The Rise of Childhood Type 1 Diabetes in the 20th Century

Edwin A.M. Gale

Disclosures

Diabetes. 2002;51(12) 

In This Article

How Common Was Childhood Diabetes Before Insulin?

In the absence of epidemiological studies, the only sources available to us are clinic series and mortality statistics. The reported death rate from diabetes for children under 15 years of age was 1.3/100,000/year in the U.S. in 1890, as compared with 3.1/100,000/year in 1920[6]. These results are comparable with those for Denmark, with estimates rounded to 2/100,000/year under age 15 years for 1905-1909 and 4/100,000/year for 1915-1919[13]. Data for Norway can be derived from Gundersen[14] and suggest an incidence rising from 2 to 7/100,000/year over the period 1900-1920.

Clinic series are less helpful, since they typically describe the percentage of referrals in each age category. By 1922, Joslin was able to report that 366 (14%) patients in his personal series had been diagnosed in the first two decades of life, with 149 presenting in the first decade. He also comments that the proportion of children in his caseload was rising, although this may have been due to his special interest in the condition, which was readily passed on by other physicians because of the "general feeling of the hopelessness of the disease in children." Other series quoted by Joslin give a much lower proportion of children under the age of 10 years, ranging from 0.5 to 1.4% of the total, and one Japanese series of 680 patients contained no children at all. His view was that "the increase in the percentage of cases in the first decade as compared with a generation ago speaks emphatically in favor of the better diagnostic methods of today rather than of actual increase in the frequency of the disease"[6], and at this remove of time we must rest content with this conclusion.

We may therefore conclude from this limited evidence that childhood diabetes terminating in ketoacidosis was uncommon but well recognized in the decades before insulin, that mortality statistics show an increasing incidence over the first two decades of the century, probably due to greater awareness of the condition, and that mortality statistics from the U.S., Denmark, and Norway suggest an incidence range of 2-7/100,000/year under age 15 years for the period 1900-1920.

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