Epidemiology of type 2 diabetes–SEARCH update

At the virtual Scientific Sessions for the American Diabetes Association, Dr. Angela D. Liese, PhD, MPH, FACE, FAHA, from the University of South Carolina, presented as part of a symposium, "Children with type 2 diabetes are not just little adults." In her discussion, she addressed the surveillance and epidemiology of youth-onset type 2 diabetes (T2D), including early complications within this age group and the impact of social determinants of health (SDH) on the disease.

Dr. Liese outlined the key features of the SEARCH for Diabetes in Youth study, which took place from 2002 to 2020, and remains one of the largest studies of childhood diabetes. The study included surveillance of diabetes incidence in youth aged less than 20 years; the mortality surveillance in youth-onset diabetes and the inception cohort of 3000 youth followed for more than 13 years. "It is important to note," said Dr. Liese, that SEARCH was not just a registry to track incidence, but, in certain clinics, a place where participants could come in for an in-person visit, allowing us to build on other studies."

Most of the data focused on children aged 10 to 18 years. The highest incidence trends of type 2 diabetes were in non-Hispanic Blacks (NHB), the lowest in non-Hispanic Whites (NHW). Overall, prevalence trends increased by 4.3% between 2001 and 2017.

The research to date shows significant increases in the annual incidence an prevalence of T2D in youth in the United States (that data is currently being written up in research papers, so the most recent numbers were not available), wih a high increase in T2D in non-Hispanic Black (NHB), Asian-Pacific Indian (API), and low increases, or flat numbers, for non-Hispanic White (NHW). Dr. Liese explained the higher incidence was, in part, due to poor glycemic control (43.8% of Native American (NA), 36.4% of API, andd 27.4% of Hispanic reported poor glycemic control, compared to 12.2% of NHW youth, with another contributor being obesity, with African-American (AA) and American Indian (AI) reporting the highest incidence of obesity.

Dr. Liese then briefly touched on the impacts of SDH in contributing to T2D in children, which include education, economic stability, social and community context, health care access, and neighborhood/built environment. As these impacts are often compromised in ethnic/minority groups, it was no surprise that NHB, API and AI comprised the greatest increases in T2D. Between 2001 and 2017, the rates of T2D per 1,000 NHB youth went from 0.9% to 1.8%; for API, 0.4% to 0.6%; and AI, 1.2% to 1.6%.

In conclusion, Dr. Liese noted that T2D is increasing, particularly in racial and ethinc minorities; youth and young adults with T2D frequently suffer from poor glycemic control, risk factors, and pre-clinical complications and those with the highest percentages of T2D are significatntly disadvantaged, in terms of both socio-economic position and social determinants of health.

Reference
Liese AD. Epidemiology of type 2 diabetes–SEARCH update. American Diabetes Association Scientific Sessions 2021; June 27, 2021; virtual. Accessed June 27, 2021.