From the Journals

Both diabetes types increase markedly among youths

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Youths fuel overall diabetes burden

This study by Mayer-Davis et al. provides the most current data available on the incidence of diabetes in this age group.

The consequence of this increase in diabetes among youths is that the overall disease burden on public health is actually increasing, despite improvements in mortality and CVD rates among older diabetes patients.

According to the 2015 Global Burden of Disease report, the number of years lived with disability has increased by 32.5% and the number of years of life lost has increased by 25.4%.

What do the marked increase in the incidence of diabetes and more people at risk imply about therapy? Data from two large studies over the past several decades support that intensive glycemic control improved outcomes in persons with type 1 or type 2 diabetes mellitus. But what is missing, despite a growing understanding about the pathogenesis of each condition, is knowledge about how best to lower the number of new cases and how best to treat problems once they arise in persons with diabetes.

It is clear that we are far from controlling the negative effects of diabetes on health worldwide. As the prevalence increases, we clearly need new approaches to reduce the burden of this disease on public health.

Julie R. Ingelfinger, M.D., and John A. Jarcho, M.D., are deputy editors of The New England Journal of Medicine. They reported having no relevant disclosures. Dr. Ingelfinger and Dr. Jarcho made these remarks in an editorial accompanying Dr. Mayer-Davis’s report (N Engl J Med. 2017 April 13. doi: 10.1056/NEJMe1616575).


 

FROM THE NEW ENGLAND JOURNAL OF MEDICINE

The annual incidence of both types 1 and 2 diabetes markedly increased among youths between 2002 and 2012, especially among those in minority racial and ethnic groups, according to a report published online April 13 in the New England Journal of Medicine.

In this analysis of SEARCH data, there were 11,245 youths with type 1 diabetes in 54,239,600 person-years of surveillance and 2,846 with type 2 diabetes in 28,029,000 person-years of surveillance.

“We estimated that approximately 15,900 cases of type 1 diabetes were diagnosed annually in the U.S. in the 2002-2003 period, and this number increased to 17,900 annually in the 2011-2012 period. Overall, the adjusted annual relative increase in the incidence of type 1 diabetes was 1.8%,” noted Elizabeth J. Mayer-Davis, PhD, of the departments of nutrition and medicine, University of North Carolina, Chapel Hill, and her associates (N Engl J Med. 2017 April 13. doi: 101056/NEJMoa1610187).

Similarly, they estimated that approximately 3,800 cases of type 2 diabetes were diagnosed in the first year of the study, increasing to 5,300 in the final year. The annual relative increase in type 2 diabetes was 4.8%.

The rate of increase varied across the five major ethnic groups studied: non-Hispanic whites, non-Hispanic blacks, Hispanics, Asians or Pacific Islanders, and Native Americans. Type 1 diabetes incidence rose rapidly among Hispanic youths, and type 2 diabetes rose rapidly in all racial and ethnic groups other than whites, with the greatest rate of increase among Native Americans.

These increases suggest “a growing disease burden that will not be shared equally” because of differences among ethnic groups in barriers to care, methods of treatment, and clinical outcomes. “These findings highlight the critical need to identify approaches to reduce disparities among racial and ethnic groups,” Dr. Mayer-Davis and her associates noted.

The National Institute of Diabetes and Digestive and Kidney Diseases and the Centers for Disease Control and Prevention funded the study. Dr. Mayer-Davis reported having no relevant disclosures. One of her associates reported serving as a consultant to Denka-Seiken and MedTest DX.

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