Risk factors for diabetes mellitus (Dm) In american indian children and adolescents: Types 2 and 3

PURPOSE: Type 2 diabetes mellitus (DM) has increased dramatically in children and adolescents during the last two decades, especially among American Indians where DM is highly prevalent in the adult population. Risk factors specific to children as well as clinical knowledge about children with non-insulin dependent DM are limited. METHODS: A case-control study was conducted with the assistance of the tribal clinical network and the Oklahoma City Area Indian Health Service; 121 cases (66 boys and 55 girls) were found consisting of 99 Type 2 and 22 Type 3 DM cases. Type 3 shares some features of both Types 1 and 2 DM. Frequency matching by age and facility at birth was used to randomly select 121 controls. Medical and maternal birth records of cases and controls were abstracted. RESULTS: Mean age of DM onset was 12.3 years. Body mass index (BMI) was significantly higher in cases than in controls (32.3 vs. 26.4, P = .002). Mean weight at onset of DM was significantly higher for patients with Type 2 (188 lbs) vs Type 3 DM (121 lbs) [p = .001]. Mean fasting blood glucose at diagnosis was very high, but higher in individuals with Type 3 (539 mg/dl) vs Type 2 DM (411 mg/dl) [p = .003]. Bottle feeding, excessive maternal weight gain during pregnancy, early childhood excessive weight gain and higher birth order were all found to be associated with Type 2 and Type 3 DM. CONCLUSION: Improved surveillance as well as clinical and community-based interventions are needed to address the diabetes epidemic in young American Indians.