The Many Faces of Diabetes in American Youth: Type 1 and Type 2 Diabetes in Five Race and Ethnic Populations: The SEARCH for Diabetes in Youth Study

D iabetes, a leading cause of nephropathy, retinopathy, neuropathy, and coronary and peripheral vascular disease, is the third most prevalent severe chronic disease of childhood in the U.S. (1). People with diabetes diagnosed before the age of 20 years have a life expectancy that is 15–27 years shorter than people without diabetes (1), although prospective data show improvements in mortality for those diagnosed in more recent years (2). Until only a decade ago, diabetes diagnosed in children and adolescents was almost entirely considered to be type 1 diabetes, most often due to the autoimmune destruction of the -cells of the pancreas leading to an absolute deficiency of insulin. Diabetes in children and adolescents is now viewed as a complex disorder with heterogeneity in its pathogenesis, clinical presentation, and clinical outcome. The occurrence of what appears clinically to be type 2 diabetes in youth, particularly overweight minority youth, has been documented in several studies. The SEARCH for Diabetes in Youth Study, funded by the Centers for Disease Control and Prevention, Division of Diabetes Translation, with support from the National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, began in 2000 with an overarching objective to describe childhood diabetes as it occurs among the five major race and ethnic groups in the U.S. These groups include non-Hispanic white, Hispanic, Asian/Pacific Islander, African American, and American Indian. Key aims of the study with a focus on race and ethnicity are the following: