prevalence also varies by race and ethnicity, ranging from 0.17/1,000 in non-­Hispanic white youth to 1.20/1,000 among young people of Native American heritage (see Table, above).10

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