People of Asian and Pacific Island ancestry under age 14 in Hawaii and elsewhere in the United States have three times more type 1 diabetes than Asian youths in Japan, Korea, Shanghai, Taiwan, Thailand and Singapore, a national study has found.

The reasons for the big difference are not clear, said Dr. Beatriz Rodriguez, principal investigator in Hawaii for the study, known as SEARCH for Diabetes in Youth.

Type 1 diabetes, formerly known as juvenile diabetes, is an autoimmune disorder requiring insulin for survival because the body's immune cells destroy insulin-producing cells in the pancreas.

Non-Hispanic white youths under age 20 have one of the highest type 1 diabetes rates in the world — 1 in about 4,200 youths per year, Rodriguez said. “;The rates are higher than all previous reports from the United States and many European studies.”;

Some genetic factors have been established for type 1 diabetes, and some nongenetic factors have been proposed, said Rodriguez, Pacific Health Research Institute investigator and professor in the University of Hawaii John A. Burns School of Medicine. “;But we still don't have clear evidence.”;

Type 2 diabetes, which occurs when the body develops resistance to insulin, is relatively rare among Caucasian youths, but rates still are seven times higher than those reported in European countries, she said.

Rodriguez said some viral infections and early infant diet have been proposed as possibly related to type 1 diabetes. Other factors suggested include early cessation of breast milk, early introduction of cow's milk, other infections at about the time of birth, diet and different toxins that can be found in foods, she said.

Asian youths have not been separated from Pacific Islanders in the U.S. study because many children are both, she said, adding her hope that the separation can be done as the study progresses. More than half of these youths are from Hawaii, she said.

Hawaii is one of six states with clinical centers conducting the largest surveillance of diabetes in youth ever done, in its ninth year. A series of articles presenting a comprehensive picture of diabetes in youth of five racial groups appears in a March supplement of Diabetes Care.

The study included 150 Asians, 34 Pacific Islanders and 62 mixed Asian-Pacific Islanders. Of those, 177 have type 1 diabetes and 68 have type 2.

Rodriguez said the incidence rate for type 1 among youths of Asian, Pacific Island and Asian-Pacific Islanders ancestry combined was 6.4 per 100,000 population.

Asian and Pacific Islander youths also had substantially higher rates for type 2 diabetes than reported in Japan and Taiwan — 12.1 cases per 100,000 population in the U.S., compared with 2.6 for Japan and 6.5 for Taiwan, Rodriguez said.

“;The only group showing higher rates than Asian/Pacific Islanders are American Indians,”; she noted.

Genetics, demographic and lifestyle factors are related to type 2, she said. “;We've seen type 2 diabetes occurring as we have become more Westernized, modernized and urbanized in the (Hawaiian) islands.”;

It was no surprise to find high rates of obesity and overweight associated with type 2 diabetes, she said, explaining 90 percent of Asians with the disease and 100 percent of Pacific Islanders either were overweight or obese.

But it was surprising that 34 percent of Asians and 80 percent of Pacific islanders with type 1 diabetes either were overweight or obese, she said.

She said all the Asian youths, Pacific Islanders and combined groups with type 2 diabetes had a body mass index well above the measure of 30 or greater for obesity. The average BMI for Pacific Islander youths was 42; for Asians, 34; and the combined group, 35.

Subjects sought

Children and youths under 21 are still being recruited in Hawaii for SEARCH, the largest national study ever undertaken of diabetes in youth. For more information, call Project Coordinator Fiona Kennedy, 441-5532 or 441-5511.