Significant gaps existed at the end of the 20th century in our understanding of the incidence and burden of diabetes in youth. The SEARCH for Diabetes in Youth, initiated in 2000, has taught us that diabetes among youth is frequent and increasing in the U.S. The prevalence of type 1 diabetes (T1D) and type 2 diabetes (T2D) among youth <20 years of age increased by 21% and 30.5%, respectively between 2001 and 2009. The increasing burden of T1D is seen in most racial/ethnic and age groups while increasing trends in the burden on T2D are noted in 10-14 and 15-19 year old Hispanic, non-Hispanic white and non- Hispanic black youth. Similarly, the incidence of both T1 and T2D is increasing in the U.S (1.4% and 4.2% annually between 2002-2012, respectively). T1D is no longer a rarity among minority youth, with the steepest trend in incidence observed among Hispanic youths. The incidence of T2D has increasing among all race/ethnic groups except non-Hispanic whites. Ongoing, timely and efficient surveillance of diabetes diagnosed in youth is essential to identify health disparities and inform health care systems and the public health community to identify and prioritize strategies to prevent diabetes and its complications. While the SEARCH surveillance approach clarified many gaps in our understanding of diabetes among youth, less costly, time- and labor-intensive approaches are needed that utilize the enormous wealth of data in the electronic medical record and other clinical datasets, while maintaining the critical infrastructure and expertise developed during SEARCH. The Colorado DiCAYA surveillance team is ideally situated to address the critical challenge of utilizing existing electronic data sources to generate accurate, timely estimates of the incidence and prevalence of diabetes among youth, by age, sex, and race/ethnicity subgroups. In response to RFA-DP-20-001- Component A, we propose to ascertain the annual prevalence and incidence of diabetes among youth <18 years of age in the state of Colorado starting with year 2020 from the well-established SEARCH, network of pediatric endocrinology clinics, community clinics and hospital networks in Colorado. Our simple, yet innovative integrated surveillance approach will utilize a combination of algorithms and targeted chart review to identify youth with diabetes, distinguish diabetes type and estimate onset date.
Our specific aims are:
Aim 1 : SURVEILLANCE (Prevalence)- To ascertain cases of prevalent diabetes among youth age < 18 years, by age, race/ethnicity and diabetes type ;
Aim 2 : SURVEILLANCE (Incidence)- To ascertain newly diagnosed diabetes cases in youth age < 18 years at diagnosis, by age, race and diabetes type;
Aim 3 : EVALUATE PUBLIC HEALTH SURVEILLANCE METHODS - To evaluate the strengths and challenges of our integrated surveillance approach to determine the burden and incidence of diabetes among youth < 18 years by ascertaining validity, completeness and representativeness of case ascertainment methods.
Reliable, timely surveillance data on the prevalence and incidence of diabetes among youth in the U.S. is needed to identify current and future healthcare and public health priorities. Ongoing estimates are critical to determine the needs and monitor the effects of treatment to reduce complications and design effective prevention activities. It is of critical importance to identify groups or populations that might have increased burden or special health care needs related to diabetes.
