ESPE Yearbook of Paediatric Endocrinology

Brief summary: The incidences of T1D and T2D in children and young people increased in the USA over the last 2 decades. For the first time, the incidence of T2D has surpassed that of T1D.

Comment: The SEARCH study has served as a national resource to explore the epidemiology and consequences of diabetes in the US. Published over the years, the findings contribute to understanding future trends in other parts of the world. Overall, the current report shows almost doubling of the adjusted incidence of T2DM among children and adolescents, from 9.0 to 17.9 cases per 100 000 persons per year, from 2002-03 to 2017-18. For the specific age group of 15–19 years, the incidence of T2D in 2017-2018 exceeded that of T1D (19.7 per 100 000 vs. 14.6 per 100 000). This is the first time that among youth the incidence of T2D surpassed that of T1D, and is a substantial and alarming warning that effective prevention plans are needed. Also, for the first time, this study showed a significant seasonal variation in the onset of T2D in children and young people. Specifically, diagnoses were increased in August. Possible explanations are childhood weight gain during the summer vacation from school, and an uptick in physical exams for school athletic programs, which may detect asymptomatic hyperglycemia. This is consistent with the greater proportion of diagnoses at routine health visits rather than following symptoms. Benefits are likely to accrue from early diagnosis of T2D,¹ which allows for prompt multifactorial treatment and attention to cardiovascular risk factors. The findings from the current study emphasize the importance of routine evaluations.

Of note, the increase in the incidence of T2D among youth is not limited to the US. In Germany, a three-fold increase in the prevalence of T2D was reported for 10-19-year-olds during 2002-2020 (from 3.4 to 10.8 per 100 000 persons). ² The estimated standardized prevalence of T2D was 1.4 times higher among girls (12.8) than boys (9.0). Data from the UK reveals that the number of children registered as having T2D and being treated in paediatric diabetes units in England and Wales has risen by more than 50% in the past five years.

References: 1. Herman WH, Ye W, Griffin SJ, Simmons RK, Davies MJ, Khunti K, Rutten GE, Sandbaek A, Lauritzen T, Borch-Johnsen K, Brown MB, Wareham NJ. Early detection and treatment of type 2 diabetes reduce cardiovascular morbidity and mortality: A simulation of the results of the Anglo-Danish-Dutch study of intensive treatment in people with screen-detected diabetes in primary care (ADDITION-Europe). Diabetes Care. 2015 Aug;38(8):1449–55. doi: 10.2337/dc14-2459. 2. Stahl-Pehe A, Kamrath C, Prinz N, Kapellen T, Menzel U, Kordonouri O, Schwab KO, Bechtold-Dalla Pozza S, Rosenbauer J, Holl RW. Prevalence of type 1 and type 2 diabetes in children and adolescents in Germany from 2002 to 2020: A study based on electronic health record data from the DPV registry. J Diabetes. 2022 Dec;14(12):840–850. doi: 10.1111/1753-0407.13339. 3. Wise J. Type 2 diabetes: Charity warns of “perfect storm” putting more children at risk. BMJ. 2022 Jun 15;377:o1451. doi: 10.1136/bmj.o1451. PMID: 35705201.