144-LB: Pediatric Type 2 Diabetes Prevalence from Real-World Data in the United States

Background: The SEARCH for Diabetes in Youth Study has provided critical insights into the epidemiology of pediatric T2D. The 2021 report estimated an annual percent change (APC) in prevalence of 4.8% between 2009 to 2017. Multi-center longitudinal cohort studies generate robust data, but are time, resource, and effort intensive. Large real-world data repositories may offer cost-effective opportunities to validate and expand on these findings.

Hypothesis: Youth-onset T2D prevalence is rising at a rate in excess of 5% per year in the US in the previous five years.

Methods: We queried the Trinetx Research Network which includes EHR data from 58 institutions with 86,487,854 total patients. We included patients <22 years of age, who had at least one incidence of an E11 ICD-10 code for T2D associated with an ambulatory, emergency room, or inpatient encounter for each calendar year from 2016 to 2021. Patients with other diabetes ICD-10 codes (E08, E09, E10, or E13) were excluded. Summary statistics of the query cohort describing sex, race and ethnicity, labs, medications, and anthopometrics were extracted from the platform. Chi-squared test for trend was used to determine statistical significance in demographic change.

Results: The mean APC in prevalence per center rose by 9.1% between 2016 to 2019 (2016: 127 cases/center, 5334 total cases; 2019: 166.2 cases/center, 7919 total cases) , but subsequently declined by 6.6% between 2019 to 2020. There was a consistent increase in the median BMI percentile over time from 2016 to 2021. The percentage of black youth diagnosed with T2D rose (from 30 to 33%, P<0.0001) whereas that of Hispanic youth was unchanged (25%, P=0.73) . The proportion of male also increased over time (P<0.0001) .

Conclusion: Real-world data from Trinetx demonstrates a rising incidence of youth-onset T2D that parallels an increase in median BMI percentile. The decrease in case rate in 2020 may be the result of decreased encounters during the Covid-19 pandemic. The rising prevalence of T2D in black youth and male gender warrants further analysis, to understand the driver behind this trend.