Type 1 diabetes mellitus (DM) is a serious condition that occurs when the pancreas is unable to produce a substance called insulin. Without insulin, the body cannot use sugar (from food that is consumed); the unused sugar accumulates in the blood and, untreated, can result in death. When considering the prevalence of Type 1 diabetes, some questions arise. First, what is the definition of prevalence? Second, what is the prevalence of type 1 diabetes? Finally, is there a difference between type 1 and type 2 diabetes?
Identification
Identification of children with type 1 diabetes is of course an important component in ensuring that the prevalence numbers are accurate. In children with type 1 diabetes, certain symptoms (frequent urination, thirst, unintended weight loss) are considered "classic" symptoms; also consistent with type 1 diabetes is a medical emergency called diabetic ketoacidosis (DKA). In a patient with DKA, the sugar level in the blood is extremely high, the breathing is very fast, and a distinct fruity odor may occur on the breath. Finally, in patients with type 1 diabetes proteins called autoantibodies are often present--these are immune system cells that incorrectly attack the insulin-producing cells of the pancreas.
Definitions
Often, when looking at statistics relating to type 1 diabetes, the term "incidence" is used. It is important to distinguish this from the term "prevalence," because they are different, though related, concepts. Incidence is the term used to describe the number of new cases of a disease occurring during a specified time period (often one year), in a specific population. The prevalence of disease, in contrast, is the total number of cases of a disease that exist in a specific population, at a specific point in time. For instance, an annual prevalence of Disease X would be the total number of people who had that disease during a given year, including any new cases of Disease X that were diagnosed within the year.
Considerations
A study published in 2006 used data from the 2001 U.S. Census to estimate the prevalence of diabetes in various racial and ethnic groups of children.
In non-Hispanic white children, the authors of the study concluded that in children zero to nine years old the prevalence of type 1 DM was 1.0 case per 1,000 children; in children 10 to 19 years old the prevalence was 2.8 cases per 1,000 children . This means that of 1,000 white children up to age nine,one of them has type 1 DM. In older children, nearly three of 1,000 have the diagnosis of type 1 DM.
Looking at the same age groups (zero to nine and 10 to19 years old), the prevalence of type 1 DM is much lower: approximately six of 10,000 younger children carried the diagnosis and only two of 1,000 children had type 1 diabetes.
Prevalence of type 1 DM in Hispanic children is similar to that in black children: four cases per 10,000 children in the younger group; 1.6 cases per 1,000 children in the older group.
In Asian/Pacific Islander children, prevalence was much lower than other groups: 2.5 cases per 10,000 children among the younger children and only eight cases per 10,000 among the older children.
Prevalence of type 1 DM among American Indian children was the lowest of all racial/ethnic groups: merely two cases per 10,000 in the younger children and five cases per 10,000 in the older children.
Overall, the prevalence of type 1 diabetes in all zero to nine- year-old children can be estimated at eight cases per 10,000 children. In all 10- to19-year-old children, the prevalence is 2.3 cases per 1,000 children, and the prevalence of "all comers"--that is, all children ages zero to 19, regardless of racial or ethnic group, can be estimated at 1.5 cases per 1,000 children.
Impact
Type 1 diabetes is a lifelong disease, and its impact may be both physical and emotional. To a child who has just been diagnosed with type 1, the impact is huge. Suddenly, he has to monitor his food intake and blood sugar level (using a device that requires a small amount of blood to test the level of sugar) and give insulin either via injections or via an insulin pump. While this becomes part of daily life, the adjustment is certainly challenging and may be difficult for the child and the whole family. Psychologically, there are effects as well--children with type 1 diabetes may become depressed or have other emotional issues.
Misconceptions
It is easy to confuse type 1 and type 2 diabetes--after all, they have nearly the same name. However, there are some crucial differences. In type 1 diabetes, the problem is that the child cannot make insulin on her own. So treating type 1 diabetes requires the use of insulin, either given via injections or via a pump that delivers insulin continuously. In children with type 2 diabetes, the ability to make insulin is intact. However, the ability to use the insulin is impaired, a condition called insulin resistance. For these children, diet changes and exercise may be enough to reverse type 2 diabetes; in some cases, the use of medications (such as a common one called metformin) may be needed. Finally, children with type 1 diabetes may have certain symptoms (thirst, frequent urination, weight loss) that children with type 2 diabetes don't often have. In fact, children with type 2 diabetes are more likely to be overweight or even obese. Sadly, while type 2 diabetes used to be predominantly a diagnosis of adulthood, the diagnosis has become a more common one in children. As overweight and obesity become more common in children, the diagnosis of type 2 diabetes has become a more common diagnosis.
References
- "Pediatrics" The burden of diabetes mellitus among US youth: prevalence estimates from the SEARCH for Diabetes in Youth Study; SEARCH for Diabetes in Youth Study Group; October 2006
- "A Dictionary of Epidemiology"; John M. Last; 2001
- "CURRENT Diagnosis & Treatment: Psychiatry"; Michael Ebert et. al.; 2008
- "UpToDate"; Denise S. Basow; 2010
