title: Obesity at the onset of diabetes in an ethnically diverse population of children: what does it mean for epidemiologists and clinicians?
abstract: OBJECTIVE
  It is often difficult to determine the pathophysiology of childhood diabetes at onset, particularly in overweight children, because obesity has been associated with both type 1 and type 2 diabetes. We compared children at the diagnosis of diabetes in a multiethnic population-based registry to understand the epidemiology of the disease during a time of rapidly changing diagnostic and treatment norms.
  
  
  METHODS
  Incident diabetes was ascertained in Chicagoans who were aged 0 to 17 years from 1985 to 2001. We classified as type 2 those with polycystic ovary syndrome, acanthosis, or a physician's note indicating type 2 or those who reported subsequent use of oral agents (n = 203); 73% of them were also obese. Patients with obesity at onset but no other indicator of possible type 2 (n = 197) were classified as having obesity-related/undetermined type. The remaining 842 cases were classified as type 1. Logistic regression analyses were conducted.
  
  
  RESULTS
  Fully 32% of cases were classified as non-type 1, including 37% of non-Hispanic blacks, 30% of Latinos, and 14% of non-Hispanic whites. The proportion of obesity-undetermined and type 2 increased over the 17 years. Comparing the 3 patient groups, type 2 cases were more often female, non-Hispanic black, and older and had a first-degree diabetic relative, whereas Latino boys were overrepresented among the obese/undetermined.
  
  
  CONCLUSIONS
  Obesity is prevalent in youths with newly diagnosed diabetes, particularly during recent years. The growth in non-type 1 diabetes in children since 1985 likely reflects both a true increase and greater physician awareness of the possibility that type 2 diabetes may occur in children.
authors.affiliation: Department of Pediatrics, University of Chicago, Chicago, Illinois, USA. lipton@uchicago.edu
authors.forename: Rebecca B
authors.initials: RB
authors.lastname: Lipton
authors.forename: Melinda
authors.initials: M
authors.lastname: Drum
authors.forename: Deborah
authors.initials: D
authors.lastname: Burnet
authors.forename: Barry
authors.initials: B
authors.lastname: Rich
authors.forename: Andrew
authors.initials: A
authors.lastname: Cooper
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Baumann
authors.forename: William
authors.initials: W
authors.lastname: Hagopian
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D044383:Black People; D002641:Chicago / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000175:diagnosis / Q000208:ethnology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis / Q000208:ethnology*; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D007223:Infant; D016015:Logistic Models; D008297:Male; D009765:Obesity / Q000150:complications* / Q000208:ethnology; D012042:Registries; D012959:Socioeconomic Factors; D001741:Black or African American