What is pediatric diabetes?
Diabetes, also known as diabetes mellitus, is a metabolic disease. In diabetes there is too much sugar in the bloodstream. This is because the body doesn't have enough insulin. This can be due to the body not producing enough or any insulin or the body's cells do not respond to insulin. It is not a contagious disease. There are 2 types of diabetes in children, type 1 and type 2. With diabetes, the blood sugar rises can cause frequent urination, thirst, and hunger. Diabetes can be controlled by keeping blood sugar levels within a normal range, eating well, and being physically active. However, when diabetes is poorly controlled, it can lead to blindness, kidney failure, heart disease, and amputation of toes, feet, and legs.
What is type 1 diabetes?
Type 1 diabetes may be more commonly known as insulin-dependent diabetes. It is also commonly known as juvenile diabetes, or early-onset diabetes. It is usually brought on suddenly as the body stops making insulin.
While the disease can develop at any age, type 1 diabetes is diagnosed more often in children and young adults. Type 1 diabetes makes up the majority of diabetes diagnoses in children. It is thought to be an autoimmune disease or triggered by a virus, but a clear cause is currently unknown. Possible risk factors for type 1 diabetes include genetics and environmental exposures. Type 1 diabetes is usually controlled with insulin injections, diet, and exercise. People with type 1 diabetes need to take insulin for the rest of their life.
Between 2002 and 2018, the incidence, or new cases, of type 1 diabetes in people from birth to 19 years of age rose significantly nationwide. This time period saw an increase of about 2% each year. Type 1 diabetes occurs equally among males and females. It is more common in whites than in nonwhites. The World Health Organization's Multinational Project for Childhood Diabetes indicates that type 1 diabetes is rare in most African, American Indian, and Asian populations. Some northern European countries, including Finland and Sweden, have high rates of type 1 diabetes.
1. Wagenknecht LE, Lawrence JM, Isom S, et al. Trends in incidence of youth-onset type 1 and type 2 diabetes in the USA, 2002-18: results from the population-based SEARCH for Diabetes in Youth study. Lancet Diabetes Endocrinol. 2023;11(4):242–250. doi: 10.1016/S2213-8587(23)00025-6
What is type 2 diabetes?
Type 2 diabetes comes on more slowly than type 1 diabetes and is more commonly diagnosed in people 45 years of age or older who are overweight. Among adults, type 2 diabetes is by far the most common type, making up approximately 90 to 95% of all cases. However, individuals can be diagnosed with type 2 diabetes at any age, and it is increasingly being diagnosed in younger populations. With type 2 diabetes, the body does not make enough insulin or cannot use the insulin that it makes. Genetics and environmental causes can play a role in the development of type 2 diabetes. Treatment for people with type 2 diabetes includes insulin pills or injections, healthy eating, and increased physical activity.
How does MA EPHT track pediatric diabetes?
Pediatric diabetes tracking is the ongoing collection of diabetes data from Massachusetts students. Once collected, this data is also analyzed and interpreted. The pediatric diabetes tracking program collects data through school health records. An annual survey is used to collect the records. Records are from approximately 1,800 schools serving Kindergarten through 8th grade.
Why is MA EPHT tracking pediatric diabetes?
Diabetes is on the rise worldwide. The collection of pediatric diabetes data began in 2008 as part of the pediatric asthma surveillance program due to resident concerns of pediatric diabetes prevalence in specific cities and towns in Massachusetts. MDPH/BCEH tracks pediatric diabetes data to learn how much diabetes exists in the state and which counties have a higher prevalence of diabetes than others (both type 1 and type 2). This enables the MDPH/BCEH to look at diabetes trends over time and plan targeted public health interventions.
What is the relationship between diabetes and environmental factors?
Type 1 diabetes is diagnosed more often in children and young adults. Type 2 diabetes is more prevalent in adults but can occur in children. Type 1 is thought to be an autoimmune disease or triggered by a virus, but a clear cause is currently unknown. The presence of certain genes is known to increase risk for type 1 diabetes.
Research suggests that in cases of identical twins where one has type 1 diabetes, the other twin may get the disease only half the time. Environmental causes of type 1 diabetes may be related to diet. For example, the early or late introduction of certain foods (e.g., cow’s milk, dietary gluten, or vitamin D). Drinking water that contains nitrates may also be related. Viral infections, such as rubella and human enterovirus, have also been hypothesized as a causes. These viruses can infect the cells of the pancreas. An increase in psychological stress has also been suggested as an environmental cause.
Type 2 diabetes also has a genetic basis. The likelihood of the disease being approximately 3 in 4 for identical twins if their twin sibling is diagnosed with type 2 diabetes.
Research into the role of Persistent Organic Pollutants (POPs) suggests a possible association with adult diabetes type 2. Examples of POPs include dioxin, PCBs, and chlorinated pesticides. Little research has been conducted on children to date. POPs may alter insulin action; however, a specific mechanism is not known. Air pollution, specifically exposure to particulate matter (PM2.5), may contribute to diabetes prevalence in adults. No information exists for children at this time. Lastly, according to the American Diabetes Association, being overweight is a risk factor for developing type 2 diabetes. Other risk factors related to family history, ethnicity, and age can also play a role.
Available data
Use the Explore Pediatric Diabetes Data link to access the following measures:
- Pediatric diabetes counts and prevalence by geography. These measures are offered by county, EP Region, EOHHS Region and statewide.
Prevalence is used to measure the amount of pediatric diabetes in each school or county. Prevalence is presented per 1,000 students. Confidence intervals shown indicate the precision of the prevalence estimate. Prevalence in counties is the percentage of students from that county that are enrolled in Massachusetts schools. These are also students reported by school nurses to have asthma during the school year.
School nurses gather this information from the student’s school health records. They also use physician reports and parent information forms. Pediatric diabetes prevalence estimates are compared to statewide prevalence. Doing so shows if the prevalence is statistically higher, lower, or the same. In some instances, school or county data may not be available. This is because MDPH does not have data available for that school or community in the year selected.
The most current available data will be shown. Be sure to check the site periodically as new data are added each year. To protect privacy, no information is shown that could identify an individual.
Additional resources
Massachusetts
- Diabetes Prevention and Control Program (DPCP): Information on Massachusetts Health and Human Services' statewide program to improve access to diabetes care and increase education
National
- American Association of Diabetes Educators: Homepage for the American Association of Diabetes Educators who work to help health professionals to deliver diabetes education, management, and support
- American Diabetes Association (ADA): The website for the ADA who work to prevent and cure diabetes and improve the lives of those affected by diabetes
- CDC Diabetes Public Health Resources: The U.S. Centers for Disease Control and Prevention's homepage regarding diabetes
- The Environmental Determinants of Diabetes in the Young (TEDDY): An international study looking into the etiology of type 1 diabetes
- Juvenile Diabetes Research Foundation International (JDRF): The website for JDRF who funds type 1 diabetes research
- National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health (NIDDK): Homepage for NIDDK and the National Diabetes Information Clearinghouse regarding research and resources about diabetes