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2002~2012年青少年儿童1型和2型糖尿病的发病趋势
Incidence Trends of Type 1 and Type 2 Diabetes among Youths, 2002–2012


Elizabeth J. Mayer-Davis ... 糖尿病 围产医学和儿科 • 2017.04.13
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关注中国青少年1型和2型糖尿病的防控


翁建平

中山大学附属第三医院内分泌与代谢病学科;广东省糖尿病防治重点实验室;中山大学糖尿病研究所

 

本期《新英格兰医学杂志》发表的一篇美国针对20岁以下人群糖尿病发病流行病学登记研究1,展示了2002~2012年美国5个城市近500万青少年儿童人群1型糖尿病和2型糖尿病发病率的增长趋势。该项研究表明,1型糖尿病发病率以每年1.4%增加,粗发病率由2002~2003年19.5/10万人增长至2011~2012年21.7/10万人;西班牙语裔较非西班牙语裔白种人发病率增加显著(4.2%对1.2%)。2型糖尿病以每年7.1%增长,粗发病率由2002~2003年9.0/10万人增长至2011~2012年12.5/10万人;非西班牙语裔白种人增长较其他族裔慢;美国原住民增长较西班牙语裔增长明显(8.9%对3.1%)。经过校正性别、年龄,民族和种族后,1型糖尿病年增长率为1.5%,2型糖尿病年增长率为4.8%。该增长趋势在不同种族间差异较大。

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摘要


背景

青少年儿童诊断为1型和2型糖尿病会带来巨大的临床和公共卫生负担。在2001~2009年这些疾病的患病率上升,但缺少关于近期发病趋势的数据。

 

方法

我们在美国5个研究中心中确认了1型和2型糖尿病病例。我们从全美人口普查数据或医疗保险计划参保人员统计中得到计算发病率的分母数(每年490万青少年儿童)。在计算了2002~2012年的年发病率后,我们通过2年的移动平均数,采用广义自回归移动平均模型分析了其趋势。

 

结果

我们共确定了11,245例青少年儿童1型糖尿病患者(0~19岁)和2,846名青少年儿童2型糖尿病患者(10~19岁)。估计的总体未校正1型糖尿病发病率每年上升1.4%(从2002~2003年的每年19.5例/10万青少年儿童上升至2011~2012年的每年21.7例/10万青少年儿童,P=0.03)。在校正后的两两比较中,西班牙语裔白种人中的年增长率比非西班牙语裔白种人高(4.2%对1.2%,P<0.001)。总体未校正2型糖尿病发病率每年上升7.1%(从2002~2003年的每年9例/10万青少年儿童上升至2011~2012年的每年12.5例/10万青少年儿童,不同人种或民族、性别和年龄亚组间的趋势分析P<0.001)。校正后的两两比较显示,非西班牙语裔白种人(0.6%)2型糖尿病发病率的相对年度升幅比非西班牙语裔黑种人、亚裔或太平洋岛民以及美国原住民小(所有比较P均<0.05),而西班牙语裔人中的年增长率与美国原住民有显著差异(3.1%对8.9%,P=0.01)。在校正了年龄、性别及人种或民族后,1型糖尿病发病率的相对年度升幅为1.8%,而2型糖尿病则为4.8%(P<0.001)。

 

结论

青少年儿童1型和2型糖尿病的发病率均在2002~2012年显著上升,尤其在少数人种和民族的青少年儿童中(由美国国立糖尿病、消化和肾脏疾病研究所[National Institute of Diabetes and Digestive and Kidney Diseases]以及美国疾病控制和预防中心[Centers for Disease Control and Prevention]资助)。





作者信息

Elizabeth J. Mayer-Davis, Ph.D., Jean M. Lawrence, Sc.D., M.P.H., M.S.S.A., Dana Dabelea, M.D., Ph.D., Jasmin Divers, Ph.D., Scott Isom, M.S., Lawrence Dolan, M.D, Giuseppina Imperatore, M.D., Ph.D., Barbara Linder, M.D., Ph.D., Santica Marcovina, Ph.D., Sc.D., David J. Pettitt, M.D., Catherine Pihoker, M.D., Sharon Saydah, Ph.D., M.H.S., and Lynne Wagenknecht, Dr.P.H., for the SEARCH for Diabetes in Youth Study*
From the Departments of Nutrition and Medicine, University of North Carolina, Chapel Hill (E.J.M.-D.), and the Department of Biostatistical Sciences (J.D., S.I.) and the Division of Public Health Sciences (L.W.), Wake Forest School of Medicine, Winston-Salem — both in North Carolina; the Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena (J.M.L.), and Santa Barbara (D.J.P.) — both in California; the Department of Epidemiology, Colorado School of Public Health, Aurora (D.D.); the Department of Endocrinology, Children’s Hospital Medical Center, Cincinnati (L.D.); the Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta (G.I., S.S.); the Division of Diabetes, Endocrinology, and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD (B.L.); and the Northwest Lipid Research Laboratory (S.M.) and the Department of Pediatrics, University of Washington (C.P.) — both in Seattle. Address reprint requests to Dr. Mayer-Davis at the University of North Carolina, 245 Rosenau Hall, Campus Box 7461, Chapel Hill, NC 27599, or at ejmayer-davis@unc.edu. *A complete list of investigators in the SEARCH for Diabetes in Youth Study is provided in the Supplementary Appendix, available at NEJM.org.

 

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