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A Call to Action for the CDC: Don’t Treat Diabetes as One Disease

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Earlier this month, the CDC published a statement that had a lot of people talking. The data reported the number of new cases of diabetes decreased from 2009 to 2014. What many of us have found so frustrating is that the CDC doesn’t distinguish between type 1 and type 2, and in fact, type 1 is on the rise. The Glu team worked with our Chief Medical Officer, Dr. Henry Anhalt, and Executive Director/Founder Dana Ball to respond in a statement of their own:

T1D Exchange, a nonprofit focused on driving better, faster research to improve care and speed development of new therapies for people and families living with type 1 diabetes, calls upon the Centers for Disease Control (CDC) to clarify its recent statement about a significant decrease in the incidence of new cases of diabetes from 2009-2014.

Strikingly absent from the CDC statement was the statistical breakdown by diabetes types. In particular, the report comingled data collected from people living with type 2 diabetes and people living with type 1 diabetes.

Comingling of the data, particularly from the leading national public health institute of the United States, perpetuates the myth that diabetes is one disease sharing a name, while the reality is that type 1 and type 2 diabetes are actually two different diseases in the diabetes family. Among key differences is that unlike type 2 diabetes, type 1 diabetes is not lifestyle-dependent; it is the result of relentless autoimmune destruction of the insulin-producing cells of the pancreas. Once insulin cells are destroyed, individuals spend their lifetime closely monitoring blood sugars and dosing insulin in an attempt to mimic the function of the pancreas. Type 2 diabetes is a metabolic disease with many confounding factors including genetics, diet, activity and weight; it can be managed by oral medications and lifestyle changes.   Type 1 and type 2 diabetes require very different approaches to clinical care; each also requires different models for research and development programs.

Another difference among type 2 and type 1 diabetes; while the CDC reports a significant decrease in the incidence of new cases of type 2 diabetes, all measures show that type 1 diabetes is actually on the rise (see the data at the end of this statement).

Type 1 diabetes (also known as autoimmune diabetes) represents only approximately 5% of the total number of people living with diabetes, yet it is a very complex, demanding disease that represents a huge burden to those living with it. Among the challenges:

  • most people with type 1 diabetes cannot achieve good glycemic control as recommended by the American Diabetes Association
  • there are significant financial burdens for people living with type 1 diabetes
  • there is difficulty accessing specialized clinical care, which complicates and threatens the health outcomes of individuals affected by type 1

The type 1 diabetes community is a community in need—in need of more awareness, more research funding, more clinical specialists and better outcomes. Yet by treating type 1 diabetes the same as type 2 diabetes, the CDC is not only spreading confusion, it is also adding to the discrimination and isolation that both children and adults living with type 1 diabetes frequently experience—in school, the workplace and in social environments. This “one size fits all approach” can also have far-reaching implications on public policy, biomedical research funding, and access to care.

We call on the CDC to issue a clarifying statement. It’s also time to demonstrate in action that diabetes is more than one disease through the practice of data collection, analysis, and dissemination.

This community is faced with many real burdens.  A fundamental lack of awareness about type 1 diabetes shouldn’t be one of them.

Dana Ball
Executive Director and Founder
T1D Exchange

Henry Anhalt, DO
Chief Medical Officer
T1D Exchange

Data Points to a Rise in Type 1 Diabetes

While there is no current data set on type 1 diabetes in the United States, data from recent type 1 diabetes specific research shows type 1 is on the rise.

International Diabetes Federation: The most recent data about type 1 incidence is from the International Diabetes Federation’s (IDF) Seventh Atlas (2015), which demonstrates a 9% increase from data presented in the IDF’s Sixth Atlas ( 2013).

IDF most recently reports that worldwide, in children ages 0-14 years there are:

  • 542,000 children have type 1 diabetes(2015), compared with 497,100 (2013)
  • 86,000 new cases (2015) compared with 79,100 new cases (2013).

One limitation to the data set is the lack of reporting on adults with type 1 diabetes, however it is likely that the same phenomenon is occurring in adults.

SEARCH for Diabetes in Youth: The incidence of type 1 diabetes in children has been increasing by 3% to 5% per year worldwide since the 1960s 1–4. SEARCH for Diabetes in Youth, a multicenter study funded by CDC and NIH to examine diabetes (type 1 and type 2) among children and adolescents in the United States reported that between 2002–2005, 15,600 youth were newly diagnosed with type 1 diabetes, and 3,600 youth were newly diagnosed with type 2 diabetes annually.5

  • In 2001, 4958 of 3.3 million youth were diagnosed with type 1 diabetes for a prevalence of 1.48 per 1000 (95% CI, 1.44-1.52).
  • In 2009, 6,666 of 3.4 million youth were diagnosed with type 1 diabetes for a prevalence of 1.93 per 1000 (95% CI, 1.88-1.97).
    • In 2009, the highest prevalence of type 1 diabetes was 2.55 per 1000 among white youth (95% CI, 2.48-2.62)
    • The lowest was 0.35 per 1000 in American Indian youth (95% CI, 0.26-0.47)
    • Type 1 diabetes increased between 2001 and 2009 in all sex, age, and race/ethnic subgroups except for those with the lowest prevalence (age 0-4 years and American Indians). Adjusted for completeness of ascertainment, there was a 21.1% rise (95% CI, 15.6%-27.0%).

The following chart depicts the data visually:

T1DX DX DATA 4502015

REFERENCES

  1. Diabetes Epidemiology Research International Group Secular trends in incidence of childhood IDDM in 10 countries. Diabetes. 1990;39:858–864. doi: 10.2337/diabetes.39.7.858. [PubMed] [Cross Ref]
  2. The Diamond Project Group Incidence and trends of childhood T1DM worldwide 1990–1999. Diabet Med. 2006;23:857–866. doi: 10.1111/j.1464-5491.2006.01925.x. [PubMed] [Cross Ref]
  3. EURODIAB ACE Study Group Variation and trends in incidence of childhood diabetes in Europe. Lancet. 2000;335:873–876. [PubMed]
  4. Patterson CC, Dahlquist GG, Gyürüs E, et al. Incidence trends for childhood type 1 diabetes in Europe during 1989–2003 and predicted new cases 2005–20: a multicentre prospective registration study. Lancet. 2009;373:2027–2033. doi: 10.1016/S0140-6736(09)60568-7. [PubMed] [Cross Ref]
  5. Dabelea D, Mayer-Davis E, et al. Prevalence of Type 1 and Type 2 Diabetes Among Children and Adolescents From 2001 to 2009. JAMA. 2014;311(17):1778-1786. doi:10.1001/jama.2014.3201.
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