SAT-147 Diabetes Mellitus Prevalence and Associated Weight Status in a Contemporary Pediatric Population

BACKGROUND: Prior to the 1990s, most cases of diabetes mellitus (DM) in children were due to type 1 (T1) DM. Subsequent studies have shown the incidence of type 2 (T2) DM has increased with the obesity epidemic. This study examines the prevalence and subtype of DM by age, sex, and body mass index (BMI) in an ethnically diverse cohort of children receiving health care in Northern California. METHODS: Using data from a large integrated healthcare delivery system, 160,178 children between age 3-17y were identified from well-child clinic visits during July 2007 to December 2010. Age, race/ethnicity, weight, and height were obtained from health plan databases. BMI was calculated from weight (kg) divided by height (m) squared and expressed as a percentile (normal ≤85th percentile, overweight 85th to <95th percentile, obese ≥95th percentile). DM status was assigned based on diagnosis, pharmacotherapy, or Endocrine MD chart review. T1DM was determined by a) insulin therapy via pump or b) insulin injections if T1DM was confirmed by chart review. T2DM was determined by receipt of a) oral hypoglycemic drug (and no insulin), anti-hyperglycemic drug with ICD-9 250.x, or anti-hyperglycemic drug if T2DM was confirmed by MD review; or b) ICD-9 250.x in the absence of pharmacotherapy if T2DM was confirmed by MD review. All other DM subtypes (e.g. maturity onset, transient, or medication-induced), were confirmed by MD review. RESULTS: Among 160,178 children, we identified 414 cases of DM, an overall prevalence of 258/100,000. Among DM cases, 82.1% had T1DM, 14.5% had T2DM, and 3.4% included all other DM subtypes. The prevalence of DM increased with age: 116/100,000 (age 3-9), 285/100,000 (age 10-13), and 475/100,000 (age 14-17). By DM type, the prevalence of T1DM increased from 110/100,000 (age 3-9) to 358/100,000 (age 14-17) while the prevalence of T2DM increased from 1/100,000 (age 3-9) to 108/100,000 (age 14-17). The majority of T1DM children were normal weight (66.5%), with 22.4% overweight and 11.2% obese. This contrasts with T2DM where only 8.3% were normal weight, but 15.0% were overweight and 76.7% obese. Across age groups, a high proportion of children with T2DM were obese, ranging from 100% (age 3-9), 81.8% (10-13) and 75% (age 14-17), whereas children with T1DM were more likely to have normal BMI (63%-69%). For those age 12-17y, the prevalence of T1DM was 307/100,000 among normal weight, 447/100,000 among overweight, and 159/100,000 among obese teens, whereas the prevalence of T2DM was only 9/100,000 among normal weight and 61/100,000 among overweight, but 151/100,000 among obese teens. CONCLUSIONS: In this contemporary pediatric cohort, the prevalence of DM was 258/100,000 overall and increased with age. Although the prevalence of T2DM remains quite low in children, a strong relationship of T2DM and obesity was seen, supporting screening efforts to identify prediabetes and diabetes in adolescents with high BMI.