- Skrivarhaug T.
- Stene L.
- Drivvoll A.
- Strøm H.
- Joner G.
Incidence of type 1 diabetes in Norway among individuals aged 0–14 years between 1989 and 2012: has the incidence stopped rising? Results from the Norwegian Childhood Diabetes Registry.
- •Medline was accessed using OvidSP restricted to human studies published since 1980 and using [exp registries OR exp incidence OR exp prevalence) AND exp diabetes mellitus, insulin-dependent AND exp with the/ep [Epidemiology] sub-heading. If a country was not indexed in Medline then it was included in the search as a text word.
- •PubMed using the Boolean search terms (incidence OR prevalence) AND diabetes AND.
- •Published abstracts from recent international meetings including those in the Web of Science database were also searched.
- •The titles and abstracts of all articles were reviewed and those likely to provide incidence or prevalence rates were obtained. The reference lists of articles were also scanned to check for further relevant publications. No restrictions were placed on the language of published articles.
- •More recent studies, preferably covering periods into the 1990s.
- •Studies with widest coverage within the country.
- •Studies providing rates for the target age range of 0–14 years.
- •Studies providing sex-specific rates for the 0–4, 5–9 and 10–14 year age groups.
- Prevalence (age 5) = 5* (0–4 year incidence rate) + 0.5*(5–9 year incidence rate).
- Prevalence (age 6) = 5* (0–4 year incidence rate) + 1.5*(5–9 year incidence rate).
- Prevalence (age 7) = 5* (0–4 year incidence rate) + 2.5*(5–9 year incidence rate).
- Prevalence (age 8) = 5* (0–4 year incidence rate) + 3.5*(5–9 year incidence rate).
- Prevalence (age 9) = 5* (0–4 year incidence rate) + 4.5*(5–9 year incidence rate).
The World Factbook [Internet]. Washington DC, USA: Central Intelligence Agency. Available from: https://www.cia.gov/library/publications/the-world-factbook.
- A.Studies that were based on registers that were population based with validated ascertainment levels of 90% or more.
- B.Other studies in which population denominators were given to enable rates to be calculated (so excluding case-series and studies which used non population-based denominators).
3.1 Worldwide estimates of type 1 diabetes
|Country||Period||Region represented by the study||Cases||Completeness (%)||Quality|
|United Republic of Tanzania |
|1982–1991||Dar es Salaam||36||100||A|
|Bosnia and Herzegovina |
|1998–2010||Republic of Srpska||320||100||A|
|Bulgaria||1990–1999||Varma, West Bulgaria||924||99–100||A|
|Czech Republic |
|2004–2008||Baden-Württemberg, North Rhine-Westphalia, Saxony||5099||94–100||A|
|1990–2003||Turin, Liguria, Pavia, Modena, Trento, Firenze-Prato, Marche, Lazio, Umbria, Abruzzo, Campania, Sardinia||5180||91–99||A|
|2004||Lodzkie, Malopolskie, Podlasie, Pomorskie, Silesia, Warmia-Mazury, Podkarpackie||NA||NA||B|
|Russian Federation |
|1995–2011||Catalonia, Castlla y Leon, Castilla La Mancha, Madrid, Andalusia, Almeria, Galicia, Aragon, Canaries, Navarro||∼1500||83–100||A/B|
|United Kingdom |
|2004–2008||Leeds, Oxford, N. Ireland||2169||99||A|
|pre 1992||Alexandria, Damahour||NA||NA||B|
|Islamic Republic of Iran |
|Saudi Arabia |
|Tunisia||1990–1999||Beja, Gafsa, Kairoan, Monastir||297||NA||B|
|Antigua and Barbuda |
|1990–2010||Edmonton, Manitoba, Calgary, Prince Edward Island, Quebec, Newfoundland & Labrador||∼1200||75–100||A/B|
|United States of America |
|2002–2003||Ohio, South Carolina, Washington, Amerindian reservations, California & Hawaii||1574||87–99||A/B|
|US Virgin Islands||1990–1996||Whole country||22||NA||B|
|Argentina||1990–1999||Avellaneda, Cordoba, Corrientes, Tierra del Fuego||141||88–100||A/B|
|Colombia||1990–1999||Cali: Santafe de Bogota||76||NA; 97||A/B|
|Dominican Republic||1995–1999||Whole country||34||39–67||B|
|Puerto Rico||1990–1999||Whole country||1625||90–97||A|
|Hong Kong SAR |
|New Zealand |
|Papua New Guinea |
|Republic of Korea||1990–1991||Seoul||61||NA||B|
3.2 Incidence and prevalence
|IDF Region||Number of countries||Number of countries with incidence or prevalence rates available (%)||Population of children (0–14 years) (1000s)||Number of newly diagnosed children per year (1000s)||Number of children with type 1 diabetes (1000s)|
3.3 Regional estimates of type 1 diabetes
|Country/territory||Number of newly diagnosed children per year (1000s)||Number of children with type 1 diabetes (1000s)||Country/territory||Number of newly diagnosed children per year (1000s)||Number of children with type 1 diabetes (1000s)||Country/territory||Number of newly diagnosed children per year (1000s)||Number of children with type 1 diabetes (1000s)||Country/territory||Number of newly diagnosed children per year (1000s)||Number of children with type 1 diabetes (1000s)||Country/territory||Number of newly-diagnosed children per year (1000s)||Number of children with type 1 diabetes (1000s)|
|Cameroon||0.3||1.7||Belgium||0.3||1.9||Iraq||0.5||3.1||Costa Rica||0.01||0.1||Dem. People's Rep. of Korea||0.1||0.4|
|Cape Verde||0.00||0.03||Bosnia & Herzegovina||0.05||0.4||Islamic Republic of Iran||0.7||3.9||Cuba||0.04||0.3||Fed. States of Micronesia||0.00||0.00|
|Central African Republic||0.1||0.3||Bulgaria||0.1||0.6||Jordan||0.1||0.4||Dominican Republic||0.02||0.1||Fiji||0.00||0.01|
|Chad||0.2||1.1||Channel Islands||0.01||0.04||Kuwait||0.2||1.1||Ecuador||0.1||0.4||French Polynesia||0.00||0.00|
|Côte d’Ivoire||0.2||1.5||Cyprus||0.03||0.2||Libya||0.2||0.8||French Guiana||0.00||0.00||Hong Kong SAR||0.02||0.1|
|Dem. Rep. of Congo||0.2||1.5||Czech Republic||0.3||1.9||Morocco||0.8||4.9||Guatemala||0.4||2.4||Indonesia||0.4||2.7|
|Djibouti||0.03||0.2||Denmark||0.2||1.5||State of Palestine||0.1||0.3||Honduras||0.2||1.1||Japan||0.4||2.6|
|Eritrea||0.01||0.1||Finland||0.5||3.7||Pakistan||0.3||1.6||Panama||0.01||0.1||Lao People's Dem. Rep.||0.01||0.1|
|Gambia||0.02||0.2||Germany||2.4||16.5||Sudan||1.6||9.8||Puerto Rico||0.1||0.7||Marshall Islands||0.00||0.00|
|Ghana||0.3||1.8||Greece||0.2||1.3||Syrian Arab Republic||0.2||1.5||Uruguay||0.1||0.4||Mongolia||0.00||0.03|
|Guinea-Bissau||0.02||0.1||Iceland||0.01||0.1||United Arab Emirates||0.04||0.2||Nauru||0.00||0.00|
|Malawi||0.1||0.4||Kyrgyzstan||0.02||0.1||Anguilla||0.00||0.00||India||10.9||67.7||Papua New Guinea||0.00||0.02|
|Mali||0.2||1.3||Latvia||0.02||0.1||Antigua and Barbuda||0.00||0.00||Maldives||0.00||0.02||Philippines||1.3||7.9|
|Mauritania||0.05||0.3||Liechtenstein||0.00||0.00||Aruba||0.00||0.00||Mauritius||0.00||0.02||Republic of Korea||0.1||0.5|
|Republic of Congo||0.02||0.1||Moldova||0.03||0.2||British Virgin Islands||0.00||0.00||Thailand||0.1||0.5|
|São Tome and Principe||0.00||0.01||Netherlands||0.5||3.6||Dominica||0.00||0.01||Tonga||0.00||0.00|
|Sierra Leone||0.1||0.5||Portugal||0.2||1.5||Guyana||0.00||0.00||Viet Nam||0.1||0.8|
|South Africa||0.1||0.8||Russian Federation||2.6||16.0||Jamaica||0.02||0.1|
|Uganda||0.2||1.0||Slovakia||0.1||0.7||St Kitts & Nevis||0.00||0.00|
|United Rep. of Tanzania||0.2||0.7||Slovenia||0.04||0.3||St Lucia||0.00||0.01|
|Western Sahara||0.01||0.1||Spain||1.5||9.2||St Vincent & the Grenadines||0.00||0.00|
|Zimbabwe||0.04||0.3||Switzerland||0.2||1.1||Trinidad and Tobago||0.01||0.03|
|Tajikistan||0.04||0.2||United States of America||13.0||85.6|
|Turkey||0.6||3.8||US Virgin Islands||0.00||0.02|
|Rank||Country||(a) Incidence rate (per 100,000 population aged under 15 year)||Rank||Country||(b) Estimated new cases (1000s)|
|1||Finland||57.6||1||United States of America||13.0|
|4||Saudi Arabia||31.4||4||United Kingdom||3.1|
|5||United Kingdom||28.2||5||Russian Federation||2.6|
|8||United States of America||23.7||8||Nigeria||2.2|
3.3.2 Middle East and North Africa
3.3.4 North America Caribbean
3.3.5 South and Central America
3.3.6 South-East Asia
3.3.7 Western Pacific
- •The available incidence data sometimes covers only one small part of a large country. For example, in India incidence data were extrapolated from a study in Haryana and in the Russian Federation from a study in Moscow. Obviously there may be considerable variability within such large countries in both the distribution of risk genes and environmental exposures such as climate and lifestyle-related factors.
- •For some countries where extrapolation of incidence rates was necessary the choice had to be made between countries whose reported rates were very different, possibly on occasions because they were based on small datasets. Where possible characteristics of the countries were taken into account in making the choice.
- •The need for extrapolation was most evident in the African continent, particularly in sub-Saharan Africa. Here rates from undesirably small, dated and unreliable datasets have had to be used in extrapolations because of the lack of published studies.
- •Another problem was the need to make extrapolations involving isolated island populations such as in Polynesia where both genetic predisposition and lifestyle habits may be very different. The danger inherent in such extrapolations is clear from recent publications of island populations that have very different rates compared with their mainland neighbours: Crete has a lower rate than mainland Greece [], Newfoundland has a higher rate than other parts of Canada [] and Sardinia has a higher rate than peninsular Italy [].
- •Of the reports on childhood type 1 diabetes rates used in this edition, only one-third relate to periods since 2000 with all but a few of the remainder relating to periods starting in the 1990s. Given that a rising incidence has been documented in many countries, it is likely that this will result in the underestimation of numbers, particularly for those countries whose estimates rely on rates from older reports.
- •Many cases in sub-Saharan Africa, and quite possibly also in some countries in South-East Asia and the Americas likely die undiagnosed. Rwiza et al. [] showed that in Tanzania diagnosis of diabetes was very frequently missed at first (only 39.4% correct), with diagnostic rates increasing steadily at each level of the health system. Even on admission to the ward the diagnosis was only accurate in 77.1% of cases. This and numerous other anecdotal reports show that diabetes (particularly diabetic ketoacidosis) is frequently misdiagnosed as malaria, gastroenteritis, typhoid, pnuemonia, meningitis, HIV/AIDS, malnutrition and other disorders. The authors believe that many die undiagnosed, particularly in rural areas. This will affect some incidence studies, potentially leading to an underestimate of true incidence.
- •There is a lack of data on mortality rates among children already diagnosed with diabetes in most populations. In less developed countries, in which mortality could have a significant impact, the disease rates were often based on such small numbers of cases or on extrapolation so that the application of an adjustment to incidence data to allow for mortality was not thought to be justified.
- •In sub-Saharan Africa mortality among children with diabetes has frequently been reported to be high [11,12,82,83,84,85,86]. Most of these papers are from leading centres in these countries and so it is likely that mortality rates are even higher overall. Reasons for the high mortality are – misdiagnosis as another condition, lack of access to or unaffordability of insulin, blood glucose monitoring and diabetes education; limited health professional experience with type 1 diabetes in children; distance from clinics; and other factors. Programmatic data from the International Diabetes Federation Life for a Child Programme suggest that the prevalences calculated are far higher than actual numbers in many countries, particularly when support is first commenced. Therefore it is very likely that actual prevalence numbers in sub-Saharan Africa are substantially lower than the estimates in this publication. Further studies are needed to gather reliable information for improving the estimates in these regions.
4.1 Time trends
4.2 Potential risk factors
4.3 Type 2 diabetes in youth
5. Monogenic diabetes
- Gilliam L.K.
- Pihoker C.
- Ellard S.
- Hattersley A.T.
- Dabelea D.
- Davis C.
- et al.
- Gilliam L.K.
- Pihoker C.
- Ellard S.
- Hattersley A.T.
- Dabelea D.
- Davis C.
- et al.
Conflict of interest
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