Type 1 Diabetes Incidence Set to Double in 20 Years in Europe

Becky McCall

November 28, 2018

The incidence of type 1 diabetes in Europe is continuing to increase at an average rate of around 3% per year in children up to 14 years of age, shows a 25-year study.

These new findings have prompted a call for even greater improvements in disease management and services to cope with the growing demand of people with type 1 diabetes.

Writing in in this week's edition of Diabetologia, the authors, led by Chris Patterson, PhD, Centre for Public Health, Queen's University Belfast, United Kingdom, suggest, "a doubling in incidence rate within approximately 20 years in Europe."

"Despite current efforts to prevent type 1 diabetes, or at least delay its onset, we must prepare for increasing numbers of children across Europe being affected," Patterson told Medscape Medical News.

"Improved insulin delivery methods should help get better control of blood sugar levels and so reduce diabetes-related complications and deaths, but dedicated staff will be needed to educate, train, and motivate these children if they are to get the best results."

Other findings included a significant 4-year cycle in incidence rate that was only observed in four of the total of 26 centers, and a possible leveling off, or very marginal reduction in incidence, in a few high-incidence countries.

Dataset of 84,000 Children Analyzed

The EURODIAB registry provides data on newly diagnosed individuals with type 1 diabetes in geographically defined regions across a 25-year period.

Between 1989 and 2013, age- and sex-standardized incidence rates for physician-diagnosed type 1 diabetes of 84,000 children aged 0 to 14 years were reported for 22 countries.

Statistical analyses estimated rates of incidence increase and tested for cyclical patterns. Separate estimates of incidence rate increases were derived for each of five subperiods (1989-1993; 1994-1998; 1999-2003; 2004-2008; 2009-2013).

The authors report that "despite some high-risk countries showing some slowing in the rate of increase in recent years, the overall pattern is still one of an approximately 3% per year increase, although with a possible temporary slowing in the 2004-2008 period."

Of note, the analysis showed that a few specific centers did not reflect the overall trend of an increasing incidence (3.4% per year pooled across all centers).

In particular, high-incidence countries, including Finland and two centers in the United Kingdom, have shown the possible start of a trend for the rate of increase to level off in recent years.

Specifically, the incidence rate per 100,000 person-years was 63.3 in 2004-2008, dropping to 60.9 in 2009-2013 in Finland; 25.2 to 22.8 in Oxford, UK; and 34.2 to 34.4 in Northern Ireland over the same time period.

However, Patterson is cautious on this point and highlights that these statistics provide insufficient evidence to draw any conclusions yet as to whether the rise in incidence of type 1 diabetes in children is leveling off in these regions. 

"We need to keep monitoring incidence to find out," he remarked.

Steadily Increasing Numbers of Kids Diagnosed With Type 1 Diabetes

In contrast, "Despite evidence from certain parts of Europe that the rise in incidence may be leveling off, there are other parts of Europe where incidence rates continue to rise," Patterson stressed.

One center in Poland (out of 26 centers across Europe) showed a maximum rate of increase of 6.6% per year, and a center in Catalonia, Spain showed the lowest increase, of 0.5% per year.

"The steadily increasing number of children being diagnosed with this chronic disease, which is associated with well-documented, life-long increases in morbidity and mortality, has important implications for those planning and delivering healthcare," say Patterson and colleagues in a Diabetologia press release accompanying the article.

"The limited success in identifying either environmental causes or gene–environment interactions that could eventually lead to disease prevention means that efforts must continue to improve quality of care to help reduce long-term complications and diabetes-related deaths."

Age-standardized rates of increase were also assessed by sex, and there was no difference between genders for the 0 to 4 years age group or 5 to 9 years age group.

However, rates of increase were higher in boys than girls in the 10 to 14 years age group (3.3% and 2.6% per year, respectively).

Four-Year Cycles

Four centers (North Rhine-Westphalia, Germany; Saxony, Germany; Switzerland; and Oxford, UK) showed support for a 4-year cyclical pattern of incidence; however, there was no clear rationale proposed for these periodic patterns, as Patterson explained when asked by Medscape Medical News.

"Although the findings on cyclical variation are interesting, they must be interpreted with a good deal of caution in the absence of any plausible hypothesis to explain them," he said.

In the article, the authors write that, to their knowledge, "no climatological factor, viral infection, or other environmental exposure has yet been firmly established that exhibits such a cyclical pattern."

"Since autoimmunity and progressive beta-cell destruction typically start long before the clinical diagnosis of type 1 diabetes, the periodicity in diagnosis could be indicative of cycles of infectious disease that accelerate the diagnosis rather than initiate the disease," they hypothesize.

The researchers add that it is unclear why only a small proportion of the 26 centers showed this periodicity and "that it may have more localized origins."

"What determines this localization remains enigmatic, as cyclical patterns were absent in Austria, the Czech Republic, and Germany–Baden Württemberg, three large registers each with neighboring areas where pronounced cyclical patterns were noted," they conclude.

The authors have reported no relevant financial relationships.

Diabetologia. Published November 28, 2018. Full text

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