Rising Incidence of Type 2 Diabetes in Children in the U.K. LINDA HAINES, MSC 1 KAY CHONG WAN, DPHIL 1 RICHARD LYNN, MSC 1 TIMOTHY G. BARRETT, PHD 2,3 JULIAN P.H. SHIELD, MD 4,5 OBJECTIVE — To estimate the incidence of type 2 diabetes in children 17 years of age and to investigate the relationship of diabetes with increasing childhood obesity in the U.K. and the Republic of Ireland (ROI). RESEARCH DESIGN AND METHODS — Active monthly reporting of cases by con- sultant pediatricians through the framework of the British Pediatric Surveillance Unit, with additional reports from specialist diabetes nurses. All children 17 years of age and diagnosed by their clinician as having non–type 1 diabetes from 1 October 2004 to 31 October 2005 were included. RESULTS — A total of 168 confirmed cases of non–type 1 diabetes were reported, resulting in a national incidence (excluding the ROI) of 1.3  100,000 -1  year -1 . Of these, 40% were diagnosed with type 2 diabetes giving a minimum incidence of 0.53  100,000 -1  year -1 . Children of ethnic minorities were greatly overrepresented, with those of black and South-Asian origin (England data only) having an incidence of 3.9 and 1.25  100,000 -1  year -1 , respec- tively, compared with 0.35  100,000 -1  year -1 in those defined as white. Of those diagnosed with type 2 diabetes, 95% were overweight and 83% obese according to International Obesity Task Force guidelines. Eighty-four percent had a family history of type 2 diabetes. CONCLUSIONS — Type 2 diabetes is still less common than type 1 diabetes in U.K. chil- dren. However, compared with previous prevalence data, the frequency of type 2 diabetes appears to be increasing. Incidence among ethnic minorities is far higher than in whites, as previously described in the U.S. Increased adiposity and family history of type 2 diabetes were strongly associated with the diagnosis of type 2 diabetes in U.K. children. Diabetes Care 30:000 – 000, 2007 T he growing prevalence of childhood obesity in the U.K. (1,2) undoubt- edly has implications for our chil- dren’s health. Predictions from the U.S. imply that obesity-driven type 2 diabetes might become the most common form of newly diagnosed diabetes in adolescent youth within 10 years (3). Evidence now exists suggesting a global spread of type 2 diabetes in children, although incidence data are uncommon (4). Various centers in the U.S. have recorded dramatic in- creases in the number of children diag- nosed with type 2 diabetes. A 10-fold increase was reported by a center in New York from 1990 to 2000, with 50% of all new cases having type 2 diabetes (5), and similar increases have been reported else- where (6). In Japan, researchers have doc- umented a rise in annual incidence from 1.73/100,000 to 2.76/100,000 over 20 years (7), while evidence is emerging of an increase in urban South-Asian children (8). Data from Europe are scarce (9); a population-based study in Austria estab- lished an incidence of 0.25/100.000 chil- dren (10), while a report from France indicated relatively low but increasing numbers of children presenting with type 2 diabetes (11). In the U.K., Ehtisham et al. (12) estimated a crude prevalence of type 2 diabetes under 16 years of 0.21/ 100,000, while a recent report reviewing first hospital admissions with a diagnosis of type 2 diabetes in patients 18 years of age indicated a significant rise between 1996 –1997 and 2003–2004 (13). The emergence of type 2 diabetes in adolescents has important implications for both the health of the individual and health service resources. Treatment com- pliance (14) and psychological health (15) are often poor in childhood type 2 diabetes. Various studies imply an accel- erated risk of nephropathy (16,17) and retinopathy (18) compared with young people with type 1 diabetes, while recent data indicate early signs of cardiovascular disease in youth with type 2 diabetes (19). The only currently available longitudinal data give cause for concern— of 79 chil- dren recontacted up to 15 years after the diagnosis of type 2 diabetes, 9% had died and 6% were on dialysis (20). The growing number of anecdotal re- ports of increasing type 2 diabetes in U.K. children and a need to establish clinical guidelines and frameworks for their treat- ment prompted us to initiate a prospec- tive, population-based, surveillance study to establish baseline incidence rates for non–type 1 diabetes and, more specifi- cally, type 2 diabetes in childhood. RESEARCH DESIGN AND METHODS — A prospective monthly surveillance of 2,665 consultant pediatri- cians in the U.K. and the Republic of Ire- land (ROI) through the British Pediatric Surveillance Unit (BPSU) of the Royal College of Pediatrics and Child Health was undertaken to identify cases of non– type 1 diabetes in 0- to 16-year-old indi- viduals. The study ran from October 2004 until October 2005 (inclusive). The study received ethical approval from the South West Multi Research Ethics Com- mittee (04/MREC06/39) and was also given approval not to seek patient or par- ent consent by the Patient Information ●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●● From the 1 Research Division, Royal College of Paediatrics and Child Health, London, U.K.; the 2 Institute of Child Health, University of Birmingham, Birmingham, U.K.; the 3 Birmingham Children’s Hospital, Birming- ham, U.K.; the 4 University of Bristol, Bristol, U.K.; and the 5 Bristol Royal Hospital for Children, Bristol, U.K. Address correspondence and reprint requests to Dr. Julian Shield, Level 6, Education Centre, Bristol Royal Hospital for Children, Upper Maudlin St., Bristol, BS2 8AE, U.K. E-mail: j.p.h.shield@bristol.ac.uk. Received for publication 29 August 2006 and accepted in revised form 15 January 2007. Published ahead of print at http://care.diabetesjournals.org on 26 January 2007. DOI: 10.2337/dc06- 1813. Abbreviations: BPSU, British Pediatric Surveillance Unit; HNF, hepatocyte nuclear factor; ICA, islet cell antibody; MODY, maturity-onset diabetes of the young; ROI, Republic of Ireland. A table elsewhere in this issue shows conventional and Syste `me International (SI) units and conversion factors for many substances. © 2007 by the American Diabetes Association. The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact. Epidemiology/Health Services/Psychosocial Research O R I G I N A L A R T I C L E DIABETES CARE, VOLUME 30, NUMBER 5, MAY 2007 1 Artofn rich4/zdc-dcare/zdc-dcare/zdc00507/zdc6080d07a allend S=6 3/15/07 9:07 doi: 10.2337/dc06 –1813 artno: 1813