Building Competency in Diabetes Education THE ESSENTIALS

3-36 | CHAPTER 3

• North America and Caribbean IDF Region includes USA, Mexico, Canada and 25 Caribbean countries and territories. The region has the highest prevalence of diabetes (10.8-14.5%) (48). It is estimated that 45.9 million people with diabetes age 20-79 years live in the region in 2017. Out of that number, around 17 million were undiagnosed (48). Type 1 diabetes • Approximately three-quarters of all cases of type 1 diabetes occur in patients younger than 18 years (51). • More than 28% of children and adolescents with type 1 diabetes live in Europe and more than 21% live in North America and Caribbean IDF region (48). The USA is home to the largest number of children and adolescents with type 1 diabetes 169,900 or 78.5% of the total number for the North America and Caribbean IDF Region (48). • The risk for developing type 1 diabetes is higher in children if their parents developed type 1 diabetes before the age of 11 years (52). • The risk of developing type 1 diabetes among the offspring of affected fathers is 1.5 to three times higher, as compared with the offspring of affected mothers. There is no explanation for this phenomenon (18,47): o By 20 years of age, offspring of a father with type 1 diabetes: 6.0 to 8.0% are affected (47). o Offspring of a mother with type 1 diabetes: the risk is 1.3 to 4.0% (53). o If the mother is older than 25 years at the time of the child’s birth, then the risk of developing diabetes is low (~1.3%). If the mother is younger than 25 years, the risk is higher (~4.0%) (52). • The risk of developing type 1 diabetes in identical twins, if one twin is affected: 21 to 70% (53). • The risk of developing type 1 diabetes in non-identical twins, if one twin is affected: 0 to 13% (53). Type 2 diabetes • Approximately 80 to 90% of patients who develop type 2 diabetes are obese. Measures, such as BMI, waist circumference and body fat distribution with increased abdominal adiposity are related to higher metabolic risk (24,54).