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Here are four things MCOs should know about a new study focusing on young patients with diabetes.
Rates of newly diagnosed cases of type 1 and type 2 diabetes are increasing among children and teens in the United States, according to a report published in the New England Journal of Medicine (NEJM). The fastest rise is among racial/ethnic minority groups.
As reported in Diabetes Care, in the United States in 2009, an estimated 191,986 youth under age 20 had diabetes; 166,984 had type 1 diabetes, 20,262 had type 2 diabetes, and 4,740 had other types.
Here are four things MCOs should know about the study and why diabetes rates are increasing in young populations.
1. The drivers of increased diabetes are very different for type 1 and type 2 diabetes
The NEJM study is the first one to estimate trends in newly diagnosed cases of diabetes types 1 and 2 in youths from the United States’ five major racial/ethnic groups-non-Hispanic whites, non-Hispanic blacks, Hispanics, Asian Americans/Pacific Islanders, and Native Americans. The study included 11,244 youth ages 0 to 19 with type 1 diabetes and 2,846 youth ages 10 to 19 with type 2 diabetes.
“The reason for increasing incidences of diabetes is most likely very different for types 1 and 2 diabetes, because they are very different in their etiologies,” says Elizabeth J. Mayer-Davis, PhD, the lead author of the study and professor and chair, Department of Nutrition, The University of North Carolina, Chapel Hill, North Carolina. “Both involve genetic influences, although the specific genes involved are quite different for the two types, and environmental and behavioral factors are likely very different.”
For type 1, the specific environmental or behavioral triggers that push the autoimmune process to destroy cells that produce insulin are unknown. For type 2, it’s believed that childhood obesity-which has increased-is the main culprit, Mayer-Davis says.
Giuseppina Imperatore, MD, PhD, a study co-author and epidemiologist at the CDC’s Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, adds that several reports have also shown that exposure to maternal diabetes in utero has been associated with increased risk of type 2 diabetes in youth. Other factors, yet to be identified, may also contribute to reduced insulin secretion in youth.
2. Rates of newly diagnosed diabetes are higher for type 2 diabetes
The source of data for the NEJM study, The SEARCH for Diabetes in Youth study-funded by the CDC and the National Institutes of Health - found that from 2002 to 2012, the rate of newly diagnosed cases of type 1 diabetes in youth increased by about 1.8% each year. During the same period, the rate of newly diagnosed cases of type 2 diabetes increased more quickly, at 4.8%.
“As our study has shown, there are differences in risk for both diabetes types 1 and 2 across the various racial and ethnic groups,” Imperatore says. “Understanding these differences is crucial for identifying factors that lead to these diseases.”
3. Rates of newly diagnosed diabetes varied greatly among different racial and ethnic groups
The rate of newly diagnosed cases of type 2 diabetes rose most sharply in Native Americans (8.9%), Asian Americans/Pacific Islanders (8.5%), and non-Hispanic blacks (6.3%). However, it should be noted that Native American youth who participated in the SEARCH study don’t represent all Native American youth in the United States so rates cannot be generalized to all Native American youth nationwide.
Mayer-Davis believes the increase in rates of diabetes development greatly varies among specific racial and ethnic groups because combinations of genes and environmental factors differ among ethnic groups. “These factors can help us understand the causes of diseases, how to prevent diabetes in these groups, and recognize circumstances that are needed in order to take the best care of youth with diabetes regardless of their ethnic group."
4. Rates of diabetes in different ethnic groups could indicate different patterns of genetic susceptibility
The rate of newly diagnosed cases of type 1 diabetes increased most sharply in Hispanic youth, a 4.2% annual increase. In non-Hispanic blacks, the rate of new diagnosed cases of type 1 diabetes increased by 2.2%, and in non-Hispanic whites by 1.2% per year.
Mayer-Davis says it’s important to study rates in different ethnic groups because there may be different patterns of genetic susceptibility that relate to diabetes types 1 and 2. It’s also important for healthcare systems to understand and recognize what groups in the population are likely to experience more incidences of diabetes, so they can better understand the expectations of care that they need to provide and can better project the cost of care.
“Historically, we know that groups other than non-Hispanic whites haven’t had as much access to some of the more current treatment modalities such as insulin pumps,” Mayer-Davis says.
Karen Appold is a medical writer in Lehigh Valley, Pennsylvania.