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• W2001714275 abstract "The rising prevalence of type 2 diabetes mellitus (T2DM) in children and adolescents was initially recognized in the United States in the 1990s. T2DM, which 15 years ago accounted for less than 3% of all cases of new-onset diabetes in children and adolescents, today accounts for up to 45% of new-onset cases among adolescents.1Type 2 diabetes in children and adolescents. American diabetes association.Diabetes Care. 2000; 323: 381-390Google Scholar Though the diagnosis was initially regarded with skepticism, T2DM is now a serious diagnostic consideration in all young people who present with signs and symptoms of diabetes. Subsequent studies conducted in Asia and Europe revealed a similar pattern, and, more recently, reports on T2DM in children and adolescents have begun to mount worldwide. The review of the North American experience with youth-onset T2DM published by Fagot-Campagna et al2Fagot-Campagna A. Pettitt D.J. Engelgau M.M. Burrows N.R. Geiss L.S. Valdez R. et al.Type 2 diabetes among North American children and adolescents: an epidemiologic review and a public health perspective.J Pediatr. 2000; 136: 664-672Abstract Full Text PDF PubMed Scopus (929) Google Scholar in 2000 has proved to be an important resource for both clinicians and investigators addressing this problem. The growing number of reports of this problem in an ever-expanding list of countries and its increasingly important implications for international public health prompted the present effort to collate published reports of case-series and epidemiology to complement the previous review of the North American literature. The Medline database and Cochrane Library online were searched for articles on T2DM in children and adolescents published between September 1978 and May 2004 in all languages. Searches were performed by using the following key words alone and in combination: non–insulin-dependent diabetes mellitus, type 2 diabetes mellitus, children, adolescents, and youth. A total of 1902 publications were identified; however, only 110 contained epidemiologic data on T2DM in children and adolescents, including publications in English, French, and Hebrew. However, the vast majority of publications were in English, and this is primarily a review of English language reports. The remaining 1792 articles addressed T2DM in adults with references to their children and thus were not relevant. Twenty-two additional reports were identified from abstracts or conference summaries. There were no documents identified in the Cochrane Library relevant to epidemiology of T2DM in children. For the sake of clarity, studies reviewed are classified as either population studies (PS) if they have clearly defined population numerators and denominators or case studies (CS) if they are clinical series or surveys. The apparent prevalence and incidence of T2DM determined from population-based studies in specific countries or regions are presented in Figure 1 and Figure 2, respectively. The percentages of new cases of diabetes in children and adolescents reported to have T2DM are presented in Figure 3.Figure 2Reported incidence of type 2 diabetes mellitus among children and adolescents.View Large Image Figure ViewerDownload Hi-res image Download (PPT)Figure 3Reported percentage of newly diagnosed diabetes patients with type 2 diabetes mellitus.View Large Image Figure ViewerDownload Hi-res image Download (PPT) The recent recognition of T2DM in children and the recent proliferation of reports in the literature from around the world is illustrated by the number of publication included in our report: Before 1990, there were only 2 reports; between 1990 and 1994, 4 reports; 1995 to 1999, 12 reports; and between 2000 and 2003 53 reports. Because of the nature of the search parameters, the reports varied extensively; some of the identified reports were from public health organizations with population-based data, whereas others were series from diabetes clinics. Furthermore, there was important variation in the age range of the patients reported, the details of which are provided in the summary of each report. Finally, there were variations in the definition of T2DM used in the various reports over time, though the diagnoses in all studies were generally based on either American Diabetes Association (ADA) or World Health Organization guidelines and supported by a combination of antibody testing, insulin/c-peptide measurement, or disease natural history during follow-up. However, given the limitations of a retrospective analysis of this type, we report the results of all reports identifying patients as having T2DM. In Japan, 80% of all new cases of diabetes in children and adolescents are diagnosed as type 2.3Cockram C.S. The epidemiology of diabetes mellitus in the Asia-Pacific region.Hong Kong Med J. 2000; 6: 43-52PubMed Google Scholar The incidence of T2DM among Japanese primary school children in Tokyo increased 10-fold, from 0.2 per 100,000 in 1976 to 2 per 100,000 in 1995.4Kida K. Type 2 diabetes in Japanese youths. (Abstract).J Pediatr Endocrinol Metab. 2000; 13 (1209): S4Google Scholar, 5Kitagawa T. Owada M. Urakami T. Tajima N. Epidemiology of type 1 (insulin-dependent) and type 2 (non-insulin-dependent) diabetes mellitus in Japanese children.Diabetes Res Clin Pract. 1994; 24 (13): S7Abstract Full Text PDF PubMed Scopus (91) Google Scholar In junior high school children (age not specified in report), the reported incidence in 1995 was 13.9 per 100,000, almost twice that in 1976. By contrast, the incidence of type 1 diabetes mellitus (T1DM) in Japanese children and adolescents was 1.5 cases per 100,000 in 1976 and did not change appreciably over the next 20 years.6Lee W. Type 2 diabetes in Asian children. The 26th Annual Meeting of the International Society for Pediatric Adolescent Diabetes; Universal City, California, 2000.Google Scholar The adolescent population affected with T2DM showed a strong female predominance of 2.1:1, and approximately 80% of the children with T2DM were obese. Accordingly, researchers noted that the increase in the diagnosis of T2DM was paralleled by both an increase in childhood and adolescent obesity in Japan and a shift from the traditional Japanese diet to consumption of more animal fat and protein.7Kitagawa T. Owada M. Urakami T. Yamauchi K. Increased incidence of non-insulin dependent diabetes mellitus among Japanese schoolchildren correlates with an increased intake of animal protein and fat.Clin Pediatr (Phila). 1998; 37: 111-115Crossref PubMed Scopus (262) Google Scholar T2DM appears to be the leading cause of childhood DM in Taiwan. A nationwide screening program for diabetes among schoolchildren aged 6 to 18 years was undertaken in 1992 to 1999. Screening was done by urine and blood testing. Individuals were considered to have T2DM if the fasting plasma glucose level was >126 mg/dL, current treatment was an oral hypoglycemic drug or diet control with no insulin injection, and there was no recurrent diabetic ketoacidosis (DKA). Of newly diagnosed diabetes, 54.2% of cases were diagnosed with T2DM, with an incidence of newly identified T2DM of 6.5 per 100,000 (compared with 1.5 per 100.000 T1DM). Factors associated with the diagnosis of T2DM were hypercholesterolemia, elevated blood pressure, and family history of T2DM.8Wei J.N. Sung F.C. Lin C.C. Lin R.S. Chiang C.C. Chuang L.M. National surveillance for type 2 diabetes mellitus in Taiwanese children.JAMA. 2003; 290: 1345-1350Crossref PubMed Scopus (187) Google Scholar In general, T2DM is on the rise in Singapore, accounting for ~10% of all new cases of childhood diabetes.9Lee W.R. The changing demography of diabetes mellitus in Singapore.Diabetes Res Clin Pract. 2000; 50: S35-S39Abstract Full Text Full Text PDF PubMed Scopus (57) Google Scholar The KKH Diabetes registry, a multicenter audit of diabetes diagnoses in Singapore, reported >50 T2DM cases in 2000 versus 10 cases in 1997.10Lee W.R.W. Yap K.P.F. Loke K.Y. Hamidah K. Chia Y.Y. Ang S. Characteristics of childhood onset type 2 diabetic patients in Asia and Singapore (Abstract).Pediatr Endocrinol Metab. 2000; 13: 1209PubMed Google Scholar The mean reported age of children with T2DM in Singapore was 12 years, and mean body mass index (BMI) was 25.6 kg/m2. Anti-GAD antibodies and ICA were negative; family history of T2DM was noted in 80% of cases. According to the Hong Kong childhood diabetes registry, T2DM accounted for 7% of all identified cases of childhood diabetes in all districts of Hong Kong in 1996.11Huen K.F. Low L.C. Wong G.W. Tse W.W. Yu A.C. Lam Y.Y. et al.Epidemiology of diabetes mellitus in children in Hong Kong: the Hong Kong childhood diabetes registry.J Pediatr Endocrinol Metab. 2000; 13: 297-302Crossref PubMed Scopus (28) Google Scholar The annual age-standardized incidence of T1DM and T2DM in southern Chinese children (<15 years old) was 1.4 per 100,000 and 0.1 per 100,000, respectively. At an academic diabetes center, the proportion of new cases of T2DM in children 0 to 14 years of age rose from 5% in 1987 to 1996 to 17.9% in 1997 to 1999.12Likitmaskul S. Tuchinda C. Punnakanta L. Kiattisakthavee P. Chaichanwattanakul K. Angsusingha K. Increase of type 2 diabetes in Thai children and adolescents in Thailand (Abstract).J Pediatr Endocrinol Metab. 2000; 13: 1209PubMed Google Scholar, 13Likitmaskul S. Kiattisathavee P. Chaichanwatanakul K. Punnakanta L. Angsusingha K. Tuchinda C. Increasing prevalence of type 2 diabetes mellitus in Thai children and adolescents associated with increasing prevalence of obesity.J Pediatr Endocrinol Metab. 2003; 16: 71-77Crossref PubMed Scopus (98) Google Scholar The mean age of onset was 11.6 ± 2.1 years, and BMI was 29 ± 6.1 kg/m2. Here too, the increase in the disorder occurred concomitantly with an increase in the prevalence of obesity in the population from 5.8% in 1990 to 13.3% in 1996. A survey at the Children's Hospital of Fundan University in 2001 revealed that among 83 patients with diabetes <18 years of age, 2.4% had T2DM.14Zhi D, Shen S, Luo F, Zhao Z, Hong Q. IDF WPR childhood and adolescence, Diabcare survey 2001 in Shanghai (Abstract). O-25 ISPAD Saint-Malo 2003.Google Scholar Eighteen children (5 boys and 13 girls), 9 to 15 years of age, with insidious onset of nonketotic diabetes and responsiveness to oral antidiabetic agents for periods from 2 months to 12 years were reported from a diabetes specialty center in Chennai. All of the children were tested for the presence of anti-GAD antibodies and for pancreatic beta-cell reserve. A positive family history of diabetes was present in all cases.15Ramachandran A. Snehalatha C. Satyavani K. Sivasankari S. Vijay V. Type 2 diabetes in Asian-Indian urban children.Diabetes Care. 2003; 26: 1022-1025Crossref PubMed Scopus (90) Google Scholar At another specialty care center, 3% of 93 cases of diabetes in children and adolescents (<18 years old) were classified as T2DM.16Narayan K.M. Fagot-Campagna A. Imperatore G. Type 2 diabetes in children: a problem lurking for India?.Indian Pediatr. 2001; 38: 701-704PubMed Google Scholar A larger series of 545 patients <30 years of age in South India evaluated at a diabetes center in the mid-1980s yielded 314 (58%) with T2DM, including a small but unspecified number of patients who were younger than 20 years.17Ramachandran A. Mohan V. Snehalatha C. Bharani G. Chinnikrishnudu M. Mohan R. et al.Clinical features of diabetes in the young as seen at a diabetes center in south India.Diabetes Res Clin Pract. 1988; 4: 117-125Abstract Full Text PDF PubMed Scopus (24) Google Scholar Trends in T2DM among adolescents were studied in a diabetes clinic serving Maori of the Pacific Island ethnic group in Auckland, New Zealand in1996 and 2002. T2DM accounted for 12.5% of new cases of diabetes in the years 1997 to 1999 and 35.7% of new cases in the years 2000 to 2001.18Hotu S. Carter B. Watson P.D. Cutfield W.S. Cundy T. Increasing prevalence of type 2 diabetes in adolescent.J Paediatr Child Health. 2004; 40: 201-204Crossref PubMed Scopus (109) Google Scholar Mean age at diagnosis was 15 years, and the mean BMI was 34.6 kg/m2. Family history of T2DM and risk factors for cardiovascular disease were common in the subjects with T2DM: 85% had dyslipidemia, 58% had increased albumin excretion rates, and 28% had systolic hypertension. These findings are in agreement with other reports of an increasing rate of diabetes among young Maori.19McGrath N.M. Parker G.N. Dawson P. Early presentation of type 2 diabetes mellitus in young New Zealand Maori.Diabetes Res Clin Pract. 1999; 43: 205-209Abstract Full Text Full Text PDF PubMed Scopus (71) Google Scholar In 1998, 55% of all patients registered with the Northland New Zealand Diabetes Services, diagnosed with diabetes before the age of 30 years, had T2DM, accounting for 2.7% of the population; 61% of the patients had been diagnosed before age 20. Studies in the 1980s have shown a relatively lower incidence in the under-20 age group. The majority of patients had a strong family history of diabetes. In addition, 86% were overweight. A delay in detection of T2DM was suggested by the high presence of microalbuminuria at diagnosis. Data from the Children's Hospital at Westmead (CS) showed that between 1999 and 2001, 5% of all children and adolescents presenting with diabetes had T2DM.20Davis E. Increasing type 2 diabetes in children and adolescents in Western Australia (Abstract). Australian Diabetes Society and Australian Diabetes Educators Association, 336, 2002.Google Scholar, 21Nuala Harkin. Increasing recognition of Type 2 diabetes in adolescents (Abstract). Australian Diabetes Society and Australian Diabetes Educators Association; 171, 2002.Google Scholar In New South Wales/Australia Capital Territory (NSW/ACT), the incidence of childhood T2DM was ascertained by extending the current NSW/ACT diabetes registry, with secondary ascertainment from the National Diabetes Supply Scheme (PS). Inclusion criteria were age ≤16 years and ADA criteria for diagnosis of diabetes. An audit of initial investigations and management was undertaken by medical record review and questionnaire, with completeness of ascertainment estimated using capture-recapture. The mean annual incidence was 2.5 per 100,000 in 2001 to 2002, representing approximately 10% of newly diagnosed cases of diabetes in this population. Mean age was 14.2 ± 2.0 years, with an equal distribution of male and female subjects. The median BMI standard deviation score (SDS) was 2.3 (−1.9 to 9.7). The ethnic distribution was white (27%), Asian (22%), Aboriginal (19%), and Middle Eastern (11%). Urban/rural and socioeconomic status were evenly distributed; 75% had a family history of T2DM.22Craig ME, Bryoda V, Crock P, Howard N. The epidemiology of type 2 diabetes in NSW and the ACT, Australia 2001-2002 (Abstract). O-13 ISPAD Saint-Malo 2003.Google Scholar The first report of T2DM in adolescent patients in Germany was published in 1983.23Panzram G. Adolph W. Results of a population study of non-insulin dependent diabetes mellitus in childhood and adolescence.Schweiz Med Wochenschr. 1983; 28: 779-784Google Scholar Among 40,927 diabetics registered in the Erfurt district (PS), 61 (0.15%) were classified as having T2DM since early life. Age of onset in the 58 examined patients (36 male, 22 female) was 10 to 24 years. A history of diabetes in at least one parent was noted in 76.4%; occurrence was sporadic in 19%. In the Systemic Diabetes Survey conducted almost 20 years later (PS), 70 patients <15 years of age were identified as having T2DM (percentages not specified).24Kiess W, Raile K, Galler A, Bottner A, Kapellen T. Type 2 diabetes in children and adolescents: a European perspective (Abstract). The 13th NovoNordisk symposium on growth hormone and endocrinology, Budapest, Hungary 2002.Google Scholar, 25Kiess W. Bottner A. Raile K. Kapellen T. Muller G. Galler A. et al.Type 2 diabetes mellitus in children and adolescents: a review from a European perspective.Horm Res. 2003; 59: 77-84Crossref PubMed Scopus (69) Google Scholar Estimates suggest that more than 5000 young people in the country meet the diagnostic criteria of T2DM. In another large German cohort of 520 white children and adolescents with obesity (mean age, of 14.0 ± 2.0 years; BMI >97th percentile) (CS), T2DM was present in 1.5% of the patients, and an additional 5.8 % of the patients had impaired glucose regulation.26Wabitsch M. Hauner H. Hertrampf M. Muche R. Hay B. Mayer H. et al.Type II diabetes mellitus and impaired glucose regulation in Caucasian children and adolescents with obesity living in Germany.Int J Obes Relat Metab Disord. 2004; 28: 307-313PubMed Google Scholar A prospective, national, population-based epidemiologic study of T2DM from 1999 to 2001 yielded 8 cases (7 girls, 1 boy) among 529 children with diabetes <15 years of age (1.6 %), for a calculated incidence of 0.25 per 100,000.27Schober E, Rami B, Nachbauer E, Waldhor T, and the Austrian Diabetes Incidence Study Group. Type 2 diabetes is rare but not absent in children <15 years in Austria (Abstract). The 9th European workshop on pediatric endocrinology, Slovakia, 2002.Google Scholar, 28Rami B. Schober E. Nachbauer E. Waldhor T. Austrian Diabetes Incidence Study Group Type 2 diabetes mellitus is rare but not absent in children under 15 years of age in Austria.Eur J Pediatr. 2003; 162: 850-852Crossref PubMed Scopus (47) Google Scholar The diagnosis of T2DM was according to the ADA diagnostic criteria. The age of onset was 12 to 15 years, and all affected children were overweight. Half of the patients were of Pakistan, Turkey, and South American origin, and half of Austrian origin. The first study on T2DM in children and adolescents from the United Kingdom was conducted in West Midlands and Leicester in 2000 (CS).29Ehtisham S. Barrett T.G. Shaw N.J. Type 2 diabetes mellitus in UK children-an emerging problem.Diabet Med. 2000; 17: 867-871Crossref PubMed Scopus (208) Google Scholar Eight girls 10 to 16 years of age of Pakistani, Indian, or Arabic origin were identified. Their BMI was 2.1 to 3.4 SDS above the mean for age and sex. A subsequent paper (CS) from the southern and western regions of England reported T2DM in 4 obese white children, 3 girls and one boy, 13 to 15 years of age, who were diagnosed over a 2-year period.30Drake A.J. Smith A. Betts P.R. Crowne E.C. Shield J.P. Type 2 diabetes in obese white children.Arch Dis Child. 2002; 86: 207-208Crossref PubMed Scopus (157) Google Scholar According to a crude estimate (PS), the prevalence of T2DM in the under-18 population in England is 0.038 per 1000, with an annual incidence of 1.52 per 100,000.31Ehtisham S. Kirk J. McEvilly A. Shaw N. Jones S. Rose S. et al.Prevalence of type 2 diabetes in children in Birmingham.BMJ. 2001; 322: 1428Crossref PubMed Google Scholar In Leeds in 2000, the prevalence of T2DM was 0.05 per 1000 for patients 10 to 19 years of age; 40% of the subjects were south Asians.32Feltbower R.G. McKinney P.A. Campbell F.M. Stephenson C.R. Bodansky H.J. Type 2 and other forms of diabetes in 0-30 year olds: a hospital based study in Leeds, UK.Arch Dis Child. 2003; 88: 676-679Crossref PubMed Scopus (61) Google Scholar A cross-sectional survey of all pediatric diabetes centers in the United Kingdom (PS) yielded a 0.2% prevalence of T2DM in children <16 years of age.33Barrett T.G. Ehtisham S. Smith A. Hattersley A.T. UK diabetes survey shows type 2 diabetes present in 0.4% of newly diagnosed children, associated with overweight, females and ethnic minority (Abstract).Diabetes. 2002; 51: A25Crossref Google Scholar A study of the distribution of T1DM and T2DM from 1993 to 1998 in a large diabetes center in Paris revealed 8 cases (2%) of T2DM,34Ortega-Rodriguez E. Levy-Marchal C. Tubiana N. Czernichow P. Polak M. Emergence of type 2 diabetes in a hospital based cohort of children with diabetes mellitus.Diabetes Metab. 2001; 27: 574-578PubMed Google Scholar 6 of which were diagnosed in 1998 in children 8.5 to 14.9 years of age. One child was of Caribbean origin and the rest were white. Four were obese. A national, retrospective, population-based case study, detecting all known cases of T2DM in Sweden in 2001, suggested that T2DM represents only 0.5% of all cases of diabetes in the age group of 0 to 18 years.35Zachrisson I, Tibell C, Bang P, Ortqvist E. Prevalence of type 2 diabetes among known cases of diabetes aged 0-18 in Sweden (Abstract). 18th International Diabetes Federation Congress, 2003, Paris, France.Google Scholar Additional cases of T2DM are accumulating from various parts of Europe. Forty-two young patients were identified in a study in Budapest, Hungary.36Körner AM, Gombos E, Horváth E, Madácsy L, Kelemen J. Early signs of cardiovascular Involvement in children with type 2 diabetes mellitus (Abstract). EASD, Budapest, Hungary, 2002.Google Scholar In a multicenter study evaluating the safety and efficacy of metformin in adolescents, 20 of the 82 participants were from Russia (Moscow, Volgograd, Kazan), Belarus (Minsk), or Poland (Warszawa).37Jones K.L. Arslanian S. Peterokova V.A. Park J.S. Tomlinson M.J. Effect of metformin in pediatric patients with type 2 diabetes: a randomized controlled trial.Diabetes Care. 2002; 25: 89-94Crossref PubMed Scopus (329) Google Scholar Several cases have been reported from Bulgaria (Sofia),38Konstantinova M. Damianove M. Koprvarova K. Savova R. Poppva G. Zancheva V. Type 2 diabetes in obese children-therapy with metformin.J Pediatr Endocrinol Metab. 2000; 13: 1213Google Scholar Italy (Naples),39Franzese A. De Filippo G. Argenziano A. Variable expression of non insulin dependent diabetes mellitus in childhood.Minerva Pediatr. 1996; 48: 229-232PubMed Google Scholar and the Netherlands.40Roeleveld-Versteegh A.B. Jansen M. De-Vroede M. En 12-jarig meisje met diabetes mellitus type 2.Ned-Tijdschr-Geneeskd. 1998; 142 ([A twelve-year old girl with diabetes mellitus type 2]): 2256-2258PubMed Google Scholar Three cases of T2DM in obese female subjects were reported in 2000.41Pinhas-Hamiel O. Koren I. Vardi P. Type 2 diabetes among adolescents in Israel.Harefuah. 2000; 138: 186-189PubMed Google Scholar Among 101 obese adolescents who underwent an oral glucose tolerance test, asymptomatic T2DM was discovered in 3%, whereas 8% had impaired glucose tolerance.42VardI P, Shahaf K, Sprecher E, Koren I, Zadik Z, Meron E, et al. Abstract: The 20TH meeting of the Israeli Diabetes Association, Tel-Aviv, 2003.Google Scholar According to the Israeli Registry Study Group of Diabetes, in 1997, T2DM accounted for 0.6% of newly diagnosed diabetes in patients <18 years of age, compared with 1.9% in 2000. This can be translated to an estimated incidence of 0.05/100,000 in 1997, compared with 0.17/100,000 in 2000 (personal communication, Silva Koton, PhD, Israel Center for Disease Control, June 2004). A total of 25,337 Saudis were screened for diabetes mellitus and impaired glucose tolerance, using World Health Organization criteria for diagnosis. The reported prevalence of T2DM in the Saudi population under-14-year age group is 0.12%, and 0.79% for the 14- to 29-year age group.43El-Hazmi M.A.F. Warsy A.S. Al-Swailem A.R. Al-Swailem A.M. Sulaimani R. Diabetes mellitus as a health problem in Saudi Arabia and its complications.Eastern Mediterr Health J. 1998; 4: 58-67Google Scholar Between 1990 and 1998, T2DM was diagnosed in 12.5% of all patients 0 to 18 years of age with new-onset diabetes at Al-Ain general hospital. Affected patients were superobese and had a positive family history of T2DM.44Punnose J. Agarwal M.M. El Khadir A. Devadas K. Mugamer I.T. Childhood and adolescent diabetes mellitus in Arabs residing in the United Arab Emirates.Diabetes Res Clin Pract. 2002; 55: 29-33Abstract Full Text Full Text PDF PubMed Scopus (42) Google Scholar The percentage of new cases of diabetes in the diabetes unit in Hospital General de Ninos Pedros that were T2DM increased from 0% in 1992 to 4.16% in 2001.45Ramos O, Ferraro M, Andres ME, Arce L. Type 2 diabetes in youth, an increasing problem in Buenos Aires? (Abstract). 18th International Diabetes Federation Congress, 2003, Paris, France.Google Scholar Mean age was 12.9 ± 2.8; the majority of subjects were obese, with acanthosis nigricans and family history of diabetes. The Pima Indians of Arizona (PS) have the world's highest reported incidence of diabetes. Since 1965, this population has participated in a longitudinal study of diabetes and its complications. The report of this longitudinal study was included in the review of T2DM in North American children in 2000.2Fagot-Campagna A. Pettitt D.J. Engelgau M.M. Burrows N.R. Geiss L.S. Valdez R. et al.Type 2 diabetes among North American children and adolescents: an epidemiologic review and a public health perspective.J Pediatr. 2000; 136: 664-672Abstract Full Text PDF PubMed Scopus (929) Google Scholar By the 1990s, the prevalence of T2DM in the 15- to 19-year age group had increased to 51 per 1000, and the disease had emerged also in the 10- to 14-year age group, with a prevalence of 22 per 1000.46Savage P.J. Bennett P.H. Senter R.G. Miller M. High prevalence of diabetes in young Pima Indians.Diabetes. 1979; 28: 937-942Crossref PubMed Google Scholar Similar findings were subsequently reported in other American Indians, such as the Tohono O'odham Nation in the southwestern United States.47Coddington D.A. Hisnanick J.J. Clinical characteristics of non-insulin-dependent diabetes mellitus among southwestern American Indian youths.J Health Popul Nutr. 2001; 19: 12-17PubMed Google Scholar At six Indian Health Service facilities in Montana and Wyoming (CS), medical records were reviewed annually for all patients with diabetes who were <20 years of age.48Harwell T.S. McDowall J.M. Moore K. Fagot-Campagna A. Helgerson S.D. Gohdes D. Establishing surveillance for diabetes in American indian youth.Diabetes Care. 2001; 24: 1029-1032Crossref PubMed Scopus (19) Google Scholar T2DM was diagnosed when a child had one or more of the following characteristics: weight ≥95th percentile, acanthosis nigricans, elevated C-peptide or insulin, family history of T2DM, treatment with oral agents with or without insulin, or no hypoglycemic therapy after 1 year of follow-up. From 1999 to 2001, 53% of prevalent cases and 70% of incident cases were categorized as probable T2DM. The average annual prevalence of probable T2DM was 1.3 per 1000. The average annual incidence rates for T2DM was 23.3 per 100,000, approximately 4 times higher than T1DM.49Moore K.R. Harwell T.S. McDowall J.M. Helgerson S.D. Gohdes D. Three-year prevalence and incidence of diabetes among American Indian youth in Montana and Wyoming, 1999 to 2001.J Pediatr. 2003; 143: 368-371Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar The Navajo appear to be an exception to this pattern. Although the prevalence of T2DM is high (20%) among tribe members over-20, only 0.4% in adolescents attending high school on the reservation have been diagnosed with T2DM, with an additional 3% having impaired glucose tolerance or impaired fasting glucose.50Kim C. McHugh C. Kwok Y. Smith A. Type 2 diabetes mellitus in Navajo adolescents.West J Med. 1999; 170: 210PubMed Google Scholar High rates of T2DM in youth have been documented among the First Nations people, who comprise 3% of the country's population. The majority reside in Manitoba, Southwestern Quebec, Southwestern Ontario, and Southern Alberta. The first child with T2DM was reported in 1984, and by 1998, 75 children 5 to 17 years old had been diagnosed, representing 10% to 20% of new cases of diabetes (CS).51Dean H. NIDDM-Y in First Nation children in Canada.Clin Pediatr (Phila). 1998; 37: 89-96Crossref PubMed Scopus (103) Google Scholar The recent estimated prevalence of T2DM was 1 to 2.5 per 1000 in the 5- to 14-year age group and 2.3 to 3.5 per 100052Harris S.B. Perkins B.A. Whalen-Brough E. Non-insulin-dependent diabetes mellitus among First Nations children: new entity among First Nations people of north western Ontario.Can Fam Physician. 1996; 42: 869-876PubMed Google Scholar in the 15- to 19-year age group. The Sioux Lookout Zone Hospital is a secondary-care referral hospital for 28 remote First Nations communities in northwestern Ontario. According to the hospital's records and Diabetes Program Registry, from 1978 to 1984 (PS), T2DM was documented in 18 First Nations youths <16 years of age,53Dean H.J. Mundy R.L. Moffatt M. Non-insulin-dependent diabetes mellitus in Indian children in Manitoba.CMAJ. 1992; 147: 52-57PubMed Google Scholar for an age-adjusted prevalence of 2.5 per 1000. The ratio of female to male subjects was 6:1. Typical patients were asymptomatic and obese, showed no predilection for ketosis, and had a strong family history of T2DM. In a study of Indian children <15 years of age, with no history of DKA, who attended the diabetes clinic at the Children's Hospital of Winnipeg between 1984 and 1990, 20 patients with a diagnosis of T2DM were identified (CS).54Dean H. Incidence and prevalence of type 2 diabetes in youth Manitoba Canada 1984-1998 (Abstract).Diabetes. 1999; 48: A168Google Scholar These included 16 girls and 4 boys 7 to 14 years of age. All 16 children whose family history could be confirmed had at least one parent with T2DM. Five of the 20 children reported having polyuria or nocturia; the remainder presented with asymptomatic glycosuria. A cross-sectional survey of school children from northern Ojibwa-cree in 1996 to 1997 found a 1.1% prevalence of T2DM in the 4- to" @default.
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• W2001714275 date "2005-05-01" @default.
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• W2001714275 title "The global spread of type 2 diabetes mellitus in children and adolescents" @default.
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