Diabetes in African American youth: prevalence, incidence, and clinical characteristics: the SEARCH for Diabetes in Youth Study

Elizabeth J Mayer-Davis, Jennifer Beyer, Ronny A Bell, Dana Dabelea, Ralph D'Agostino Jr, Giuseppina Imperatore, Jean M Lawrence, Angela D Liese, Lenna Liu, Santica Marcovina, Beatriz Rodriguez, SEARCH for Diabetes in Youth Study Group, Elizabeth J Mayer-Davis, Jennifer Beyer, Ronny A Bell, Dana Dabelea, Ralph D'Agostino Jr, Giuseppina Imperatore, Jean M Lawrence, Angela D Liese, Lenna Liu, Santica Marcovina, Beatriz Rodriguez, SEARCH for Diabetes in Youth Study Group

Abstract

Objective: To report the prevalence and incidence of type 1 and type 2 diabetes among African American youth and to describe demographic, clinical, and behavioral characteristics.

Research design and methods: Data from the SEARCH for Diabetes in Youth Study, a population-based, multicenter observational study of youth with clinically diagnosed diabetes aged 0-19 years, were used to estimate the prevalence for calendar year 2001 (692 cases) and incidence based on 748 African American case subjects diagnosed in 2002-2005. Characteristics of these youth were obtained during a research visit for 436 African American youth with type 1 diabetes and 212 African American youth with type 2 diabetes.

Results: Among African American youth aged 0-9 years, prevalence (per 1,000) of type 1 diabetes was 0.57 (95% CI 0.47-0.69) and for those aged 10-19 years 2.04 (1.85-2.26). Among African American youth aged 0-9 years, annual type 1 diabetes incidence (per 100,000) was 15.7 (13.7-17.9) and for those aged 10-19 years 15.7 (13.8-17.8). A1C was >or=9.5% among 50% of youth with type 1 diabetes aged >or=15 years. Across age-groups and sex, 44.7% of African American youth with type 1 diabetes were overweight or obese. Among African American youth aged 10-19 years, prevalence (per 1,000) of type 2 diabetes was 1.06 (0.93-1.22) and annual incidence (per 100,000) was 19.0 (16.9-21.3). About 60% of African American youth with type 2 diabetes had an annual household income of <$25,000. Among those aged >or=15 years, 27.5% had an A1C >or=9.5%, 22.5% had high blood pressure, and, across subgroups of age and sex, >90% were overweight or obese.

Conclusions: Type 1 diabetes presents a serious burden among African American youth aged <10 years, and African American adolescents are impacted substantially by both type 1 and type 2 diabetes.

Figures

Figure 1
Figure 1
Prevalence (2001) and incidence (2002–2005) of type 1 and type 2 diabetes among African American youth according to age and sex: the SEARCH study. □, male subjects; , female subjects.
Figure 2
Figure 2
Markers of socioeconomic status among African American youth with type 1 and type 2 diabetes: the SEARCH study. Less income is

Figure 3

Overweight and obesity among African…

Figure 3

Overweight and obesity among African American youth with type 1 and type 2…

Figure 3
Overweight and obesity among African American youth with type 1 and type 2 diabetes according to age and sex: the SEARCH study. *Difference in weight status between type 1 diabetic female and male subjects is significant (P < 0.01). Age represents age at time of SEARCH study visit. Weight categories are defined based on Centers for Disease Control and Prevention definitions of weight status. □, underweight/normal; , overweight; ▪, obese.
Figure 3
Figure 3
Overweight and obesity among African American youth with type 1 and type 2 diabetes according to age and sex: the SEARCH study. *Difference in weight status between type 1 diabetic female and male subjects is significant (P < 0.01). Age represents age at time of SEARCH study visit. Weight categories are defined based on Centers for Disease Control and Prevention definitions of weight status. □, underweight/normal; , overweight; ▪, obese.

References

    1. Pinhas-Hamiel O, Zeitler P: The global spread of type 2 diabetes mellitus in children and adolescents. J Pediatr 146 :693 –700,2005
    1. Liese AD, D'Agostino RB Jr, Hamman RF, Kilgo PD, Lawrence JM, Liu LL, Loots B, Linder B, Marcovina S, Rodriguez B, Standiford D, Williams DE: The burden of diabetes mellitus among US youth: prevalence estimates from the SEARCH for Diabetes in Youth Study. Pediatrics 118 :1510 –1518,2006
    1. Egede LE, Gogo-Jack S: Epidemiology of type 2 diabetes: focus on ethnic minorities. Med Clin North Am 89 :949 –975, viii, 2005
    1. Crook ED, Patel SR: Diabetic nephropathy in African-American patients. Curr Diab Rep 4 :455 –461, 2004
    1. Harris MI, Flegal KM, Cowie CC, Eberhardt MS, Goldstein DE, Little RR, Wiedmeyer HM, Byrd-Holt DD: Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in U.S. adults: the Third National Health and Nutrition Examination Survey, 1988–1994. Diabetes Care 21 :518 –524,1998
    1. Kirk JK, D'Agostino RB Jr, Bell RA, Passmore LV, Bonds DE, Karter AJ, Narayan KM: Disparities in HbA1c levels between African-American and non-Hispanic white adults with diabetes: a meta-analysis. Diabetes Care 29 :2130 –2136,2006
    1. SEARCH Study Group: SEARCH for Diabetes in Youth: a multicenter study of the prevalence, incidence and classification of diabetes mellitus in youth. Control Clin Trials 25 :458 –471,2004
    1. Ingram DD, Parker JD, Schenker N, Weed JA, Hamilton B, Arias E, Madans JH: United States Census 2000 population with bridged race categories. Vital Health Stat 21 –55,2003
    1. Mayer-Davis EJ, Nichols M, Liese AD, Bell RA, Dabelea DM, Johansen JM, Pihoker C, Rodriguez BL, Thomas J, Williams D: Dietary intake among youth with diabetes: the SEARCH for Diabetes in Youth Study. J Am Diet Assoc 106 :689 –697,2006
    1. Brener ND, Kann L, Kinchen SA, Grunbaum JA, Whalen L, Eaton D, Hawkins J, Ross JG: Methodology of the youth risk behavior surveillance system. MMWR Recomm Rep 53 :1 –13,2004
    1. Radloff L: The CES-D scale: a self report depression scale for research in the general population. Applied Psychological Measurement 1 :385 –401,1977
    1. Lawrence JM, Standiford DA, Loots B, Klingensmith GJ, Williams DE, Ruggiero A, Liese AD, Bell RA, Waitzfelder BE, McKeown RE: Prevalence and correlates of depressed mood among youth with diabetes: the SEARCH for Diabetes in Youth study. Pediatrics 117 :1348 –1358,2006
    1. Kershnar AK, Daniels SR, Imperatore G, Palla SL, Petitti DB, Pettitt DJ, Marcovina S, Dolan LM, Hamman RF, Liese AD, Pihoker C, Rodriguez BL: Lipid abnormalities are prevalent in youth with type 1 and type 2 diabetes: the SEARCH for Diabetes in Youth Study. J Pediatr 149 :314 –319,2006
    1. Silverstein J, Klingensmith G, Copeland K, Plotnick L, Kaufman F, Laffel L, Deeb L, Grey M, Anderson B, Holzmeister LA, Clark N: Care of children and adolescents with type 1 diabetes: a statement of the American Diabetes Association. Diabetes Care 28 :186 –212,2005
    1. Cook S, Weitzman M, Auinger P, Nguyen M, Dietz WH: Prevalence of a metabolic syndrome phenotype in adolescents: findings from the third National Health and Nutrition Examination Survey, 1988–1994. Arch Pediatr Adolesc Med 157 :821 –827,2003
    1. Rodriguez BL, Fujimoto W, Mayer-Davis E, Imperatore G, Williams DE, Bell RA, Wadwa RP, Palla SL, Liu L, Kershnar A, Daniels S, Linder B: Prevalence of cardiovascular disease risk factors in U.S. children and adolescents with diabetes: the SEARCH for Diabetes in Youth Study. Diabetes Care 29 :1891 –1896,2006
    1. Brunzell JD, Davidson M, Furberg CD, Goldberg RB, Howard BV, Stein JH, Witztum JL: Lipoprotein management in patients with cardiometabolic risk: consensus statement from the American Diabetes Association and the American College of Cardiology Foundation. Diabetes Care 31 :811 –822,2008
    1. Molitch ME, DeFronzo RA, Franz MJ, Keane WF, Mogensen CE, Parving HH, Steffes MW: Nephropathy in diabetes. Diabetes Care 27 (Suppl. 1):S79 –S83,2004
    1. National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents: The fourth report on the diagnosis, evaluation, and treatment of high blood pressure in children and adolescents. Pediatrics 114 :555 –576,2004
    1. Rewers A, Klingensmith G, Davis C, Petitti DB, Pihoker C, Rodriguez B, Schwartz ID, Imperatore G, Williams D, Dolan LM, Dabelea D: The presence of diabetic ketoacidosis at diagnosis mellitus in youth: the SEARCH for Diabetes in Youth Study. Pediatrics 121 :e1258 –e1266,2007
    1. Rushton JL, Forcier M, Schectman RM: Epidemiology of depressive symptoms in the National Longitudinal Study of Adolescent Health. J Am Acad Child Adolesc Psychiatry 41 :199 –205,2002
    1. Brown LD, Cai TT, DasGupta A: Interval estimation for a binomial proportion. Stat Sci 16 :101 –133,2001
    1. Misra A, Ganda OP: Migration and its impact on adiposity and type 2 diabetes. Nutrition 23 :696 –708,2007
    1. Mokdad AH, Ford ES, Bowman BA, Dietz WH, Vinicor F, Bales VS, Marks JS: Prevalence of obesity, diabetes, and obesity-related health risk factors, 2001. JAMA 289 :76 –79,2003
    1. Agardh EE, Ahlbom A, Andersson T, Efendic S, Grill V, Hallqvist J, Ostenson CG: Socio-economic position at three points in life in association with type 2 diabetes and impaired glucose tolerance in middle-aged Swedish men and women. Int J Epidemiol 36 :84 –92,2007
    1. DIAMOND Project Group: Incidence and trends of childhood type 1 diabetes worldwide 1990–1999. Diabet Med 23 :857 –866,2006
    1. Libman IM, Pietropaolo M, Trucco M, Dorman JS, LaPorte RE, Becker D: Islet cell autoimmunity in white and black children and adolescents with IDDM. Diabetes Care 21 :1824 –1827,1998
    1. Lipman TH, Jawad AF, Murphy KM, Tuttle A, Thompson RL, Ratcliffe SJ, Levitt Katz LE: Incidence of type 1 diabetes in Philadelphia is higher in black than white children from 1995 to 1999: epidemic or misclassification? Diabetes Care 29 :2391 –2395,2006
    1. Smith TL, Drum ML, Lipton RB: Incidence of childhood type I and non-type 1 diabetes mellitus in a diverse population: the Chicago Childhood Diabetes Registry, 1994 to 2003. J Pediatr Endocrinol Metab 20 :1093 –1107,2007
    1. Libman IM, Pietropaolo M, Arslanian SA, LaPorte RE, Becker DJ: Evidence for heterogeneous pathogenesis of insulin-treated diabetes in black and white children. Diabetes Care 26 :2876 –2882,2003
    1. Dabelea D, Bell RA, D'Agostino RB, Jr, Imperatore G, Johansen JM, Linder B, Liu LL, Loots B, Marcovina S, Mayer-Davis EJ, Pettitt DJ, Waitzfelder B: Incidence of diabetes in youth in the United States. JAMA 297 :2716 –2724,2007
    1. Bell RA, Mayer-Davis EJ, Beyer JW, D'Agostino RB Jr, Lawrence JM, Linder B, Liu LL, Marcovina SM, Rodriguez BL, Williams D, Dabelea D: Diabetes in non-Hispanic white youth: prevalence, incidence, and clinical characteristics: the SEARCH for Diabetes in Youth Study.32 (Suppl. 2):102 –111,2009
    1. Wang MC, Kim S, Gonzalez AA, MacLeod KE, Winkleby MA: Socioeconomic and food-related physical characteristics of the neighbourhood environment are associated with body mass index. J Epidemiol Community Health 61 :491 –498,2007
    1. Dabelea D, D'Agostino RB Jr, Mayer-Davis EJ, Pettitt DJ, Imperatore G, Dolan LM, Pihoker C, Hillier TA, Marcovina SM, Linder B, Ruggiero AM, Hamman RF: Testing the accelerator hypothesis: body size, β-cell function, and age at onset of type 1 (autoimmune) diabetes. Diabetes Care 29 :290 –294,2006
    1. Wilkin TJ: The accelerator hypothesis: weight gain as the missing link between type I and type II diabetes. Diabetologia 44 :914 –922,2001
    1. Thompson DR, Obarzanek E, Franko DL, Barton BA, Morrison J, Biro FM, Daniels SR, Striegel-Moore RH: Childhood overweight and cardiovascular disease risk factors: the National Heart, Lung and Blood Institute Growth and Health Study. J Pediatr 150 :18 –25,2007
    1. Banerji MA: Diabetes in African Americans: unique pathophysiologic features. Curr Diab Rep 4 :219 –223, 2004
    1. Banerji MA: Impaired beta-cell and alpha-cell function in African-American children with type 2 diabetes mellitus: “Flatbush diabetes.” J Pediatr Endocrinol Metab 15 (Suppl. 1):493 –501,2002
    1. Banerji MA, Chaiken RL, Huey H, Tuomi T, Norin AJ, Mackay IR, Rowley MJ, Zimmet PZ, Lebovitz HE: GAD antibody negative NIDDM in adult black subjects with diabetic ketoacidosis and increased frequency of human leukocyte antigen DR3 and DR4: Flatbush Diabetes. Diabetes 43 :741 –745,1994
    1. Delamater AM, Shaw KH, Applegate EB, Pratt IA, Eidson M, Lancelotta GX, Gonzalez-Mendoza L, Richton S: Risk for metabolic control problems in minority youth with diabetes. Diabetes Care 22 :700 –705,1999
    1. Chalew SA, Gomez R, Butler A, Hempe J, Compton T, Mercante D, Rao J, Vargas A: Predictors of glycemic control in children with type 1 diabetes: the importance of race. J Diabetes Complications 14 :71 –77,2000
    1. Auslander WF, Thompson S, Dreitzer D, White NH, Santiago JV: Disparity in glycemic control and adherence between African-American and Caucasian youths with diabetes. Family and community contexts. Diabetes Care 20 :1569 –1575,1997
    1. Ellis DA, Templin T, Naar-King S, Frey MA, Cunningham PB, Podolski CL, Cakan N: Multisystemic therapy for adolescents with poorly controlled type I diabetes: stability of treatment effects in a randomized controlled trial. J Consult Clin Psychol 75 :168 –174,2007
    1. Adams AS, Trinacty CM, Zhang F, Kleinman K, Grant RW, Meigs JB, Soumerai SB, Ross-Degnan D: Medication adherence and racial differences in A1C control. Diabetes Care 31 :916 –921,2008
    1. Hajjar I, Kotchen TA: Trends in prevalence, awareness, treatment, and control of hypertension in the United States, 1988–2000. JAMA 290 :199 –206,2003
    1. Muntner P, He J, Cutler JA, Wildman RP, Whelton PK: Trends in blood pressure among children and adolescents. JAMA 291 :2107 –2113,2004
    1. Li S, Chen W, Srinivasan SR, Tang R, Bond MG, Berenson GS: Race (black-white) and gender divergences in the relationship of childhood cardiovascular risk factors to carotid artery intima-media thickness in adulthood: the Bogalusa Heart Study. Atherosclerosis 194 :421 –425,2007
    1. Hoq S, Chen W, Srinivasan SR, Berenson GS: Childhood blood pressure predicts adult microalbuminuria in African Americans, but not in whites: the Bogalusa Heart Study. Am J Hypertens 15 :1036 –1041,2002
    1. Albers JJ, Marcovina SM, Imperatore G, Snively BM, Stafford J, Fujimoto WY, Mayer-Davis EJ, Petitti DB, Pihoker C, Dolan L, Dabelea DM: Prevalence and determinants of elevated apolipoprotein B and dense low-density lipoprotein in youths with type 1 and type 2 diabetes. J Clin Endocrinol Metab 93 :735 –742,2008
    1. Ford ES, Giles WH, Dietz WH: Prevalence of the metabolic syndrome among US adults: findings from the third National Health and Nutrition Examination Survey. JAMA 287 :356 –359,2002
    1. Duncan GE, Li SM, Zhou XH: Prevalence and trends of a metabolic syndrome phenotype among U.S. adolescents, 1999–2000. Diabetes Care 27 :2438 –2443,2004
    1. Bantle JP, Wylie-Rosett J, Albright AL, Apovian CM, Clark NG, Franz MJ, Hoogwerf BJ, Lichtenstein AH, Mayer-Davis E, Mooradian AD, Wheeler ML: Nutrition recommendations and interventions for diabetes: a position statement of the American Diabetes Association. Diabetes Care 31 (Suppl. 1):S61 –S78,2008
    1. Wysocki T, Harris MA, Buckloh LM, Mertlich D, Lochrie AS, Mauras N, White NH: Randomized trial of behavioral family systems therapy for diabetes: maintenance of effects on diabetes outcomes in adolescents. Diabetes Care 30 :555 –560,2007
    1. Channon SJ, Huws-Thomas MV, Rollnick S, Hood K, Cannings-John RL, Rogers C, Gregory JW: A multicenter randomized controlled trial of motivational interviewing in teenagers with diabetes. Diabetes Care 30 :1390 –1395,2007
    1. Zeitler P, Epstein L, Grey M, Hirst K, Kaufman F, Tamborlane W, Wilfley D: Treatment options for type 2 diabetes in adolescents and youth: a study of the comparative efficacy of metformin alone or in combination with rosiglitazone or lifestyle intervention in adolescents with type 2 diabetes. Pediatr Diabetes 8 :74 –87,2007

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