Comparison of the incidence of diabetes in United States and Indian youth: An international harmonization of youth diabetes registries

Objective Incidence of youth‐onset diabetes in India has not been well described. Comparison of incidence, across diabetes registries, has the potential to inform hypotheses for risk factors. We sought to compare the incidence of diabetes in the U.S.‐based registry of youth onset diabetes (SEARCH) t...

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Published in:	Pediatric Diabetes Vol. 22; no. 1; pp. 8 - 14
Main Authors:	Jensen, Elizabeth T., Dabelea, Dana A., Praveen, Pradeep A., Amutha, Anandakumar, Hockett, Christine W., Isom, Scott P., Ong, Toan C., Mohan, Viswanathan, D'Agostino, Ralph, Kahn, Michael G., Hamman, Richard F., Wadwa, Paul, Dolan, Lawrence, Lawrence, Jean M., Madhu, S.V., Chhokar, Reshmi, Goel, Komal, Tandon, Nikhil, Mayer‐Davis, Elizabeth
Format:	Journal Article
Language:	English
Published:	Former Munksgaard Hindawi Limited 01.02.2021 John Wiley & Sons A/S John Wiley & Sons, Inc
Subjects:	Adolescent Age Age composition Census Child Child, Preschool descriptive epidemiology of diabetes Diabetes diabetes in youth; incidence Diabetes mellitus (insulin dependent) Diabetes mellitus (non-insulin dependent) Diabetes Mellitus, Type 1 Diabetes Mellitus, Type 1 - epidemiology Diabetes Mellitus, Type 2 Diabetes Mellitus, Type 2 - epidemiology Female Humans Incidence India India - epidemiology Infant Infant, Newborn Male Registries Risk factors Sex differences United States United States - epidemiology Young Adult United States India United States > US United States descriptive epidemiology of diabetes diabetes in youth; incidence India
ISSN:	1399-543X, 1399-5448, 1399-5448
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Abstract	Objective Incidence of youth‐onset diabetes in India has not been well described. Comparison of incidence, across diabetes registries, has the potential to inform hypotheses for risk factors. We sought to compare the incidence of diabetes in the U.S.‐based registry of youth onset diabetes (SEARCH) to the Registry of Diabetes with Young Age at Onset (YDR—Chennai and New Delhi regions) in India. Methods We harmonized data from both SEARCH and YDR to the Observational Medical Outcomes Partnership (OMOP) Common Data Model. Data were from youth registered with incident diabetes (2006‐2012). Denominators were from census and membership data. We calculated diabetes incidence by averaging the total cases across the entire follow‐up period and dividing this by the estimated census population corresponding to the source population for case ascertainment. Incidence was calculated for each of the registries and compared by type and within age and sex categories using a 2‐sided, skew‐corrected inverted score test. Results Incidence of type 1 was higher in SEARCH (21.2 cases/100 000 [95% CI: 19.9, 22.5]) than YDR (4.9 cases/100 000 [95% CI: 4.3, 5.6]). Incidence of type 2 diabetes was also higher in SEARCH (5.9 cases/100 000 [95% CI: 5.3, 6.6] in SEARCH vs 0.5/cases/100 000 [95% CI: 0.3, 0.7] in YDR). The age distribution of incident type 1 diabetes cases was similar across registries, whereas type 2 diabetes incidence was higher at an earlier age in SEARCH. Sex differences existed in SEARCH only, with a higher rate of type 2 diabetes among females. Conclusion The incidence of youth‐onset type 1 and 2 diabetes was significantly different between registries. Additional data are needed to elucidate whether the differences observed represent diagnostic delay, differences in genetic susceptibility, or differences in distribution of risk factors.
AbstractList	Objective Incidence of youth‐onset diabetes in India has not been well described. Comparison of incidence, across diabetes registries, has the potential to inform hypotheses for risk factors. We sought to compare the incidence of diabetes in the U.S.‐based registry of youth onset diabetes (SEARCH) to the Registry of Diabetes with Young Age at Onset (YDR—Chennai and New Delhi regions) in India. Methods We harmonized data from both SEARCH and YDR to the Observational Medical Outcomes Partnership (OMOP) Common Data Model. Data were from youth registered with incident diabetes (2006‐2012). Denominators were from census and membership data. We calculated diabetes incidence by averaging the total cases across the entire follow‐up period and dividing this by the estimated census population corresponding to the source population for case ascertainment. Incidence was calculated for each of the registries and compared by type and within age and sex categories using a 2‐sided, skew‐corrected inverted score test. Results Incidence of type 1 was higher in SEARCH (21.2 cases/100 000 [95% CI: 19.9, 22.5]) than YDR (4.9 cases/100 000 [95% CI: 4.3, 5.6]). Incidence of type 2 diabetes was also higher in SEARCH (5.9 cases/100 000 [95% CI: 5.3, 6.6] in SEARCH vs 0.5/cases/100 000 [95% CI: 0.3, 0.7] in YDR). The age distribution of incident type 1 diabetes cases was similar across registries, whereas type 2 diabetes incidence was higher at an earlier age in SEARCH. Sex differences existed in SEARCH only, with a higher rate of type 2 diabetes among females. Conclusion The incidence of youth‐onset type 1 and 2 diabetes was significantly different between registries. Additional data are needed to elucidate whether the differences observed represent diagnostic delay, differences in genetic susceptibility, or differences in distribution of risk factors. Incidence of youth-onset diabetes in India has not been well described. Comparison of incidence, across diabetes registries, has the potential to inform hypotheses for risk factors. We sought to compare the incidence of diabetes in the U.S.-based registry of youth onset diabetes (SEARCH) to the Registry of Diabetes with Young Age at Onset (YDR-Chennai and New Delhi regions) in India.OBJECTIVEIncidence of youth-onset diabetes in India has not been well described. Comparison of incidence, across diabetes registries, has the potential to inform hypotheses for risk factors. We sought to compare the incidence of diabetes in the U.S.-based registry of youth onset diabetes (SEARCH) to the Registry of Diabetes with Young Age at Onset (YDR-Chennai and New Delhi regions) in India.We harmonized data from both SEARCH and YDR to the Observational Medical Outcomes Partnership (OMOP) Common Data Model. Data were from youth registered with incident diabetes (2006-2012). Denominators were from census and membership data. We calculated diabetes incidence by averaging the total cases across the entire follow-up period and dividing this by the estimated census population corresponding to the source population for case ascertainment. Incidence was calculated for each of the registries and compared by type and within age and sex categories using a 2-sided, skew-corrected inverted score test.METHODSWe harmonized data from both SEARCH and YDR to the Observational Medical Outcomes Partnership (OMOP) Common Data Model. Data were from youth registered with incident diabetes (2006-2012). Denominators were from census and membership data. We calculated diabetes incidence by averaging the total cases across the entire follow-up period and dividing this by the estimated census population corresponding to the source population for case ascertainment. Incidence was calculated for each of the registries and compared by type and within age and sex categories using a 2-sided, skew-corrected inverted score test.Incidence of type 1 was higher in SEARCH (21.2 cases/100 000 [95% CI: 19.9, 22.5]) than YDR (4.9 cases/100 000 [95% CI: 4.3, 5.6]). Incidence of type 2 diabetes was also higher in SEARCH (5.9 cases/100 000 [95% CI: 5.3, 6.6] in SEARCH vs 0.5/cases/100 000 [95% CI: 0.3, 0.7] in YDR). The age distribution of incident type 1 diabetes cases was similar across registries, whereas type 2 diabetes incidence was higher at an earlier age in SEARCH. Sex differences existed in SEARCH only, with a higher rate of type 2 diabetes among females.RESULTSIncidence of type 1 was higher in SEARCH (21.2 cases/100 000 [95% CI: 19.9, 22.5]) than YDR (4.9 cases/100 000 [95% CI: 4.3, 5.6]). Incidence of type 2 diabetes was also higher in SEARCH (5.9 cases/100 000 [95% CI: 5.3, 6.6] in SEARCH vs 0.5/cases/100 000 [95% CI: 0.3, 0.7] in YDR). The age distribution of incident type 1 diabetes cases was similar across registries, whereas type 2 diabetes incidence was higher at an earlier age in SEARCH. Sex differences existed in SEARCH only, with a higher rate of type 2 diabetes among females.The incidence of youth-onset type 1 and 2 diabetes was significantly different between registries. Additional data are needed to elucidate whether the differences observed represent diagnostic delay, differences in genetic susceptibility, or differences in distribution of risk factors.CONCLUSIONThe incidence of youth-onset type 1 and 2 diabetes was significantly different between registries. Additional data are needed to elucidate whether the differences observed represent diagnostic delay, differences in genetic susceptibility, or differences in distribution of risk factors. Objective Incidence of youth‐onset diabetes in India has not been well described. Comparison of incidence, across diabetes registries, has the potential to inform hypotheses for risk factors. We sought to compare the incidence of diabetes in the U.S.‐based registry of youth onset diabetes (SEARCH) to the Registry of Diabetes with Young Age at Onset (YDR—Chennai and New Delhi regions) in India. Methods We harmonized data from both SEARCH and YDR to the Observational Medical Outcomes Partnership (OMOP) Common Data Model. Data were from youth registered with incident diabetes (2006‐2012). Denominators were from census and membership data. We calculated diabetes incidence by averaging the total cases across the entire follow‐up period and dividing this by the estimated census population corresponding to the source population for case ascertainment. Incidence was calculated for each of the registries and compared by type and within age and sex categories using a 2‐sided, skew‐corrected inverted score test. Results Incidence of type 1 was higher in SEARCH (21.2 cases/100 000 [95% CI: 19.9, 22.5]) than YDR (4.9 cases/100 000 [95% CI: 4.3, 5.6]). Incidence of type 2 diabetes was also higher in SEARCH (5.9 cases/100 000 [95% CI: 5.3, 6.6] in SEARCH vs 0.5/cases/100 000 [95% CI: 0.3, 0.7] in YDR). The age distribution of incident type 1 diabetes cases was similar across registries, whereas type 2 diabetes incidence was higher at an earlier age in SEARCH. Sex differences existed in SEARCH only, with a higher rate of type 2 diabetes among females. Conclusion The incidence of youth‐onset type 1 and 2 diabetes was significantly different between registries. Additional data are needed to elucidate whether the differences observed represent diagnostic delay, differences in genetic susceptibility, or differences in distribution of risk factors. Incidence of youth-onset diabetes in India has not been well described. Comparison of incidence, across diabetes registries, has the potential to inform hypotheses for risk factors. We sought to compare the incidence of diabetes in the U.S.-based registry of youth onset diabetes (SEARCH) to the Registry of Diabetes with Young Age at Onset (YDR-Chennai and New Delhi regions) in India. We harmonized data from both SEARCH and YDR to the Observational Medical Outcomes Partnership (OMOP) Common Data Model. Data were from youth registered with incident diabetes (2006-2012). Denominators were from census and membership data. We calculated diabetes incidence by averaging the total cases across the entire follow-up period and dividing this by the estimated census population corresponding to the source population for case ascertainment. Incidence was calculated for each of the registries and compared by type and within age and sex categories using a 2-sided, skew-corrected inverted score test. Incidence of type 1 was higher in SEARCH (21.2 cases/100 000 [95% CI: 19.9, 22.5]) than YDR (4.9 cases/100 000 [95% CI: 4.3, 5.6]). Incidence of type 2 diabetes was also higher in SEARCH (5.9 cases/100 000 [95% CI: 5.3, 6.6] in SEARCH vs 0.5/cases/100 000 [95% CI: 0.3, 0.7] in YDR). The age distribution of incident type 1 diabetes cases was similar across registries, whereas type 2 diabetes incidence was higher at an earlier age in SEARCH. Sex differences existed in SEARCH only, with a higher rate of type 2 diabetes among females. The incidence of youth-onset type 1 and 2 diabetes was significantly different between registries. Additional data are needed to elucidate whether the differences observed represent diagnostic delay, differences in genetic susceptibility, or differences in distribution of risk factors.
Author	Viswanathan Mohan Reshmi Chhokar Anandakumar Amutha Richard F. Hamman Komal Goel Lawrence Dolan Nikhil Tandon Toan C. Ong Pradeep A. Praveen Jean M. Lawrence Michael G. Kahn Paul Wadwa S.V. Madhu Scott P. Isom Elizabeth Mayer‐Davis Christine W. Hockett Elizabeth T. Jensen Dana A. Dabelea Ralph D'Agostino
AuthorAffiliation	6 Department of Pediatrics, University of Colorado, Aurora, CO 7 Departments of Nutrition and Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 1 Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC 10 University College of Medical Science, GTB Hospital, Delhi, India 4 Madras Diabetes Research Foundation, Chennai, India 9 Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA 5 Department of Biostatistics and Data Sciences, Wake Forest School of Medicine, Winston-Salem, NC 3 All India Institute of Medical Sciences, New Delhi, India 2 Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO 8 Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
AuthorAffiliation_xml	– name: 2 Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO – name: 4 Madras Diabetes Research Foundation, Chennai, India – name: 8 Cincinnati Children’s Hospital Medical Center, Cincinnati, OH – name: 6 Department of Pediatrics, University of Colorado, Aurora, CO – name: 9 Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA – name: 3 All India Institute of Medical Sciences, New Delhi, India – name: 5 Department of Biostatistics and Data Sciences, Wake Forest School of Medicine, Winston-Salem, NC – name: 1 Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC – name: 7 Departments of Nutrition and Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC – name: 10 University College of Medical Science, GTB Hospital, Delhi, India
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Keywords	United States descriptive epidemiology of diabetes diabetes in youth; incidence India
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Notes	Funding information Indian Council of Medical Research; National Institute of Diabetes and Digestive and Kidney Diseases, Grant/Award Number: R21DK105869‐02; Centers for Disease Control and Prevention; Public Health Foundation of India ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 ObjectType-Article-2 ObjectType-Feature-1 content type line 23 Author contributions: N.T, D.D, V.M, R.F.H and E.J.M.-D conceptualized the study and oversaw the data harmonization. C.W.H., P.P., T.C.O., S.P.I., M.G.K. and A.A. harmonized and transformed data into the common data model (OMOP). S.P.I analyzed the data. E.T.J. prepared the manuscript and provided oversight for study analyses. All authors reviewed and edited the manuscript and contributed to discussion. All authors have read and approved the final manuscript.
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PublicationPlace	Former Munksgaard
PublicationPlace_xml	– name: Former Munksgaard – name: United States – name: Hoboken
PublicationTitle	Pediatric Diabetes
PublicationTitleAlternate	Pediatr Diabetes
PublicationYear	2021
Publisher	Hindawi Limited John Wiley & Sons A/S John Wiley & Sons, Inc
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References_xml	– year: 2011 – volume: 384 start-page: 766 issue: 9945 year: 2014 article-title: Global, regional, and national prevalence of overweight and obesity in children and adults during 1980‐2013: a systematic analysis for the global burden of disease study 2013 publication-title: Lancet – volume: 19 start-page: 630 issue: 4 year: 2018 end-page: 636 article-title: Incidence and prevalence trends of youth‐onset type 2 diabetes in a cohort of Canadian youth: 2002‐2013 publication-title: Pediatr Diabetes – volume: 3 start-page: 1004 issue: 12 year: 2015 end-page: 1016 article-title: Type 2 diabetes in migrant south Asians: mechanisms, mitigation, and management publication-title: Lancet Diabetes Endocrinol – volume: 17 start-page: 44 issue: 1 year: 2016 end-page: 52 article-title: Increasing trends in the incidence and prevalence rates of type 1 diabetes among children and adolescents in The Netherlands publication-title: Pediatr Diabetes – volume: 6 start-page: 979 issue: 12 year: 2018 end-page: 991 article-title: Clinical management of type 2 diabetes in South Asia publication-title: Lancet Diabetes Endocrinol – volume: 31 start-page: 470 issue: 3 year: 2008 end-page: 475 article-title: Breast‐feeding and type 2 diabetes in the youth of three ethnic groups: the SEARCh for diabetes in youth case‐control study publication-title: Diabetes Care – volume: 376 start-page: 1419 issue: 15 year: 2017 end-page: 1429 article-title: Incidence trends of type 1 and type 2 diabetes among youths, 2002‐2012 publication-title: N Engl J Med – volume: 23 start-page: 759 issue: 6 year: 2000 end-page: 764 article-title: Capture‐recapture method in the epidemiology of type 2 diabetes: a contribution from the Verona diabetes study publication-title: Diabetes Care – volume: 357 year: 2017 article-title: Diabetes, cardiovascular disease, and chronic kidney disease in South Asia: current status and future directions publication-title: BMJ – volume: 19 start-page: 130 issue: 2 year: 2002 end-page: 135 article-title: Impact of poverty on the prevalence of diabetes and its complications in urban southern India publication-title: Diabet Med – volume: 34 start-page: 652 issue: 3 year: 2011 end-page: 654 article-title: Rising rates of all types of diabetes in south Asian and non‐south Asian children and young people aged 0‐29 years in West Yorkshire, U.K., 1991‐2006 publication-title: Diabetes Care – volume: 19 start-page: 501 issue: 3 year: 2018 end-page: 505 article-title: Type 1 diabetes incidence and prevalence trends in a cohort of Canadian children and youth publication-title: Pediatr Diabetes – volume: 15 start-page: 244 issue: 3 year: 2014 end-page: 251 article-title: Metabolic risk in contemporary children is unrelated to socio‐economic status: longitudinal study of a UKurban population (EarlyBird 42) publication-title: Pediatr Diabetes – volume: 10 start-page: 1034 issue: 5 year: 2016 end-page: 1041 article-title: Registry of youth onset diabetes in India (YDR): rationale, recruitment, and current status publication-title: J Diabetes Sci Technol – volume: 21 start-page: 469 issue: 4 year: 2016 end-page: 478 article-title: Health information seeking, source trust, and culture: a comparative analysis of health information trends and needs between Guam and the United States publication-title: J Health Commun – volume: 37 start-page: 3336 issue: 12 year: 2014 end-page: 3344 article-title: The SEARCH for diabetes in youth study: rationale, findings, and future directions publication-title: Diabetes Care – volume: 22 start-page: 553 issue: 3 year: 2015 end-page: 564 article-title: Feasibility and utility of applications of the common data model to multiple, disparate observational health databases publication-title: J Am Med Inform Assoc – volume: 43 issue: 3 year: 2018 article-title: Prevalence of known risk factors for type 2 diabetes mellitus in multiethnic urban youth in Edmonton: findings from the WHY ACT NOW project publication-title: Can J Diabetes – volume: 62 issue: 3 year: 2018 article-title: Trends and cyclical variation in the incidence of childhood type 1 diabetes in 26 European centres in the 25 year period 1989‐2013: a multicentre prospective registration study publication-title: Diabetologia – volume: 37 start-page: 157 issue: 2 year: 2018 end-page: 180 article-title: Unhealthy weight in Indian families: the role of the family environment in the context of the nutrition transition publication-title: Popul Res Policy Rev – volume: 5 start-page: 427 issue: 5 year: 2004 end-page: 433 article-title: Diabetic ketoacidosis: predictors of outcome in a pediatric intensive care unit of a developing country publication-title: Pediatr Crit Care Med – ident: e_1_2_9_9_1 doi: 10.1177/1932296816645121 – ident: e_1_2_9_15_1 doi: 10.1016/S2213-8587(18)30199-2 – ident: e_1_2_9_5_1 doi: 10.1111/pedi.12232 – ident: e_1_2_9_17_1 doi: 10.1080/10810730.2015.1095822 – ident: e_1_2_9_18_1 doi: 10.1016/S2213-8587(15)00326-5 – ident: e_1_2_9_2_1 doi: 10.1111/pedi.12631 – ident: e_1_2_9_8_1 doi: 10.1016/j.jcjd.2018.10.002 – ident: e_1_2_9_10_1 doi: 10.2337/dc14-0574 – ident: e_1_2_9_3_1 doi: 10.1111/pedi.12566 – ident: e_1_2_9_16_1 doi: 10.1016/S0140-6736(14)60460-8 – ident: e_1_2_9_19_1 doi: 10.1136/bmj.j1420 – ident: e_1_2_9_7_1 doi: 10.1111/pedi.634 – ident: e_1_2_9_21_1 doi: 10.1097/01.PCC.0000137987.74235.5E – ident: e_1_2_9_4_1 doi: 10.2337/dc07-1321 – ident: e_1_2_9_12_1 doi: 10.2337/diacare.23.6.759 – ident: e_1_2_9_14_1 doi: 10.1093/jamia/ocu023 – ident: e_1_2_9_20_1 doi: 10.2337/dc10-1512 – ident: e_1_2_9_13_1 – ident: e_1_2_9_6_1 doi: 10.1007/s00125-018-4763-3 – ident: e_1_2_9_22_1 doi: 10.1046/j.1464-5491.2002.00656.x – ident: e_1_2_9_11_1 doi: 10.1056/NEJMoa1610187 – ident: e_1_2_9_23_1 doi: 10.1007/s11113-017-9455-z
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Snippet	Objective Incidence of youth‐onset diabetes in India has not been well described. Comparison of incidence, across diabetes registries, has the potential to... Incidence of youth-onset diabetes in India has not been well described. Comparison of incidence, across diabetes registries, has the potential to inform... Objective Incidence of youth‐onset diabetes in India has not been well described. Comparison of incidence, across diabetes registries, has the potential to...
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SubjectTerms	Adolescent Age Age composition Census Child Child, Preschool descriptive epidemiology of diabetes Diabetes diabetes in youth; incidence Diabetes mellitus (insulin dependent) Diabetes mellitus (non-insulin dependent) Diabetes Mellitus, Type 1 Diabetes Mellitus, Type 1 - epidemiology Diabetes Mellitus, Type 2 Diabetes Mellitus, Type 2 - epidemiology Female Humans Incidence India India - epidemiology Infant Infant, Newborn Male Registries Risk factors Sex differences United States United States - epidemiology Young Adult
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Title	Comparison of the incidence of diabetes in United States and Indian youth: An international harmonization of youth diabetes registries
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