Lipman, T. H., Jawad, A. F., Murphy, K. M., Tuttle, A., Thompson, R. L., Ratcliffe, S. J., et al. (2006). Diabetes Care, 29, 2391-2395.
Most pediatric nurses are aware that the incidence of type 2 diabetes in children, along with the prevalence of obesity, is rising. There has been a great deal written in the lay and scientific press on the increased risk of type 2 diabetes in minority children. But what about the risk of type 1 diabetes in minority children? Is it changing?
Since 1985, a registry of pediatric type 1 diabetes has been maintained in Philadelphia. At the beginning of the registry, it was shown that type 1 diabetes was 33% more common in White children than Black children. In addition, the incidence of type 1 diabetes in Hispanic children in Philadelphia was the highest of any racial group in the United States. The subjects in the most recent cohort of the registry-children diagnosed from 1995 to 1999-show similarities and differences. The Hispanic children continue to have an extremely high rate of diabetes. For the first time, however, the incidence of type 1 diabetes in Black children has surpassed that of White children. What has caused this dramatic rise? Type 1 diabetes is an autoimmune disease with a genetic predisposition and environmental triggers. Some evidence suggests that the rise in obesity may be causing an increase in type 1 and type 2 diabetes.
Although we are learning that obese minority children are at risk for type 2 diabetes, they may also have type 1 diabetes, a disease with a different etiology and treatment. It is critical to remain open minded in clinical decision making and assess children thoroughly to confirm the diagnosis. It is important to note, however, that confirming the type of diabetes may not be straightforward. Many children, including possibly some in Philadelphia, may be misclassified. Therefore, all children with diabetes must be monitored continually to ensure that the response to treatment is concordant with the diagnosis.
Terri H. Lipman