Epidemiology of Pediatric and Adolescent Diabetes PDF

Preface

Diabetes mellitus is the third most prevalent severe chronic disease of childhood. Despite this, there are currently no comprehensive books dedicated to the epidemiology of childhood diabetes. In addition, the epidemiology of diabetes in youth is changing. Until recently, diabetes diagnosed in children and adolescents was almost entirely considered to be type 1 (insulin dependent) diabetes, formerly known as ‘‘juvenile diabetes'' or ‘‘IDDM.'' Now, as youth are becoming increasingly overweight, we are seeing more obese children with a clinical phenotype of type 2, or ‘‘adult onset'' diabetes. Childhood diabetes, similar to adult diabetes, is now acknowledged to be a complex and heterogeneous disorder. Some patients not only exhibit the clinical features of type 2 diabetes but also have positive diabetes autoantibodies. This finding demonstrates the limits of the current diabetes classification scheme in youth and the need to better understand the natural history and long-term evolution of diabetes in youth, especially those with features of both type 1 and type 2 diabetes.

There is also a worldwide increase in childhood type 1 diabetes, and the reasons for this increase are still not known. New interesting data on the potential role of infant diet are emerging from longitudinal studies following youth from birth until the development of autoimmunity and type 1 diabetes. Genetic studies explore the heterogeneity of classical type 1 diabetes, as well as the genetic basis for monogenic forms of diabetes, including recently identified mutations responsible for neonatal forms. Challenging hypotheses that require careful testing are advanced, linking the worldwide obesity epidemic to the increasing incidence and earlier age at onset of both type 1 and type 2 diabetes. In both type 1 and type 2 diabetes, research is focusing on identifying early life, perinatal, and intrauterine exposures and new concepts such as ‘‘fetal programming'' are increasingly being used in conjunction with diabetes risk. The development of elevated levels of cardiovascular risk factors and preclinical cardiovascular disease among youth with diabetes and the potential future impact on morbidity and mortality poses special challenges.

Our increasing understanding of the multifactorial etiology of childhood diabetes and its complications will hopefully translate into improved quality of life for youth with diabetes, and will ultimately lead to the successful prevention of diabetes.

The goal of this book is to review the epidemiology of diabetes from a worldwide perspective and to provide an overview of where this exciting field stands today. In its broadest perspective, diabetes epidemiology provides a framework for understanding the etiology, risk factors, acute and chronic complications, and the natural history of the disease, providing insight into population and clinical patterns of onset and course, and suggesting avenues for further basic science research. This book also includes a discussion of current technologies that provide promise for prevention or cure in the future.

At the beginning of the 21st century, we have now experienced several decades of increased risk for both type 1 and type 2 diabetes in youth and adults throughout the world. Projections indicate that these trends will worsen if the causes of diabetes are not rapidly identified and preventive strategies begun. Such strategies will require both individual clinically-based approaches and a much broader population initiative, targeting social and environmental factors that operate to alter energy balance, and lead to increases in viral or toxic exposures. The challenges are large for science and public health but the cost of not proceeding urgently will be truly immense. We hope that this book will provide a benchmark for our current understanding and suggest promising paths toward diabetes prevention and cure.