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Diabetes Care 29:420-421, 2006
DOI: 10.2337/diacare.29.02.06.dc05-2182
© 2006 by the American Diabetes Association
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Epidemiology/Health Services/Psychosocial Research
Brief Report

An Epidemiologic Profile of Children With Diabetes in the U.S.

Joyce M. Lee, MD1,2,3, William H. Herman, MD, MPH4,5, Melissa L. McPheeters, PHD, MPH2,3 and James G. Gurney, PHD2,3

1 Division of Pediatric Endocrinology, University of Michigan, Ann Arbor, Michigan
2 Division of General Pediatrics, University of Michigan, Ann Arbor, Michigan
3 Child Health Evaluation and Research Unit, University of Michigan, Ann Arbor, Michigan
4 Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
5 Department of Epidemiology, University of Michigan, Ann Arbor, Michigan

Address correspondence and reprint requests to Joyce M. Lee, MD, 300 NIB, Room 6E08, Campus Box 0456, Ann Arbor, MI 48109-0456. E-mail: joyclee{at}umich.edu

Abbreviations: NSCH, National Survey of Children’s Health


   INTRODUCTION
TOP
 INTRODUCTION
RESEARCH DESIGN AND METHODS
 RESULTS
 CONCLUSIONS
 References
 
The incidence of both type 1 and type 2 diabetes in children appears to be increasing in the U.S. (1–4), likely attributable, at least for type 2 diabetes, to the emerging epidemic of childhood obesity. Unfortunately, national prevalence estimates of children with diabetes, and nationally representative data about the demographic characteristics of children with diabetes, are limited. One study, based on just 13 cases, reported the prevalence of diabetes among adolescents aged 12–19 years to be 4.1 per 1,000 (5). We used recently released data from the National Survey of Children’s Health (NSCH) to determine the prevalence of diabetes in U.S. children based on parental report and to examine the association between the presence of obesity and diabetes.


   RESEARCH DESIGN AND METHODS
TOP
 INTRODUCTION
 RESEARCH DESIGN AND METHODS
RESULTS
 CONCLUSIONS
 References
 
The NSCH was a population-based cross-sectional household telephone survey sponsored by the Maternal and Child Health Bureau, the National Center for Health Statistics, and the Centers for Disease Control and Prevention (6). The NSCH used random-digit dialing to recruit and survey households with children <18 years of age. One child in each household was randomly selected to be the subject of the survey, and the respondent for the interview was the parent or guardian who was most familiar with the child’s health and health care. Estimates reported here are based on parental interviews regarding 102,353 children, which were completed from January 2003 through July 2004.

The prevalence of diabetes was calculated based on the parent’s or guardian’s affirmative response to the question: "Has a doctor or health professional ever told you that your child has diabetes?" The type of diabetes (type 1 or type 2) was not specified. There were 352 individuals who responded affirmatively, and this number is the basis for calculating the prevalence within the study population.

Poverty status was defined as household income <200% of the poverty level based on the federal poverty guidelines (7), and variables for geographic regions of the U.S. (Northeast, Midwest, South, and West) were defined by census guidelines (8). BMI was calculated based on the child’s parent-reported weight and height. Using the 2000 Centers for Disease Control and Prevention Growth Charts (9), children in this study were stratified into three groups based on age- and sex-specific BMI: not overweight if BMI was <85th percentile, overweight if BMI was ≥85th percentile and <95th percentile, and obese if BMI was ≥95th percentile.

All analyses were conducted using Stata 8 (Stata, College Station, TX) to apply sampling weights and account for the complex sampling design and to allow for extrapolation to national population estimates. The prevalence of diabetes by each demographic variable of interest was assessed, including {chi}2 tests of association for each variable. The relative odds of having diabetes in school-age children (ages 6–11 and 12–17) was calculated from a logistic regression model that included weight status, sex, and race. The number of children with reported diabetes in the 0- to 5-year-old age-group was not sufficient for reliable statistical estimates within that group.


   RESULTS
TOP
 INTRODUCTION
 RESEARCH DESIGN AND METHODS
 RESULTS
CONCLUSIONS
 References
 
Prevalence estimates
The estimated prevalence of diabetes among U.S. children <18 years of age was 3.2 per 1,000 (95% CI 2.6–3.7), representing an estimated 229,240 children nationally. Table 1 shows prevalence rates by demographic characteristics. Statistical differences were observed for age and race but not for sex, poverty status, family structure, or geographic region. Prevalence of diabetes increased with increasing age (P < 0.001) and differed by race (P = 0.04), in that non-Hispanic white children had a substantially higher prevalence of diabetes (3.8/1,000) compared with other racial and ethnic categories (2.2/1,000).


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  		Table 1— Prevalence of diabetes among children in the U.S., from the National Survey of Children’s Health, 2003–2004

 
Weight status
Although diabetes prevalence was not statistically associated with BMI distribution (P = 0.17; Table 1), there was a higher relative odds of diabetes with higher weight status for children in the 6- to 11- and the 12- to 17-year-old age-groups after adjusting for sex and race. Children who were obese (BMI ≥95th percentile for age and sex) had more than twice the odds of having diabetes compared with those who were not overweight (BMI <85th percentile), with a similar magnitude of association in the 6- to 11-year-old age-group (odds ratio [OR] 2.67 [95% CI 1.57–4.56]) and in the 12- to 17-year-old age-group (2.45 [1.31–4.60]).


   CONCLUSIONS
TOP
 INTRODUCTION
 RESEARCH DESIGN AND METHODS
 RESULTS
 CONCLUSIONS
References
 
This analysis provides a nationally representative prevalence estimate of 3.2 diabetes cases per 1,000 children, type 1 and type 2 combined, and may serve as a baseline estimate for future studies and for public health planning. We found that obese children were over twofold more likely to have diabetes than children of normal weight, offering evidence that obesity may be a significant contributing factor to the development of childhood diabetes. If the association between obesity and diabetes in children is indeed causative, then public health strategies to prevent and treat obesity in children may help to reduce the future burden of diabetes in the U.S.

Because the NSCH is cross-sectional, and because we could not differentiate between type 1 and type 2 diabetes, we were unable to address the important issues related to changing diabetes rates over time. In addition, the NSCH is limited by the unvalidated nature of parental reported data, including weight and height used to calculate BMI, and diabetes. Finally, as in any nonclinical study, it is likely that the prevalence of type 2 diabetes is underestimated due to undiagnosed or presymptomatic disease.

These data provide further evidence of the association between obesity and diabetes in children in the U.S. and suggest cause for concern from the obesity epidemic from a clinical, public health, and health resources perspective.


   Acknowledgments
 
J.M.L. is supported by a T32HD 07534-05 National Institutes of Health (National Institute of Child Health and Human Development) Pediatric Health Services Research Training Grant.


   Footnotes
 
A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

Received for publication November 8, 2005. Accepted for publication November 9, 2005.


   References
TOP
 INTRODUCTION
 RESEARCH DESIGN AND METHODS
 RESULTS
 CONCLUSIONS
 References
 

  1. Fagot-Campagna A, Pettitt DJ, Engelgau MM, Burrows NR, Geiss LS, Valdez R, Beckles GL, Saaddine J, Gregg EW, Williamson DF, Narayan KM: Type 2 diabetes among North American children and adolescents: an epidemiologic review and a public health perspective. J Pediatr 136:664–672, 2000[Medline]
  2. Libman IM, Pietropaolo M, Arslanian SA, LaPorte RE, Becker DJ: Changing prevalence of overweight children and adolescents at onset of insulin-treated diabetes. Diabetes Care 26:2871–2875, 2003[Abstract/Free Full Text]
  3. Lipman TH, Chang Y, Murphy KM: The epidemiology of type 1 diabetes in children in Philadelphia 1990–1994: evidence of an epidemic. Diabetes Care 25:1969–1975, 2002[Abstract/Free Full Text]
  4. Gale EA: The rise of childhood type 1 diabetes in the 20th century. Diabetes 51:3353–3361, 2002[Abstract/Free Full Text]
  5. Fagot-Campagna A, Saaddine JB, Flegal KM, Beckles GL: Diabetes, impaired fasting glucose, and elevated HbA1c in U.S. adolescents: the Third National Health and Nutrition Examination Survey. Diabetes Care 24:834–837, 2001[Abstract/Free Full Text]
  6. van Dyck P, Kogan MD, Heppel D, Blumberg SJ, Cynamon ML, Newacheck PW: The National Survey of Children’s Health: a new data resource. Matern Child Health J 8:183–188, 2004[Medline]
  7. Design and Operation of the National Survey of Children’s Health, 2005. Vital and Health Statistics Series 1, No. 43. Available from http://www.cdc.gov/nchs/data/series/sr_01/sr01_043.pdf. Accessed 12 September 2005
  8. Census Bureau Regions and Divisions of the United States, 2000. Available from http://www.census.gov/geo/www/us_regdiv.pdf. Accessed 15 September 2005
  9. Kuczmarski RJ, Ogden CL, Guo SS, Grummer-Strawn LM, Flegal KM, Mei Z, Wei R, Curtin LR, Roche AF, Johnson CL: 2000 CDC Growth Charts for the United States: methods and development. Vital Health Stat 11:1–190, 2002

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