Diagnosis of diabetes in youth is increasing in the U.S. (1,2). It is not known how much of this change is due to an increase in diabetes and how much is due to improved case detection, especially for type 2 diabetes. Some researchers have hypothesized that part of the explanation for the increase in diabetes diagnosis in youth is increased screening, resulting in a higher percentage of cases being identified. The objective of this study was to assess whether the change in diabetes could be explained by changes in case identification by examining trends from 2002 to 2010 in self-reported case presentation of diabetes.
Briefly, there were 9,054 youth aged <20 years with newly diagnosed diabetes between 2002 and 2010 in the SEARCH for Diabetes in Youth study (3). Participants were asked, “How did you find out you had diabetes?” Responses were grouped into symptoms, checkup, community screening, or other. Self-reported case presentation patterns were examined in 3-year blocks to assess change over time, reported by diabetes type. We explored trends in self-reported modes of diabetes diagnosis (i.e., symptoms, checkup, screening, and other method) and reported results unadjusted and then adjusted for age-group, sex, and race/ethnicity.
Results are presented in Table 1. Among youth with type 1 diabetes, >95% of them reported diabetes diagnosis due to symptoms and many fewer reported diagnosis due to checkup, health screening, or other. Self-report of case presentation remained stable from 2002 to 2010 for youth with type 1 diabetes. Among youth with type 2 diabetes, 65% reported diagnosis due to symptoms and 30% reported diagnosis during a regular checkup. Unlike type 1 diabetes, there were significant changes in reported case presentation for type 2 diabetes with presentation due to symptoms decreasing from 72.1% in 2002–2004 to 59.1% in 2008–2010.
Table 1.
Self-reported case presentation of diabetes diagnosis by incident year and diabetes type among youth 20 years of age and younger, SEARCH for Diabetes in Youth Study 2002–2010
| Type 1 diabetes (n = 7,554) | Type 2 diabetes (n = 1,500) | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Symptoms | Checkup | Community screening | Other | P value | Symptoms | Checkup | Community screening | Other | P value | |
| Incident years | ||||||||||
| 2002–2004 | 95.4 | 3.7 | 0.2 | 0.7 | 0.0512 | 72.1 | 23.7 | 2.8 | 1.4 | <0.0001 |
| 2005–2007 | 94.8 | 3.6 | 0.4 | 0.4 | 66.4 | 29.5 | 2.5 | 1.6 | ||
| 2008–2010 | 94.2 | 4.1 | 0.3 | 0.3 | 59.1 | 37.1 | 3.3 | 0.5 | ||
| Adjusted estimates* | ||||||||||
| 2002–2004 | 95.9 | 3.2 | 0.2 | 0.2 | 0.0505 | 72.9 | 23.7 | 2.4 | 1.0 | <0.0001 |
| 2005–2007 | 95.5 | 3.3 | 0.2 | 0.2 | 66.8 | 29.9 | 2.7 | 0.6 | ||
| 2008–2010 | 94.9 | 3.4 | 0.3 | 0.3 | 59.8 | 36.9 | 3.0 | 0.4 | ||
Data are %. *Adjusted for age-groups (0 to < 5 years, 5 to < 10 years, 10 years to < 15 years, 15 years and older), sex, and race/ethnicity (Asian/Pacific).
Observed differences in patterns of the self-reported modes of case presentation by age and sex among youth with type 1 diabetes and by sex and race/ethnicity among youth with type 2 diabetes may reflect differences in how diabetes presents, medical-seeking practices, or community awareness.
Of the few previous studies reporting on modes of diabetes diagnosis, none have included youth (4,5). Previous studies have found that adults with diabetes are most likely to report diagnosis due to symptoms (4,5).
While we found no evidence that increased incidence of type 1 diabetes was due to improvements in case finding, there was evidence of increased case finding among youth with type 2 diabetes. The changes in reported modes of case presentation over time for type 2 diabetes suggest that some of the trends in prevalence over this time period may be attributable to changes in health care or community screening patterns.
Article Information
Acknowledgments. The authors thank Tony Pearson-Clarke for his invaluable editorial assistance. The SEARCH for Diabetes in Youth Study is indebted to the many youth and their families and health care providers, whose participation made this study possible.
Funding. SEARCH for Diabetes in Youth is funded by the Centers for Disease Control and Prevention (PA numbers 00097, DP-05-069, and DP-10-001) and supported by the National Institute of Diabetes and Digestive and Kidney Diseases. Site contract numbers include Kaiser Permanente Southern California (U48/CCU919219, U01 DP000246, and U18DP002714), University of Colorado Denver (U48/CCU819241-3, U01 DP000247, and U18DP000247-06A1), Kuakini Medical Center (U58CCU919256 and U01 DP000245), Children’s Hospital Medical Center (Cincinnati) (U48/CCU519239, U01 DP000248, and 1U18DP002709), University of North Carolina at Chapel Hill (U48/CCU419249, U01 DP000254, and U18DP002708), University of Washington School of Medicine (U58/CCU019235-4, U01 DP000244, and U18DP002710-01), and Wake Forest University School of Medicine (U48/CCU919219, U01 DP000250, and 200-2010-35171). The authors wish to acknowledge the involvement of General Clinical Research Centers at the South Carolina Clinical & Translational Research Institute at the Medical University of South Carolina (National Institutes of Health [NIH]/National Center for Research Resources grant number UL1RR029882), Seattle Children’s Hospital (NIH Clinical and Translational Science Award grant UL1 TR00423 of the University of Washington), University of Colorado Pediatric Clinical Translational Research Center (grant number UL1 TR000154), Barbara Davis Center for Diabetes at the University of Colorado Denver (Diabetes and Endocrinology Research Center NIH P30 DK57516), National Center for Research Resources and National Center for Advancing Translational Sciences, NIH (grant 8 UL1 TR000077), and the Children with Medical Handicaps Program managed by the Ohio Department of Health.
Duality of Interest. No potential conflicts of interest relevant to this article were reported.
Author Contributions. S.H.S., G.I., L.H., R.D., J.D., E.J.M.-D., D.D., G.K., C.P., and J.M.L. contributed to the conception and design of the work, the acquisition of the data, the interpretation of the data, and the revision of the manuscript. All authors provided final approval for publication and ensure the accuracy and integrity of the work. S.H.S. drafted the manuscript. S.H.S. and J.D. contributed to the analysis of the data. S.H.S. is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Prior Presentation. Parts of this study were presented in abstract form at the 73rd Scientific Sessions of the American Diabetes Association, Chicago, IL, 21–25 June 2013.
Footnotes
The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention and the National Institute of Diabetes and Digestive and Kidney Diseases.
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