Diabetes in Hispanic American Youth: Prevalence, incidence, demographics, and clinical characteristics: the SEARCH for Diabetes in Youth Study

Jean M. Lawrence; Elizabeth J. Mayer-Davis; Kristi Reynolds; Jennifer Beyer; David J. Pettitt; Ralph B. D'Agostino; Santica M. Marcovina; Giuseppina Imperatore; Richard F. Hamman

doi:10.2337/dc09-S204

Articles

Diabetes in Hispanic American Youth

Prevalence, incidence, demographics, and clinical characteristics: the SEARCH for Diabetes in Youth Study

Jean M. Lawrence, SCD, MPH, MSSA1,
Elizabeth J. Mayer-Davis, PHD2 3,
Kristi Reynolds, PHD, MPH1,
Jennifer Beyer, MS4,
David J. Pettitt, MD5,
Ralph B. D'Agostino, Jr., PHD4,
Santica M. Marcovina, PHD, SCD6,
Giuseppina Imperatore, MD, PHD7,
Richard F. Hamman, MD, DRPH8 and
for the SEARCH for Diabetes in Youth Study Group

¹Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
²Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
³Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina
⁴Department of Public Health Sciences, Wake Forest University Health Sciences, Winston-Salem, North Carolina
⁵Sansum Diabetes Research Institute, Santa Barbara, California
⁶Department of Medicine, Northwest Lipid Research Laboratories, University of Washington, Seattle, Washington
⁷Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
⁸Department of Preventive Medicine and Biometrics, University of Colorado Denver, Denver, Colorado

Corresponding author: Jean M. Lawrence, jean.m.lawrence{at}kp.org

Diabetes Care 2009 Mar; 32(Supplement 2): S123-S132. https://doi.org/10.2337/dc09-S204

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Figure 1—
2001 prevalence (A and B) and 2002–2005 incidence (C and D) of diabetes among Hispanic youth, by diabetes type, age-group, and sex.
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Figure 2—
Overweight and obesity among Hispanic 2001 prevalent and 2002–2005 incident cohorts of youth with diabetes, by diabetes type, age-group, and sex (A and B: Female subjects; C and D: Male subjects).

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Table 1—

Demographic characteristics of Hispanic youth with diabetes: the SEARCH study, 2001 prevalent and 2002–2005 incident cases with a study visit

Age category (years)*	Type 1 diabetes (n = 551)							Type 2 diabetes (n = 127)
Age category (years)*		Aged 0–9 years	Aged 10–14 years	Aged ≥15 years	P†	Aged 10–14 years	Aged ≥15 years	P†
n	179	210	162		40	87
Sex				0.76			0.23
Female	89 (49.7)	108 (51.4)	77 (47.5)		27 (67.5)	49 (56.3)
Male	90 (50.3)	102 (48.6)	85 (52.5)		13 (32.5)	38 (43.7)
Hispanic origin				0.61			0.28
Mexican American	112 (62.6)	139 (66.2)	100 (61.7)		27 (67.5)	62 (71.3)
Puerto Rican	10 (5.6)	18 (8.6)	12 (7.4)		2 (5.0)	6 (6.9)
Cuban	2 (1.1)	5 (2.4)	2 (1.2)		0	1 (1.2)
South American	7 (3.9)	4 (1.9)	6 (3.7)		0	0
Central American	5 (2.8)	3 (1.4)	7 (4.3)		0	5 (5.8)
Spaniard	2 (1.1)	0	2 (1.2)		0	1 (1.2)
Other Hispanic	41 (22.9)	41 (19.5)	33 (20.4)		11 (27.5)	12 (13.8)
Language for initial survey				0.029			0.84
English	157 (87.7)	169 (80.5)	145 (89.5)		31 (77.5)	66 (75.9)
Spanish	22 (12.3)	41 (19.5)	17 (10.5)		9 (22.5)	21 (24.4)
Family income category				0.86			0.50
<$25,000	30 (18.9)	41 (21.0)	26 (19.5)		15 (44.1)	22 (31.9)
$25,000–$49,000	52 (32.7)	70 (35.9)	47 (35.3)		11 (32.4)	27 (39.1)
$50,000–$74,000	32 (20.1)	43 (22.1)	27 (20.3)		2 (5.9)	9 (13.0)
≥$75,000	45 (28.3)	41 (21.0)	33 (24.8)		6 (17.6)	11 (15.9)
Highest parental education				0.40			0.87
Less than high school	25 (14)	37 (17.8)	30 (18.9)		13 (32.5)	24 (27.9)
High school graduate	46 (25.7)	45 (21.6)	28 (17.6)		10 (25)	23 (26.7)
More than high school	108 (60.3)	126 (60.6)	101 (63.5)		17 (42.5)	39 (45.3)
Household composition				<0.0001			0.19
Two parents/one household	133 (74.3)	129 (61.7)	72 (44.7)		22 (55.0)	51 (58.6)
One-parent household	38 (21.2)	64 (30.6)	63 (39.1)		16 (40.0)	24 (27.6)
Other composition	8 (4.5)	16 (7.7)	26 (16.1)		2 (5.0)	12 (13.8)
Type of health insurance				0.12			0.29
Private‡	131 (73.2)	156 (74.3)	120 (74.5)		23 (57.5)	60 (69.8)
Medicaid/ low income	44 (24.6)	45 (21.4)	28 (17.4)		14 (35.0)	17 (19.8)
Other	2 (1.1)	5 (2.4)	4 (2.5)		0	1 (1.2)
None	2 (1.1)	4 (1.9)	9 (5.6)		3 (7.5)	8 (9.3)

Data are n (%).
*
↵* Age at time of in-person visit.
†
↵† P value using χ² test for the association between variable levels and age-groups. When results were missing, descriptive information and P values are based on participants with complete data.
‡
↵‡ A total of 55.5% of the Hispanic youth were members of managed health care plans in California and Hawaii at the time of case ascertainment, although insurance status may have changed by the time of the SEARCH study in-person study visit when these demographic data were collected.

Table 2—

Clinical characteristics and laboratory results for 678 Hispanic youth with type 1 or type 2 diabetes: the SEARCH study, 2001 prevalent and 2002–2005 incident cohorts with a study visit

	Type 1 diabetes (n = 551)							Type 2 diabetes (n = 127)
		Aged 0–9 years*	Aged 10–14 years	Aged ≥15 years	P†	Aged 10–14 years	Aged ≥15 years	P†
n	179	210	162		40	87
Diagnosis
Age at diabetes diagnosis (years) (means ± SD)	4.5 ± 2.5	8.7 ± 3.2	11.2 ± 4.2	NA	11.6 ± 1.5	14.6 ± 2.1	NA
Duration of diabetes at visit (months) (means ± SD)	22.0 ± 22.9	41.4 ± 38.0	73.2 ± 50.8	<0.0001	13.8 ± 10.7	26.8 ± 24.0	0.001
Duration of diabetes at visit (months) [n (%)]				<0.0001			0.014
<6	37 (20.8)	21 (10.0)	7 (4.3)		8 (20.0)	9 (10.3)
6–12	47 (26.4)	35 (16.7)	13 (8.1)		12 (30.0)	19 (21.8)
>12	94 (52.8)	154 (73.3)	141 (97.6)		20 (50.0)	59 (67.8)
Learned they had diabetes through the following [n (%)]‡				NA			NA
Symptoms	159 (90.9)	189 (92.6)	141 (88.1)		20 (51.3)	39 (47.6)
Physical/check up	12 (7.4)	17 (9.2)	21 (14.1)		12 (31.6)	29 (35.4)
Screening	4 (2.5)	5 (2.7)	3 (2.0)		2 (5.3)	5 (6.3)
DKA at diagnosis, incident cases [n (% yes)]	30 (25.6)	22 (23.7)	8 (21.6)	0.87	3 (9.4)	3 (6.4)	0.62
Any family history of diabetes [n (% yes)]§	92 (52.3)	129 (62.0)	113 (70.2)	0.003	35 (89.7)	71 (82.6)	0.30
Clinical characteristics
BMI (means ± SD)	17.6 ± 2.7	21.7 ± 3.9	25.5 ± 5.1	<0.0001	32.0 ± 8.1	33.3 ± 7.4	0.42
BMI z score (means ± SD)	0.7 ± 1.0	0.8 ± 0.9	0.8 ± 1.1	0.29	2 ± 0.9	1.8 ± 0.8	0.28
Acanthosis nigricans [n (% present)]	1 (0.7)	20 (10.4)	16 (10.7)	0.0009	24 (66.7)	46 (56.1)	0.28
High blood pressure at visit [n (%)]‖	15 (10.8)	12 (6.2)	6 (4.0)	0.07	7 (18.9)	18 (21.7)	0.73
High blood pressure adjusted for duration (%)	11.6	6.3	3.6	0.07	20.4	20.6	0.98
Diabetes medications [n (%)]				<0.0001			0.038
Currently on insulin only	178 (100.0)	207 (99.0)	142 (88.8)		13 (37.1)	12 (16.0)
Currently on insulin and metformin	0	2 (1.0)	12 (7.5)		4 (11.4)	9 (12.0)
Currently on metformin only	0	0	6 (3.8)		17 (48.6)	42 (56.0)
No diabetes medication	0	0	0		1 (2.9)	12 (16.0)
Laboratory measurements
(%) (means ± SD)	8.0 (1.2)	8.6 (1.9)	8.9 (2.0)	0.0002	7.1 (2.2)	8.5 (2.6)	0.009
Adjusted for duration (means ± SE)	8.2 (0.2)	8.6 (0.1)	8.7 (0.2)	0.042	7.3 (0.4)	8.4 (0.3)	0.043
Glycemic control [n (%)]¶				0.0002			0.023
Good (A1C < 8.0%)	64 (51.6)	75 (42.1)	48 (34.8)		26 (74.3)	37 (46.8)
Marginal (8.0 ≤ A1C < 9.5%)	45 (36.3)	48 (27.0)	40 (29.0)		4 (11.4)	15 (19.0)
Poor (A1C ≥ 9.5%)	15 (12.1)	55 (30.9)	50 (36.2)		5 (14.3)	27 (34.2)
GAD65 positive [n (% yes)]	68 (58.1)	102 (59.3)	80 (59.3)	0.98	5 (16.1)	14 (19.2)	0.71
Adjusted for duration (%)	52.7	58.1	66.3	0.15	18.2	17.5	0.93
Fasting C-peptide (means ± SD)	0.4 (0.3)	0.6 (0.7)	0.6 (0.9)	0.06	4.4 (2.4)	3.9 (2.6)	0.35
Mean fasting C-peptide adjusted for duration (means ± SE)	0.3 (0.1)	0.6 (0.1)	0.8 (0.1)	<0.0001	4.2 (0.5)	4 (0.3)	0.69
LDL cholesterol (mg/dl) (means ± SD)	96.6 ± 22.5	96.2 ± 26.8	99.7 ± 26.1	0.51	104.4 ± 28.8	108.3 ± 3.5	0.59
Adjusted for duration (means ± SE)	98.9 ± 2.6	97.1 ± 2.0	96.9 ± 2.5	0.83	105.8 ± 6.0	107.7 ± 4.1	0.80
High LDL cholesterol (≥100 mg/dl) [n (% yes)]	42 (41.2)	58 (38.2)	58 (51.8)	0.078	18 (56.3)	38 (56.7)	0.97
Adjusted for duration (% yes)	43.5	39.0	48.8	0.33	57.4	56.2	0.91
Triglycerides (mg/dl) (geometric means ± SD)	50.1 ± 1.4	65.4 ± 1.6	91.4 ± 1.9	<0.0001	127.7 ± 1.7	159.9 ± 2.0	0.10
Adjusted for duration (geometric mean ± SE)	51.5 ± 1.1	66 ± 1.0	88.9 ± 1.1	<0.0001	128.1 ± 1.1	159.7 ± 1.1	0.13
High triglycerides (≥110 mg/dl) [n (% yes)]	3 (2.9)	21 (13.8)	38 (33.9)	<0.0001	19 (59.4)	48 (71.6)	0.22
Adjusted for duration (% yes)	3.2	14.1	30.9	<0.0001	60.8	71.2	0.32
HDL cholesterol (mg/dl) (means ± SD)	55.3 ± 11.7	54 ± 11.7	50.1 ± 14.1	0.002	41.6 ± 8.6	40.5 ± 10.4	0.61
Adjusted for duration (means ± SE)	56.1 ± 1.2	54.2 ± 0.9	49.1 ± 1.1	0.0001	42.4 ± 1.7	40.2 ± 1.1	0.29
Low HDL cholesterol (≤40 mg/dl) [n (% yes)]	9 (7.4)	24 (13.5)	30 (21.7)	0.004	17 (50.0)	43 (55.1)	0.62
Adjusted for duration (% yes)	6.3	12.7	24.7	0.0006	47.5	56.2	0.41
Apolipoprotein B [median (interquartile range)]	70.0 (15.0)	70.0 (29.0)	80.0 (40.0)	0.008	84.0 (30)	97.5 (41.0)	0.45
Adjusted for duration [median (interquartile range)]	69.2 (4.4)	70.5 (5.3)	77.8 (7.3)	0.20	88.5 (1.6)	92.9 (4.7)	0.66
High apolipoprotein B (≥90 mg/dl) [n (%)]	11 (14.5)	27 (19.7)	44 (35.8)	<0.0001	10 (47.6)	38 (61.3)	0.27
Adjusted for duration (% yes)	16.1	20.2	33.1	0.021	53.2	60.3	0.59

*
↵* Age at time of in-person visit.
†
↵† P value for categorical variables using χ² test for the association between variable levels and age-groups. P value for continuous variables using ANOVA for the overall effect of age-group. P value for adjusted variables using logistic regression (categorical variables) or linear regression (continuous variables) for the overall effect of age-group. When results were missing, descriptive information and P values are based on participants with complete data.
‡
↵‡ More than one response category allowed.
§
↵§ Family history includes parents, grandparents, and biological siblings with any form of diabetes.
‖
↵‖ High blood pressure defined as measured blood pressure (systolic or diastolic) ≥ age-, sex-, and height-specific 95th percentile.
¶
↵¶ Glycemic control categories based on American Diabetes Association recommendations.

Table 3—

Psychosocial, behavioral, and dietary characteristics of 499 Hispanic youth aged ≥10 years with type 1 or type 2 diabetes: the SEARCH study, 2001 prevalent and 2002–2005 incident cohorts with a study visit

	Type 1 diabetes (n = 372)					Type 2 diabetes (n = 127)
		Aged 10–14 years*	Aged ≥15 years	P†	Aged 10–14 years	Aged ≥15 years	P†
n	210	162		40	87
Psychosocial
CES-D score (means ± SD)	10.8 ± 7.0	12.9 ± 9.9	0.017	14.9 ± 9.6	14.9 ± 11.0	0.99
High CES-D score (≥24) [n (% yes)]‡	12 (6.1)	21 (13.8)	0.014	6 (17.6)	16 (19.5)	0.82
Behavioral
Current smoker [n (% yes)]	2 (1.0)	22 (14.3)	<0.0001	0	11 (12.9)	0.03
Physical activity measures
Three to seven days/week moderate or vigorous [n (% yes)]	124 (62.0)	85 (54.8)	0.17	20 (57.1)	47 (55.3)	0.85
Watching television ≥2 h/day [n (% yes)]	129 (64.5)	100 (64.5)	0.99	23 (65.7)	64 (75.3)	0.29
Dietary intake
Percent total kcal from total fat (mean kcal ± SD)	37.3 ± 6.0	38.5 ± 7.1	0.15	39.1 ± 6.1	36.3 ± 7.4	0.08
≥7% of kcal from saturated fat [n (% yes)]	161 (100.0)	126 (99.2)	0.26	29 (100.0)	67 (100.0)	NA
Number of servings of fruit and vegetables per day (mean servings ± SD)	3.3 ± 3.2	3 ± 2.2	0.53	3 ± 2.3	3 ± 2.3	0.92
Less than five servings per day of fruit and vegetables [n (% yes)]	136 (84.5)	106 (83.5)	0.82	25 (86.2)	55 (82.1)	0.62
Number of servings of dairy per day (mean servings ± SD)	2 ± 1.4	1.6 ± 1.2	0.011	1.6 ± 1.4	1.4 ± 1.0	0.50
Less than two servings per day of dairy [n (% yes)]	97 (60.2)	85 (66.9)	0.24	18 (62.1)	50 (74.6)	0.21

*
↵* Age at time of in-person visit.
†
↵† P value for categorical variables using χ² test for the association between variable levels and age-groups. P value for continuous variables using ANOVA for the overall effect of age-group. When results were missing, descriptive information and P values are based on participants with complete data.
‡
↵‡ Value is indicative of moderately/severely depressed mood (17,18).