Smith Tracie L S, Drum Melinda L, Lipton Rebecca B
Department of Pediatrics, University of Chicago, Chicago, IL, USA.
J Pediatr Endocrinol Metab. 2007 Oct;20(10):1093-107. doi: 10.1515/jpem.2007.20.10.1093.
Reports of increasing risk for type 1 (T1) and type 2 diabetes mellitus in youth are emerging, but information on socioeconomically diverse populations is limited.
The Chicago Childhood Diabetes Registry is a city-wide study of patients 0-17 years old at onset. Incidence data came from medical records and interviews; census data provided denominators; analyses used Poisson regression. Non-type 1 (nT1) patients had a type 2-like clinical course or related indicators.
There were 1,366 incident cases: 719 in non-Hispanic Black (NHB), 379 in Hispanic, 229 in non-Hispanic White (NHW), and 39 in children of other ethnicities. Average annual incidence was 16.0 (95% CI: 14.6, 17.6)/10(5) for boys, 20.1 (18.3, 22.1)/10(5) for girls, and 18.1 (16.9, 19.3)/10(5) overall. Risk was 21.6 (19.6, 23.8)/10(5) for NHB, 14.6 (13.0, 16.4)/10(5) for Hispanic, and 18.1 (15.9, 20.6)/10(5) for NHW. Children aged 10-14 years experienced the highest incidence, irrespective of ethnicity. T1 was predominant in all ethnic groups, except NHB, where the rates of T1 and nT1 were similar. Over ten years there was a marked increase in all childhood diabetes in Chicago, averaging 2.73% (95% CI: 0.49, 5.02) per annum, adjusted for age. This increase was confined to nT1, with an average annual percent change of +6.23% (2.28, 10.34), while T1 incidence remained stable.
Incidence of childhood diabetes increased between 1994-2003, driven primarily by nT1, suggesting a role for behavioral and/or environmental determinants of insulin resistance. These estimates are likely to be conservative, if nT1 cases were more apt to be missed.
青少年1型（T1）和2型糖尿病风险增加的报告不断涌现，但关于社会经济背景多样人群的信息有限。
芝加哥儿童糖尿病登记处是一项针对发病时年龄在0至17岁患者的全市范围研究。发病率数据来自医疗记录和访谈；人口普查数据提供分母；分析采用泊松回归。非1型（nT1）患者具有类似2型糖尿病的临床病程或相关指标。
共有1366例新发病例：非西班牙裔黑人（NHB）719例，西班牙裔379例，非西班牙裔白人（NHW）229例，其他种族儿童39例。男孩的年均发病率为16.0（95%CI：14.6，17.6）/10⁵，女孩为20.1（18.3，22.1）/10⁵，总体为18.1（16.9，19.3）/10⁵。NHB的风险为21.6（19.6，23.8）/10⁵，西班牙裔为14.6（13.0，16.4）/10⁵，NHW为18.1（15.9，20.6）/10⁵。10至14岁儿童的发病率最高，与种族无关。除NHB外，所有种族群体中T1均占主导，在NHB中T1和nT1的发病率相似。在十年间，芝加哥所有儿童糖尿病病例显著增加，经年龄调整后平均每年增加2.73%（95%CI：0.49，5.02）。这种增加仅限于nT1，年均变化率为+6.23%（2.28，10.34），而T1发病率保持稳定。
1994年至2003年间儿童糖尿病发病率上升，主要由nT1推动，提示胰岛素抵抗的行为和/或环境决定因素发挥了作用。如果nT1病例更容易被漏诊，这些估计可能较为保守。
