Diabetes among U.S. Children and Teens: Sharp Increase Predicted for 2060

A comprehensive study by the DDZ has examined the increase in type 1 and type 2 dia-betes in children and adolescents in the United States. The results show not only in-creasing numbers, but also differences in the population groups. How can America counteract this, and what will U.S. society look like if current trends continue?

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In a large-scale study, the SEARCH study, led by Dr. PH Thaddäus Tönnies, Institute for Biometrics and Epidemiology at the German Diabetes Center, investigated how many children and teens in the USA could be projected to have diabetes in 2060. This study is part of a long-standing collaboration between scientists at the German Diabetes Center, a partner of the DZD, and the renowned Centers for Disease Control and Prevention (CDC) in the U.S. Based on a mathematical model, the prevalence (proportion of people with the disease in the population) of type 1 and type 2 diabetes in children and teens under 20 years of age was predicted for 2060. In the past, type 2 diabetes was rare in children and adolescents, and the majority of cases were still classified as type 1 diabetes. Type 2 diabetes, on the other hand, is the most common form in adults and occurs, for example, as a result of an unhealthy diet, lack of exercise and obesity (overweight), but also genetic factors.

However, data from the SEARCH study have now shown that the incidence (number of new cases within a certain period – for example within one year) of type 2 diabetes in young people in the USA has increased significantly in recent years. Between 2002 and 2015, the incidence of type 1 diabetes rose by an average of almost 2 percent per year – and by almost 5 percent for type 2 diabetes. In addition, the data show that in 2017, more than 180,000 teens and children in the U.S. had type 1 diabetes and nearly 30,000 had type 2 diabetes. Another observation also shows that temporal trends in incidence differ by ethnicity and ancestry. For example, white American youth show a much smaller increase than the same age group among African-Americans, Hispanics, Asians, or Native Americans – especially with regard to type 2 diabetes. The question is: How many children and adolescents will have diabetes in the future if this trend continues?

Taking into account the available figures, this question was investigated and the possible situation in 2060 was examined with the aid of a mathematical model. According to this model, the number of children and teens with type 1 diabetes would increase by 60 percent compared to 2017 – and by as much as 600 percent for type 2 diabetes. Based on this projection, there would be nearly 500,000 children and teens affected by diabetes in the U.S. by 2060. This would include almost as many youth affected by type 2 diabetes as by type 1 diabetes. Another facet of this future projection demonstrates that ethnic disparities in diabetes prevalence will increase significantly. For example, by 2060, African-American teens would be 30 to 40 times more likely to have type 2 diabetes than white teens if current trends continue. "If our projections are accurate, we can expect an increasing need for pediatric diabetes specialists, medical devices and programs to optimize blood glucose control and prevent complications," Dr. Toennies said. "This will lead to rising health care costs, which means that appropriate resources should be planned in the foreseeable future."

This is still only a possible scenario for the future, which does not necessarily have to occur. But without interventions, the number of children and adolescents with diabetes is very likely to increase in the coming years. "From this, we can conclude that the first priority should be to implement effective preventive interventions as soon as possible. In this context, increased efforts to promote a healthy lifestyle – aiming for more physical activity and a healthy diet – could be an option," Dr. Tönnies said. "These could target the general population, but also so-called high-risk groups. In addition, I anticipate that comprehensive population-level strategies that address the social determinants of diabetes will be needed to significantly change the direction of future trends." The study has already been presented at the American Diabetes Association meeting, where it was selected as a highlight. In this context, an interview was conducted with Dr. Toennies.