Epidemiology of Pediatric and Adolescent Diabetes

Epidemiology of Pediatric and Adolescent Diabetes

(Parte 1 de 9)

Epidemiology of

Pediatric and Adolescent Diabetes

Edited by

Dana Dabelea

University of Colorado HSC Denver, Colorado, USA

Georgeanna J. Klingensmith

University of Colorado Aurora, Colorado, USA

Epidemiology of

Pediatric and Adolescent Diabetes

Informa Healthcare USA, Inc. 52 Vanderbilt Avenue New York, NY 10017

# 2008 by Informa Healthcare USA, Inc. Informa Healthcare is an Informa business

No claim to original U.S. Government works Printed in the United States of America on acid-free paper 10 987654321

International Standard Book Number-10: 1-4200-4797-3 (Hardcover) International Standard Book Number-13: 978-1-4200-4797-4 (Hardcover)

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Library of Congress Cataloging-in-Publication Data

Epidemiologyof Pediatricand Adolescent Diabetes/ edited by Dana Dabelea, Georgeanna J. Klingensmith. p.;c m. Includes bibliographical references and index.

ISBN-13: 978-1-4200-4797-4 (hardcover : alk. paper) ISBN-10: 1-4200-4797-3 (hardcover : alk. paper)

1. Diabetes in adolescence—Epidemiology. 2. Diabetes in children—Epidemiology. I. Dabelea, Dana. I. Klingensmith, Georgeanna J.

[DNLM: 1. Diabetes Mellitus, Type 1. 2. Adolescent. 3. Child. 4.

Diabetes Mellitus, Type 1—epidemiology. 5. DiabetesMellitus, Type 2—epidemiology. 6. Diabetes Mellitus, Type 2. 7. Risk Factors. WK 810 E642 2008] RJ420.D5E65 2008

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Visit the Informa Web site at w.informa.com and the Informa Healthcare Web site at w.informahealthcare.com

We would like to dedicate this book to all youth with diabetes, their loving and supportive families, around the world. We would like to express our gratitude to our contributors who have written comprehensive, up-to-date, highly informative chapters. Finally, we remain indebted to our own, always supportive, families.

Dana Dabelea and Georgeanna J. Klingensmith


Diabetes mellitus is the third most prevalent severe chronic disease of childhood. Despite this, there are currently no comprehensive books dedicated to the epidemiology of childhood diabetes. In addition, the epidemiology of diabetes in youth is changing. Until recently, diabetes diagnosed in children and adolescents was almost entirely considered to be type 1 (insulin dependent) diabetes, formerly known as ‘‘juvenile diabetes’’ or ‘‘IDDM.’’ Now, as youth are becoming increasingly overweight, we are seeing more obese children with a clinical phenotype of type 2, or ‘‘adult onset’’ diabetes. Childhood diabetes, similar to adult diabetes, is now acknowledged to be a complex and heterogeneous disorder. Some patients not only exhibit the clinical features of type 2 diabetes but also have positive diabetes autoantibodies. This finding demonstrates the limits of the current diabetes classification scheme in youth and the need to better understand the natural history and long-term evolution of diabetes in youth, especially those with features of both type 1 and type 2 diabetes.

There is also a worldwide increase in childhood type 1 diabetes, and the reasons for this increase are still not known. New interesting data on the potential role of infant diet are emerging from longitudinal studies following youth from birth until the development of autoimmunity and type 1 diabetes. Genetic studies explore the heterogeneity of classical type 1 diabetes, as well as the genetic basis for monogenic forms of diabetes, including recently identified mutations responsible for neonatal forms. Challenging hypotheses that require careful testing are advanced, linking the worldwide obesity epidemic to the increasing incidence and earlier age at onset of both type 1 and type 2 diabetes. In both type 1 and type 2 diabetes, research is focusing on identifying early life, perinatal, and intrauterine exposures and new concepts such as ‘‘fetal programming’’ are increasingly being used in conjunction with diabetes risk. The development of elevated levels of cardiovascular risk factors and preclinical cardiovascular disease among youth with diabetes and the potential future impact on morbidity and mortality poses special challenges.

Our increasing understanding of the multifactorial etiology of childhood diabetes and its complications will hopefully translate into improved quality of life for youth with diabetes, and will ultimately lead to the successful prevention of diabetes.

The goal of this book is to review the epidemiology of diabetes from a worldwide perspective and to provide an overview of where this exciting field stands today. In its broadest perspective, diabetes epidemiology provides a framework for understanding the etiology, risk factors, acute and chronic complications, and the natural history of the disease, providing insight into population and clinical patterns of onset and course, and suggesting avenues for further basic science research. This book also includes a discussion of current technologies that provide promise for prevention or cure in the future.

At theb eginning of the2 1stc entury,w eh aven ow experienceds everal decades of increased risk for both type 1 and type 2 diabetes in youth and adults throughout the world. Projections indicate that these trends will worsen if the causes of diabetes are not rapidly identified and preventive strategies begun. Such strategies will require both individual clinically-based approaches and a much broader population initiative, targeting social and environmental factors that operate to alter energy balance, and lead to increases in viral or toxic exposures. The challenges are large for science and public health but the cost of not proceeding urgently will be truly immense. We hope that this book will provide a benchmark for our current understanding and suggest promising paths toward diabetes prevention and cure.

Dana Dabelea, MD, PhD Georgeanna J. Klingensmith, MD vi Preface



1. Definition, Diagnosis, and Classification of Diabetes in Youth 1 Nancy A. Crimmins and Lawrence M. Dolan

2. Descriptive Epidemiology of Type 1 Diabetes in Youth: Incidence,

Mortality, Prevalence, and Secular Trends 21 Anders Green

3. Genetic Epidemiology of Type 1 Diabetes 35 George S. Eisenbarth and Theresa A. Aly

4. Early-Life Diet and Risk of Type 1 Diabetes 49 Melissa D. Simpson and Jill M. Norris

5. Environmental Determinants: The Role of Viruses and Standard of Hygiene 63 Mikael Knip and Heikki Hy€oty

6. Tempo and Type 1 Diabetes: The Accelerator Hypothesis 85 Terence J. Wilkin

7. Epidemiology of Type 2 Diabetes in Children and Adolescents 103 Kristen Nadeau and Dana Dabelea

8. Obesity and T2DM in Youth 125 Ram Weiss and Sonia Caprio

9. Insulin Resistance and Insulin Secretion in the Pathophysiology of Youth Type 2 Diabetes 139 Fida Bacha and Silva Arslanian

10. High and Low Birth Weights as Risk Factors for Diabetes 157 Rachel Pessah, Lois Jovanovic, and David J. Pettitt vii

1. Monogenic Forms of Diabetes in the Young 165 Martine Vaxillaire and Philippe Froguel

12. Natural Evolution, Prediction, and Prevention of Type 1 Diabetes in Youth 185 Craig E. Taplin and Jennifer M. Barker

13. Prevention and Screening for Type 2 Diabetes in Youth 201 Phil Zeitler and Orit Pinhas-Hamiel

14. Chronic Complications of Childhood Diabetes 217 Kim C. Donaghue, Fauzia Mohsin, and Monique L. Stone

(Parte 1 de 9)