SEARCH研究表明青少年糖尿病患病率升高

费城(EGMN)——科罗拉多大学丹佛分校流行病学教授Dana Dabelea博士在美国糖尿病学会(ADA)年会上报告称，曾被认为几乎是成人特有的2型糖尿病，2001~2009年美国20岁以下青少年患病率增加21%，同期1型糖尿病患病率增加23%。

 Dabelea博士在会前新闻发布会上称，每年1型和2型糖尿病新发病例分别约为15,000例和3,700例，儿童患病人数日益增多。尽管1型糖尿病仍属“非常少见”且极度危险的疾病，但越来越多的证据表明2型糖尿病也并非良性疾病。随着儿童患病率日益升高， 2型糖尿病逐渐成为一种儿童疾病。青少年2型糖尿病与慢性并发症早期体征和症状相关，后者可增加终生共病、降低生活质量、缩短寿命预期以及增加医疗费用。

研究者报告了青少年糖尿病SEARCH研究的最新数据。目前正在美国5家医学中心开展的该项研究始于2000年，预计至少持续至2015年，其主要目的是跟踪糖尿病新发病例，以提供首个全美糖尿病流行概貌，并探究糖尿病并发症和共病、糖尿病与生活方式的相关性以及营养对疾病的影响。

最新数据显示，2001~2009年20岁以下美国糖尿病患病人数大约为189,000例(1型和2型糖尿病人数分别约为168,000例和19,000例)。无论男孩还是女孩，无论哪个种族，2种糖尿病患病率均有所增加。受试人群1型糖尿病患病率由2001年的1.55/1,000升高至2009年的2.03/1,000，呈统计学显著差异；同期2型糖尿病患病率由2.9/1,000升高至3.6/1,000。虽然土著和黑人患者比例最高，但白人和西班牙裔患病人数也在增加，表明传统高危人群儿童2型糖尿病患病人数逐渐达到平台期，而其他人群儿童2型糖尿病患病人数仍在增加。

有关SEARCH研究亚组分析数据如下：

•2种糖尿病青少年患者均呈现潜在肾损伤征兆。在5,000例4年糖尿病史人群中，蛋白尿患者所占比例最高可达17%。胰岛素抵抗但糖尿病自身抗体阴性的儿童患者比例最高(17%)，糖尿病自身抗体阳性但胰岛素敏感的儿童患者比例最低(8%)。

•2种糖尿病患儿看电视时间似乎与血糖和血脂水平直接相关。在<10岁的1,400例受试患者中，HbA_1c水平与看电视时间呈正相关，每天看电视时间≥3 h的儿童的甘油三酯水平明显高于看电视时间较少者。

•糖尿病患儿周围神经病变发病率与成人患者相当。儿童、青少年和年轻成人糖尿病患者不仅具有糖尿病周围神经病变风险，而且许多患者已经呈现出可量化的病变体征。

•有222例受试者可见心血管自主神经病变早期征兆，表明糖尿病患儿可能是未来心血管疾病易感人群。

SEARCH研究由美国疾病预防控制中心和国立卫生研究院资助，研究者报告无相关利益冲突。

PHILADELPHIA (EGMN) – The prevalence of type 2 diabetes, once considered an almost exclusively adult-onset disease, increased by 21% from 2001 to 2009 among Americans younger than 20 years.

The prevalence of type 1 diabetes increased by 23% over the same time period, Dr. Dana Dabelea reported at the annual meeting of the American Diabetes Association.

“Every year, we see about 15,000 new cases of type 1 and 3,700 new cases of type 2 diabetes, and the numbers of children living with these diseases are increasing,” she said at a press briefing.

Although type 1 diabetes remains “an extremely rare” and very dangerous condition, evidence continues to emerge that type 2 diabetes is anything but benign, said Dr. Dabelea, a professor of epidemiology at the University of Colorado at Denver, Aurora.

“It’s believed that this increase we’re seeing is making type 2 more and more a pediatric condition,” she said. “In youth, this disease is associated with early signs and symptoms of chronic complications that may increase lifelong comorbidities, reduce quality life and life expectancy, and increase health care costs.”

Dr. Dabelea and her coinvestigators discussed new data from the SEARCH for Diabetes in Youth study. The registry study was launched in 2000, and is expected to continue at least through 2015. It’s being conducted in five centers in the United States.

The primary aim is to track the prevalence of new diabetes cases, providing the first national picture of the rising epidemic. Subanalyses look at the diseases’ complications and comorbidities, associations between diabetes and lifestyle, and the impact of nutrition on the diseases.

The new data suggest that from 2001 to 2009, almost 189,000 U.S. residents aged younger than 20 years had diabetes (about 168,000 with type 1 and about 19,000 with type 2).

The prevalence of both types of diabetes has increased in both boys and girls and across all races and ethnicities. The prevalence of type 1 in the study population rose from 1.55 per 1,000 in 2001 to 2.03 per 1,000 in 2009, a statistically significant difference. The prevalence of type 2 during that period rose significantly from 2.9 per 10,000 to 3.6 per 10,000.

“Although the proportion was highest in Native Americans and blacks, the increase was also observed in whites and Hispanics,” Dr. Dabelea said. “This may suggest that pediatric type 2 diabetes is plateauing in the traditionally high-risk groups, but still increasing in other groups.”

SEARCH investigators presented a number of substudy findings at the meeting, including the following:

• Young people with either form of the disease may show signs of impending kidney damage. In a group of 5,000 patients with a 4-year diabetes history, up to 17% had albuminuria. The numbers were highest in children with insulin resistance but no diabetes autoantibodies (17%), and lowest (8%) in those with diabetes autoantibodies who were insulin sensitive.

• Television time seems directly tied to blood glucose and lipid levels in both types of diabetes. In a cohort of 1,400 SEARCH patients aged younger than 10 years, HbA1c increased as TV time increased. Triglyceride levels were significantly higher in children who watched TV for 3 or more hours each day than in those who watched less.

• Peripheral neuropathy strikes children with diabetes at about the same rate as it does adults. “Our findings suggest that children, adolescents, and young adults with diabetes are not only at risk for diabetic peripheral neuropathy, but that many already show measurable signs of it,” the authors noted.

• Among a subset of 222 SEARCH subjects, there were early indications that cardiovascular parasympathetic nerves were impaired, perhaps predisposing children with diabetes to future cardiovascular disease.

SEARCH is being sponsored by the U.S. Centers for Disease Control and Prevention and the U.S. National Institutes of Health. Dr. Dabelea did not have any financial disclosures.