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      Diabetes in Hispanic American Youth : Prevalence, incidence, demographics, and clinical characteristics: the SEARCH for Diabetes in Youth Study

      , SCD, MPH, MSSA 1 , , PHD 2 , 3 , , PHD, MPH 1 , , MS 4 , , MD 5 , , PHD 4 , , PHD, SCD 6 , , MD, PHD 7 , , MD, DRPH 8 , for the SEARCH for Diabetes in Youth Study Group

      Diabetes Care

      American Diabetes Association

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          Abstract

          OBJECTIVE—To report the 2001 prevalence and 2002–2005 incidence of type 1 and type 2 diabetes in Hispanic American youth and to describe the demographic, clinical, and behavioral characteristics of these youth.

          RESEARCH DESIGN AND METHODS—Data from the SEARCH for Diabetes in Youth Study, a population-based multicenter observational study of youth aged 0–19 years with physician-diagnosed diabetes, were used to estimate the prevalence and incidence of type 1 and type 2 diabetes. Information obtained by questionnaire, physical examination, and blood and urine collection was analyzed to describe the characteristics of youth who completed a study visit.

          RESULTS—Among Hispanic American youth, type 1 diabetes was more prevalent than type 2 diabetes, including in youth aged 10–19 years. There were no significant sex differences in type 1 or type 2 diabetes prevalence. The incidence of type 2 diabetes for female subjects aged 10–14 years was twice that of male subjects ( P < 0.005), while among youth aged 15–19 years the incidence of type 2 diabetes exceeded that of type 1 diabetes for female subjects ( P < 0.05) but not for male subjects. Poor glycemic control, defined as A1C ≥9.5%, as well as high LDL cholesterol and triglycerides were common among youth aged ≥15 years with either type of diabetes. Forty-four percent of youth with type 1 diabetes were overweight or obese.

          CONCLUSIONS—Factors such as poor glycemic control, elevated lipids, and a high prevalence of overweight and obesity may put Hispanic youth with type 1 and type 2 diabetes at risk for future diabetes-related complications.

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          Most cited references 34

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          Prevalence of overweight and obesity among US children, adolescents, and adults, 1999-2002.

          The prevalence of overweight and obesity has increased markedly in the last 2 decades in the United States. To update the US prevalence estimates of overweight in children and obesity in adults, using the most recent national data of height and weight measurements. As part of the National Health and Nutrition Examination Survey (NHANES), a complex multistage probability sample of the US noninstitutionalized civilian population, both height and weight measurements were obtained from 4115 adults and 4018 children in 1999-2000 and from 4390 adults and 4258 children in 2001-2002. Prevalence of overweight (body mass index [BMI] > or =95th percentile of the sex-specific BMI-for-age growth chart) among children and prevalence of overweight (BMI, 25.0-29.9), obesity (BMI > or =30.0), and extreme obesity (BMI > or =40.0) among adults by sex, age, and racial/ethnic group. Between 1999-2000 and 2001-2002, there were no significant changes among adults in the prevalence of overweight or obesity (64.5% vs 65.7%), obesity (30.5% vs 30.6%), or extreme obesity (4.7% vs 5.1%), or among children aged 6 through 19 years in the prevalence of at risk for overweight or overweight (29.9% vs 31.5%) or overweight (15.0% vs 16.5%). Overall, among adults aged at least 20 years in 1999-2002, 65.1% were overweight or obese, 30.4% were obese, and 4.9% were extremely obese. Among children aged 6 through 19 years in 1999-2002, 31.0% were at risk for overweight or overweight and 16.0% were overweight. The NHANES results indicate continuing disparities by sex and between racial/ethnic groups in the prevalence of overweight and obesity. There is no indication that the prevalence of obesity among adults and overweight among children is decreasing. The high levels of overweight among children and obesity among adults remain a major public health concern.
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              Sustained effect of intensive treatment of type 1 diabetes mellitus on development and progression of diabetic nephropathy: the Epidemiology of Diabetes Interventions and Complications (EDIC) study.

                (2003)
              The Diabetes Control and Complications Trial (DCCT) demonstrated the benefits of intensive treatment of diabetes in reducing glycemic levels and slowing the progression of diabetic nephropathy. The DCCT cohort has been examined annually for another 8 years as part of the follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) study. During the EDIC study, glycemic levels no longer differed substantially between the 2 original treatment groups. To determine the long-term effects of intensive vs conventional diabetes treatment during the DCCT on kidney function during the EDIC study. Observational study begun in 1993 (following DCCT closeout) in 28 medical centers in the United States and Canada. Participants were 1349 (of 1375) EDIC volunteers who had kidney evaluation at years 7 or 8. Development of microalbuminuria, clinical-grade albuminuria, hypertension, or increase in serum creatinine level. Results were analyzed by intention-to-treat analyses, comparing the 2 original DCCT treatment groups. New cases of microalbuminuria occurred during the EDIC study in 39 (6.8%) of the participants originally assigned to the intensive-treatment group vs 87 (15.8%) of those assigned to the conventional-treatment group, for a 59% (95% confidence interval [CI], 39%-73%) reduction in odds, adjusted for baseline values, compared with a 59% (95% CI, 36%-74%) reduction at the end of the DCCT (P<.001 for both comparisons). New cases of clinical albuminuria occurred in 9 (1.4%) of the participants in the original intensive-treatment group vs 59 (9.4%) of those in the original conventional-treatment group, representing an 84% reduction in odds (95% CI, 67%-92%), compared with a reduction of 57% (95% CI, -1% to +81%) at the end of the DCCT. Fewer cases of hypertension (prevalence at year 8, 29.9% vs 40.3%; P<.001) developed in the original intensive-treatment group. Significantly fewer participants reached a serum creatinine level of 2 mg/dL or greater in the intensive-treatment vs the conventional-treatment group (5 vs 19, P =.004), but there were no differences in mean log clearance values. Although small numbers of patients required dialysis and/or transplantation, fewer patients experienced either of these outcomes in the intensive group (4 vs 7, P =.36). The persistent beneficial effects on albumin excretion and the reduced incidence of hypertension 7 to 8 years after the end of the DCCT suggest that previous intensive treatment of diabetes with near-normal glycemia during the DCCT has an extended benefit in delaying progression of diabetic nephropathy.
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                Author and article information

                Journal
                Diabetes Care
                diacare
                Diabetes Care
                American Diabetes Association
                0149-5992
                1935-5548
                March 2009
                : 32
                : Supplement_2
                : S123-S132
                Affiliations
                [1 ]Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
                [2 ]Department of Nutrition, Gillings School of Global Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
                [3 ]Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina
                [4 ]Department of Public Health Sciences, Wake Forest University Health Sciences, Winston-Salem, North Carolina
                [5 ]Sansum Diabetes Research Institute, Santa Barbara, California
                [6 ]Department of Medicine, Northwest Lipid Research Laboratories, University of Washington, Seattle, Washington
                [7 ]Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
                [8 ]Department of Preventive Medicine and Biometrics, University of Colorado Denver, Denver, Colorado
                Author notes

                Corresponding author: Jean M. Lawrence, jean.m.lawrence@ 123456kp.org

                Article
                322S123
                10.2337/dc09-S204
                2647689
                19246577
                Copyright © 2009, American Diabetes Association

                Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

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