Type 1 Diabetes- Prevalence and Diabetes clinical visits

Dr. Fran Cogen Health Pro

    Anecdotally, it appears that there has been an increasing frequency of new cases of both type 1 and type 2 diabetes. This has been confirmed by the rapid rise in new patients we have welcomed into our diabetes program at the Children’s National Health System. We now have data from The SEARCH for Diabetes in Youth Study presented in a recent issue of Diabetes Care (2014;37:402-408). The authors, Pettitt, Talton, Dabelea et. al for the SEARCH for Diabetes in Youth Study Group have published the “Prevalence of Diabetes in U.S. Youth in 2009.”


    The goal of the study is to estimate the prevalence of diabetes in children and adolescents less than 20 years of age as of 2009 and to estimate the total number of youth with diabetes in the United States by age, race/ethnicity, and type of diabetes.

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    How was the study conducted?


    Youth aged less than 20 years as of December 21, 2009, were identified in areas of Colorado, Ohio, South Carolina, and Washington states; among Kaiser Permanente Southern California members; and among American Indians living on reservations in New Mexico and Arizona. The type of diabetes was described as T1, T2 or other.


    What were the results?

    1. A total population of 3,458,974 aged <20 was identified from the regions described above.
    2. 7695 youth with diabetes were identified (2.22/1000)
    3. 6668 with type 1 diabetes (1.93/1000)
    4. 837 with type 2 diabetes (0.24/1000)
    5. 190 with “other types” (0.05/1000).
    6. Prevalence:
      1. Increased with age
      2. Slightly higher in females than males
      3. Most prevalent in non-Hispanic White individuals
      4. Least prevalent in Asian/Pacific Islanders
      5. Highest prevalence of type 2 diabetes in Native American and Black youth
      6. It is estimated that 191,986 United States children/adolescents aged <20 have diabetes:
        1. Type 1 DM: 166,984
        2. Type 2 DM: 20,262
        3. Other DM: 4,740


     In summary, diabetes, one of the top three chronic illnesses in United States children, occurs in 1/433 youth aged less than 20 years. The previous statistics that were usually quoted was a prevalence of 1/400-600. Now we are closer to the 1/400 range. In addition, the increased estimate is still largely driven by increased number of new cases of type 1 diabetes. Therefore, in addition to the attempts to intervene and prevent obesity in our school aged children, hopefully preventing the development of type 2 diabetes, we will still be confronted by the increasing number of children/adolescents with type 1 diabetes.


    Having noted this influx of newly diagnosed patients, additional literature from the same issue of Diabetes Care (2014; 37:341-345) emphasizes the need for quarterly visits with Hb A1c monitoring for our children/adolescents with T1DM.  The authors T. Phan, J. Hossain, S. Lawless and L. Werk evaluated the “association between the frequency of visits and Hb A1c measurements on glycemic control in youth with type 1 diabetes.” It has always been our target at Children’s National Health System to see patients every four months based on common sense as the Hb A1c correlates to the three month estimated average blood sugar based on glucose molecules adhering to the hemoglobin molecule in the red blood cell.


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    In this longitudinal study a group of 1449 children/adolescent with type 1 diabetes were followed at five pediatric endocrinology clinics from 2008-2011. Three groups were generated: those with an increased Hb A1c (237), no change in Hb A1c (842) and a decrease in Hb A1c (370).


    The results were significant! (p<0.05). Patients with quarterly visits were least likely to have worsened glycemic control and were most likely to have improved blood sugar control (p<0.01).  Most importantly, patients with four Hb A1c tests/year (p<0.05) were least likely to have worsening of glycemic control.


    Prior to this evidence- based study, Children’s was already working to increase the number of healthcare providers at Children’s National in order to accommodate both the increased number of patients as well as to hopefully improve glycemic status. Previous blogs have also supported the need for close communication, a unified team and family support. Now, our common sense approach in regard to appointment frequency has been validated!

Published On: March 01, 2014