Hughes,+B

__**Type 2 Diabetes Mellitus (DM) and Obesity**__

**Introduction**

__Background Information__  Today, 1 in 3 adults and 1 in 5 children struggle with obesity. It is a general assumption that obesity rates have inclined over the past few decades. We have easier access to fast food, more self-sufficiency and income that allows us to consume, and a heightened need to indulge ourselves. Maybe it’s the constant bombardment we get from the media of people stuffing their faces with BigMac’s, or the social complex we carry that rewards success with gluttony that is causing obesity rates to rise. Regardless, it is more of a worldwide problem then ever before. Children and adolescents are perhaps most detrimented by obesity, with 3 times more being classified as obese since 1980. And children who are obese are more than likely to continue their excessive eating patterns as adults.

Obesity is linked to more than 60 chronic diseases, specifically type 2 diabetes. This disease occurs when the patient's immune system develops a resistance to its own insulin. Therefore, the insulin is present but not used. The resistance often happens as a result to an overexposure to glucose in the diet (i.e., overeating that often times leads to obesity). Type 2 Diabetes is usually developed by adults, but with the increasingly sedentary, food-centered lifestyle that Americans have become accustomed to, it is now being developed by children as young as five.

__Brainstorming__

-Obesity levels (independent) vs. diabetes rate (dependent) -Obesity measures: Obesity defined by weight, body mass index (BMI) (calculated by dividing weight in kilograms by height in meters squared), and percentage of body fat. A BMI exceeding 25 considered overweight, while obesity is defined as a BMI of 30 or more. A BMI of 35 or more with serious comorbidity, or a BMI of 40 or more, is considered morbid obesity. -Risk for Diabetes measures: High risk children are overweight (BMI > or = to 85th percentiles for age and sex, weight-for-height > 85th percentile, or weight > 120% of ideal for height) If blood sugar is high, there is an increased risk for type 2 diabetes. Screening for blood sugar is measured by a fasting blood glucose (FBG) concentration. If FBG is higher than 6 then the patient is at risk. 7 and above means the patient is diabetic.

__Question__ In American children and adolescents, does obesity increase the prevalence of type 2 diabetes as shown between 1980-2000?

__Hypothesis__ I predict that yes, there will be a positive strong correlation between obesity levels and prevalence type 2 diabetes in American children and adolescents between 1980-2000.

**Presentation & Analysis of Data** __Data Collection__ ** Statistics: **
 * Prevalence of diagnosed and undiagnosed diabetes in the United States, all ages, 2007

|| Prevalence of diagnosed diabetes in people younger than 20 years of age, United States, 2007

|| Incidence of diagnosed diabetes in people younger than 20 years of age, United States, 2002– 2003

|| In Type 2 Diabetes (General) || **Diagnosed: **  17.9 million people **Undiagnosed: ** <span style="font-family: 'Times New Roman',Times,serif; font-size: 10pt;"> 5.7 million people <span style="font-family: 'Times New Roman',Times,serif;">
 * **<span style="font-family: 'Times New Roman',Times,serif;">Total: ** <span style="font-family: 'Times New Roman',Times,serif;">23.6 million people or 7.8% of the population have diabetes.

|| <span style="font-family: 'Times New Roman',Times,serif;">• About 186,300 people younger than 20 years have diabetes (type 1 or type 2). This represents 0.2% of all people in this age group.

|| <span style="font-family: 'Times New Roman',Times,serif; font-size: 10pt;">• 15,000 youth in the United States were newly diagnosed with type 1 diabetes annually, and about 3,700 youth were newly diagnosed with type 2 diabetes annually. <span style="font-family: 'Times New Roman',Times,serif;"> • The rate of new cases among youth was 19.0 per 100,000 each year for type 1 diabetes and 5.3 per 100,000 for type 2 diabetes. • Type 2 diabetes was extremely rare among youth aged <10 years. While still infrequent, rates were greater among youth aged 10–19 years compared to younger children

|| <span style="font-family: 'Times New Roman',Times,serif;">Most affected patients are overweight; more than 85% are overweight or obese at diagnosis.

||



<span style="font-family: 'Times New Roman',Times,serif; font-size: 9.9pt; font-weight: normal;">Before 1990s, type 2 DM accounted for 1-4% of all DM cases in this age group. Now, studies suggest type 2 DM represents 8-46% of all DM cases among children. //Note: positive correlation between an increase in type 2 DM and the rise in overweight trends in Figure 1.//

** || **<span style="font-family: 'Times New Roman',Times,serif; font-style: normal;">Prevalence (millions) ** <span style="font-family: 'Times New Roman',Times,serif; font-style: normal;"> || || <span style="font-family: 'Times New Roman',Times,serif; font-style: normal;">5.762 || || <span style="font-family: 'Times New Roman',Times,serif; font-style: normal;">5.807 || || <span style="font-family: 'Times New Roman',Times,serif; font-style: normal;">5.805 || || <span style="font-family: 'Times New Roman',Times,serif; font-style: normal;">5.928 || || <span style="font-family: 'Times New Roman',Times,serif; font-style: normal;">6.068 || || <span style="font-family: 'Times New Roman',Times,serif; font-style: normal;">6.382 || || <span style="font-family: 'Times New Roman',Times,serif; font-style: normal;">6.576 || || <span style="font-family: 'Times New Roman',Times,serif; font-style: normal;">6.574 || || <span style="font-family: 'Times New Roman',Times,serif; font-style: normal;">6.538 || || <span style="font-family: 'Times New Roman',Times,serif; font-style: normal;">6.386 || || <span style="font-family: 'Times New Roman',Times,serif; font-style: normal;">6.713 || || <span style="font-family: 'Times New Roman',Times,serif; font-style: normal;">7.032 || || <span style="font-family: 'Times New Roman',Times,serif; font-style: normal;">7.599 || || <span style="font-family: 'Times New Roman',Times,serif; font-style: normal;">7.805 || || <span style="font-family: 'Times New Roman',Times,serif; font-style: normal;">8.27 || || <span style="font-family: 'Times New Roman',Times,serif; font-style: normal;">8.246 || || <span style="font-family: 'Times New Roman',Times,serif; font-style: normal;">8.479 || || <span style="font-family: 'Times New Roman',Times,serif; font-style: normal;">10.295 || || <span style="font-family: 'Times New Roman',Times,serif; font-style: normal;">10.488 || || <span style="font-family: 'Times New Roman',Times,serif; font-style: normal;">11.136 || || <span style="font-family: 'Times New Roman',Times,serif; font-style: normal;">12.013 ||
 * <span style="font-family: 'Times New Roman',Times,serif; font-weight: normal;">//This chart shows the diabetes prevalence from 1980-2000.//
 * **<span style="font-family: 'Times New Roman',Times,serif; font-style: normal;">Year ** <span style="font-family: 'Times New Roman',Times,serif; font-style: normal;">
 * <span style="font-family: 'Times New Roman',Times,serif; font-style: normal;">1980
 * <span style="font-family: 'Times New Roman',Times,serif; font-style: normal;">1981
 * <span style="font-family: 'Times New Roman',Times,serif; font-style: normal;">1982
 * <span style="font-family: 'Times New Roman',Times,serif; font-style: normal;">1983
 * <span style="font-family: 'Times New Roman',Times,serif; font-style: normal;">1984
 * <span style="font-family: 'Times New Roman',Times,serif; font-style: normal;">1985
 * <span style="font-family: 'Times New Roman',Times,serif; font-style: normal;">1986
 * <span style="font-family: 'Times New Roman',Times,serif; font-style: normal;">1987
 * <span style="font-family: 'Times New Roman',Times,serif; font-style: normal;">1988
 * <span style="font-family: 'Times New Roman',Times,serif; font-style: normal;">1989
 * <span style="font-family: 'Times New Roman',Times,serif; font-style: normal;">1990
 * <span style="font-family: 'Times New Roman',Times,serif; font-style: normal;">1991
 * <span style="font-family: 'Times New Roman',Times,serif; font-style: normal;">1992
 * <span style="font-family: 'Times New Roman',Times,serif; font-style: normal;">1993
 * <span style="font-family: 'Times New Roman',Times,serif; font-style: normal;">1994
 * <span style="font-family: 'Times New Roman',Times,serif; font-style: normal;">1995
 * <span style="font-family: 'Times New Roman',Times,serif; font-style: normal;">1996
 * <span style="font-family: 'Times New Roman',Times,serif; font-style: normal;">1997
 * <span style="font-family: 'Times New Roman',Times,serif; font-style: normal;">1998
 * <span style="font-family: 'Times New Roman',Times,serif; font-style: normal;">1999
 * <span style="font-family: 'Times New Roman',Times,serif; font-style: normal;">2000

//<span style="font-family: 'Times New Roman',Times,serif;">These diagrams illustrate the similar geographical regions that have various degrees of diabetes and obesity levels. // <span style="border-collapse: collapse; font-family: 'Times New Roman',Times,serif; font-size: 13px; font-weight: normal; line-height: 19px;">//This graph compares// d <span style="border-collapse: separate; font-family: 'Times New Roman',Times,serif; font-size: 13px; font-weight: normal; line-height: 24px;">//iabetes prevalence to obesity between 1980 and 2000.// <span style="font-family: 'Times New Roman',Times,serif; font-size: 13px;"> // This data obtained from National Health and Nutrition Examination Surveys shows how different age groups are affected with obesity.
 * U.S. Prevalence of Diabetes and Obesity vs. Time**

// <span style="display: block; font-family: 'Times New Roman',Times,serif; text-align: left;"> __Data Analysis__ One Variable Data: <span style="display: block; font-family: 'Times New Roman',Times,serif; text-align: left;"> Two Variable Data: I will plot the obesity rates and Type 2 DM rate as a percentage of the population, with obesity being the independent variable, and diabetes being the dependent.
 * 1) <span style="display: block; font-family: 'Times New Roman',Times,serif; text-align: left;">Frequency of obese US children and adolescents as a percent of the population, from 1980-2000
 * 2) <span style="display: block; font-family: 'Times New Roman',Times,serif; text-align: left;">Frequency of US diabetes diagnoses, in millions from 1980-2000



Calculations for one/two variable data, as well as the correlation coefficent and line of best fit equation can be found here.



<span style="font-family: 'Times New Roman',Times,serif; font-size: 90%;">__Sampling Techniques__ <span style="font-family: 'Times New Roman',Times,serif; font-size: 9.9pt;">North American Data: Most of my data was collected through Pediatrics articles. The data includes all those diagnosed with diabetes and those classified as overweight. Since the population the articles’ spectrum covers is both Canada and the U.S., there is some measurement bias. Some of the data collected refers to North America as a whole and some specifically to the U.S. This creates a bias because Canada’s statistics can increase or decrease the North American records, creating a larger sampling pool then necessary for the purpose of this research.

<span style="font-family: 'Times New Roman',Times,serif;"> U.S. Data: The CDC's Obesity Statistics Index is a governement organization, and obtained their information on the number of Americans with diabetes by recording every member of the population who had the disease.

Stratified Sample: In the National Health and Nutrition Examination Survey (NHANES) people with common characteristics of age (under 19) qualify to be researched. These people are further divided into age groups (2-5, 6-11, 12-19) and the same proportion of people are surveyed from each stratum.

Voluntary Response Sample: Although the methods of how the NHANES collected their data are unclear, the fact that it was a survey means people had to take at least some initiative to complete it.

<span style="font-family: 'Times New Roman',Times,serif;">Bias Sampling Bias: This survey accounts for the years 1976-1980, 1988-1994, and 1999-2000, however it does not count for the time gaps in between. We are forced to estimate where those plots would be graphed, and the accuracy of the data is somewhat reduced. This could have been improved be surveying during every year.

Non-Response + Response Bias: Although the methods on how the NHANES collected their data are unclear, the fact that it was a survey means participation and cooperation was required from the people they were researching. This means people could ignore the survey completely. On sensitive issues such as obesity and diabetes, many would feel uncomfortable or ashamed, and might not answer honestly or at all. These people are underrepresented in the survey. To make these results more accurate, an anonymous survey could be sent out to all US citizens and become mandatory to be completed.

Measurement Bias: Obesity is defined as having a BMI above the 95th percentile, usually above 30. These body mass index tests are not foolproof, and many could have disproportionate height-to-weight results and be classfied in the wrong percentile.

Leading + Loaded Question: In the NHANES survey, it is unclear if they asked for the person in question’s height and weight, or just their BMI. Many people might not accurately know any of these, nor know what BMI stands for. The survey could have ranges of BMI’s in a multiple choice, which would not accurately represent the whole population. This could be fixed by having a questioner measure the person’s height/weight and record it in their age group for the survey.

<span style="display: block; font-family: 'Times New Roman',Times,serif; font-size: 12.87pt; text-align: left;">**<span style="font-family: 'Times New Roman',Times,serif;">Conclusions ** <span style="display: block; font-family: 'Times New Roman',Times,serif; font-size: 9.9pt; text-align: left;"> 2-5 increased from 5.0-10.4% doubled 6-11 increased from 6.5-15.3% doubled 12-19 increased from 5-15.5% tripled
 * <span style="font-family: 'Times New Roman',Times,serif;">I n the Obesity vs. Time (one variable) graph, from 1980-2000, ages:

In the Diabetes vs. Time graph, rates steadily increased from: 5.762 million - 12.013 million doubled ** <span style="font-family: 'Times New Roman',Times,serif;"> From looking at the graph of the two variable data I estimated a moderate-strong correlation, however when taking the average prevalence of obesity by combining the 3 age groups, the correlation becomes stronger (about .95). These results could be caused by a common factor however. An external variable could play a partial role in why these two variables change the same way. Type 2 Diabetes (known to more susceptible to people who are obese/overweight) rates could be increased/decreased as the supply of food increases/decreases. This would also increase/decrease obesity rates. For example during deflation, people generally eat out less, and during inflation people splurge on food, increasing consumption. An accidental relationship could also have occurred. Although more than 80% of people with type 2 diabetes are overweight, that still means that around 20% of people have type two without being overweight. Between 1980-2000 the rate of diabetes more than doubled, and so did obesity therefore my hypothesis, that there will be a positive strong correlation between obesity levels and prevalence of type 2 diabetes in American children and adolescents between 1980-2000 is correct. <span style="display: block; font-family: 'Times New Roman',Times,serif; text-align: center;">

__Works Cited__ Centers for Disease Control and Prevention. (2009, November 20). //U.S. Obesity Trends//. Retrieved December 7, 2009, from []

Cowell, K. (2008). Type 2 Diabetes Mellitus. //Pediatrics In Review//, //29//, 8, 289-291.

Hannon, T. S. (2005). Childhood Obesity and Type 2 Diabetes Mellitus. //Pediatrics: Official Journal of the American Academy of Pediatrics//, //116//, 473. Retrieved from []

Kaufman, F. (1997). Diabetes Mellitus. //pediatrics In Review//, //18//, 383. Retrieved December 7, 2009, from []

MacDonald, K. G. (2003). Overview of the Epidemiology of Obesity and the Early History of Procedures to Remedy Morbid Obesity. //Archives of Surgery//, //138//, 357. Retrieved December 7, 2009, from []

Nesmith, J. (2001). Type 2 Diabetes in Children and Adolescents. //Pediatrics In Review//, //22//, 147. Retrieved December 7, 2009, from []

Nicholas, W. (n.d.). //The Fast Food Freeway to Diabetes//. Retrieved December 7, 2009, from [|http://webinquiry.org/examples/diabetes/index.htm]

Pinhas-Hamiel, O., & Zeiler, P. (1998). Type 2 Diabetes in Adolescents, No Longer Rare. //Pediatrics In Review//, //19//, 434. Retrieved December 7, 2009, from []

Schneider, M. B., & Brill, S. R. (2005). //Obesity in Children and Adolescents//. Retrieved December 7, 2009, from []

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