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May 1, 2006 -- About 39,000 U.S. adolescents have type 2 diabetesdiabetes and nearly 2.8 million have impaired fasting glucose levels, according to a new estimate.
Those figures appear in the Archives of Pediatrics and Adolescent Medicine. Glenn Duncan, PhD, RCEPSM, based the estimate on data from national health surveys given from 1999-2002.
"Type 2 diabetes was once a condition only seen in adults, but this study provides evidence to support regional studies that point to an emerging problem of type 2 diabetes among U.S. youth," Duncan writes.
Duncan notes that the estimate may not be perfect but that a "substantial" number of U.S. youths appear to have type 2 diabetes and impaired fasting glucose levels.
A journal editorial agrees that the data has drawbacks but hints at a "public health time bomb" of diabetes.
Asking About Diabetes Diagnosis
Duncan works in Seattle at the University of Washington's nutritional sciences program. He checked data on 4,370 adolescents aged 12-19 years. Pregnant women were excluded.
The youths were asked if they had ever been told by a doctor or health professional if they had diabetes. Eighteen participants said "yes" to that question, accounting for 0.5% of the entire group.
Among those who said they had diabetes, 71% had type 1 diabetes (in which the body doesn't make enough insulin, a hormone that controls blood sugar), and 29% had type 2 diabetes (in which the body doesn't respond properly to insulin).
Estimating Diabetes Among U.S. Youths
Applying those percentages to youths nationwide, Duncan estimates that 95,066 adolescents have type 1 diabetes and 39,005 have type 2 diabetes in the U.S.
Boys accounted for 56% of the cases of self-reported diabetes. Self-reported diabetes was more common among whites than blacks or Mexican-American youths.
Undiagnosed diabetes cases aren't included in the study. Type 1 diabetes has long accounted for most diabetes cases among youths. Among adults, type 2 diabetes is more common.
Next, Duncan checked for a diabetes risk factor among participants who reported no diabetes diagnosis. Duncan wanted to see if those youths showed a subtle early warning sign of diabetes risk.
Checking Blood Glucose Levels
Duncan studied data from 1,496 participants who denied ever being told by a doctor or health professional that they had diabetes. Those participants had taken a blood sugar (glucose) test after fasting for at least eight hours.
Roughly 11% showed impaired fasting glucose levels, meaning that their body had problems handling sugar after fasting. Impaired fasting glucose levels are often a step on the path towards diabetes.
More than 15% of all adolescents with impaired fasting glucose levels were overweight, 14% were at risk of being overweight, and nearly 10% were of normal weight, the study shows.
Duncan notes certain limits in the data, like the small number of self-reported diabetes cases. Still, the findings have "important implications," Duncan writes, because impaired fasting glucose levels can lead to type 2 diabetes, and type 2 diabetes raises heart risks in adults.
Because participants weren't tracked over time, it's not clear which, if any, of the youths eventually developed those problems.
Fixing the Problem
The journal also includes an editorial by Arlan Rosenbloom, MD, of Children's Medical Services Center in Gainesville, Fla.
Rosenbloom questions the diabetes diagnosis in several of the 18 patients who claimed to have diabetes. Rosenbloom bases his questions on the medicines those patients reported taking.
However, Rosenbloom calls Duncan's percentage estimates "reasonably consistent" with other data.
"A substantial number of pediatric patients, those with body mass index greater than 85th percentile for age and sex, are going to require the kind of monitoring for cardiovascular risk factors that has been considered standard care for older adults," Rosenbloom writes.
It's possible to lower the odds of developing type 2 diabetes and heart problems. Rosenbloom writes that the "public health time bomb reflected in the report by Duncan" will hopefully spur societal efforts to curb obesityobesity, since obesity often accompanies diabetes and other health problems.
SOURCES: Duncan, G. Archives of Pediatrics and Adolescent Medicine, May 2006; vol 160: pp 523-528. Rosenbloom, A. Archives of Pediatrics and Adolescent Medicine, May 2006; vol 160 pp: 551-552. News release, JAMA/Archives.