Variation in the incidence of type 1 diabetes mellitus in children and adolescents by world region and country income group: A scoping review

Contextualization of Diabetes: A Review of Reviews from Organisation for Economic Co-operation and Development (OECD) Countries

PURPOSE OF REVIEW

The prevalence of diabetes is rising around the world and represents an important public health concern. Unlike individual-level risk and protective factors related to the etiology of diabetes, contextual risk factors have been much less studied. Identification of contextual factors related to the risk of type 1 and type 2 diabetes in Organisation for Economic Co-operation and Development (OECD) countries may help health professionals, researchers, and policymakers to improve surveillance, develop policies and programs, and allocate funding.

RECENT FINDINGS

Among 4,470 potential articles, 48 were included in this review. All reviews were published in English between 2005 and 2023 and were conducted in over 20 different countries. This review identified ten upstream contextual risk factors related to type 1 and type 2 diabetes risk, including income, employment, education, immigration, race/ethnicity, geography, rural/urban status, built environment, environmental pollution, and food security/environment. The ten upstream contextual risk factors identified this review may be integrated into diabetes research, surveillance and prevention activities to help promote better outcomes for people at risk or living with diabetes in OECD countries. Additional research is needed to better quantify the measures of associations between emerging key contextual factors and diabetes outcomes.

Examining the growing challenge: Prevalence of diabetes in young adults (Review)

Diabetes is rapidly spreading worldwide, affecting millions of individuals. Therefore, it is crucial to have a comprehensive understanding of its complications. The present review discusses the complex subject of diabetes, including the type 1 and type 2 variants. Geographical and population differences highlight the importance of targeted therapies and personalized management strategies. Ongoing research aims to identify the causes and treatment strategies for this disease. Preventive interventions, lifestyle changes and public awareness campaigns are all vital components of diabetes management. Collaboration between the general public and health departments is essential for effective prevention. Early intervention and global management strategies are necessary to reduce the significant impact on healthcare systems. A comprehensive plan from health care departments is required to address the issues caused by diabetes and minimize its effects on individuals and communities worldwide. The present review outlines specific measures which can be used to combat the spread of diabetes for a healthier future world.

Increasing trend of childhood type 1 diabetes incidence: 20-year observation from Greater Poland Province, Poland

AIM

Type 1 diabetes is one of the fastest-growing chronic health conditions. Estimating the incidence rate of childhood type 1 diabetes will allow to aid in adequate planning of health care resources. The study's aim was to assess the incidence rate of type 1 diabetes in children below 15 years of age from Greater Poland (Poland) between 2006 and 2018, and then to compare obtained data to records collected between 1998 and 2003 in pediatric population aged 0-14 years from the same area.

METHODS

In this cohort study covering the period from January 1998 to December 2018, data were collected for children and adolescents below 14 years of age with newly diagnosed type 1 diabetes living in Greater Poland. The overall population size was taken from the Statistical Office of Poland. Total, sex-, and age-specific incidence rates per 100,000 person-years were calculated for each calendar year.

RESULTS

Over a 20-year period, the incidence rate of type 1 diabetes in children aged 0-14 years rose around 3.6-fold, from 8.4/100,000 in 1998 to 30.8/100,000 in 2018, with the peak incidence recorded in last year of the study. A clear male predominance of type 1 diabetes was seen in all ages. The rate of type 1 diabetes incidence growth was comparable between all age groups, while the highest incidence rate was mostly observed in children aged 5-9 and 10-14 years.

CONCLUSIONS

The incidence of type 1 diabetes in children aged 0-14 years is rapidly increasing in Greater Poland.

Predictive markers of early endothelial dysregulation in type-1 diabetes: a meta-analysis

BACKGROUND

This study identifies a new set of salient risk factors that may trigger danger signals of vascular dysregulation in T1D. Vascular abnormalities and impairment of CVD is a major adverse effect of T1D, particularly affecting children, adolescents and young adults.

METHODS

The patients of T1D were compared with the healthy control (HC) for the risk factors of vascular dysregulation in published studies from year 2013 to 2023. The PubMed, Web of Science and Google Scholar databases were searched from 1/1/2013 to 1/9/2023. The risk of bias was assessed with the Cochrane (ROBINS-I ) tool, relevant to clinical subjects. A random effects model was followed and analysed by RevMan 5.4 and GraphPad Prism software.

RESULTS

80 relevant case-control studies having 7492 T1D patients and 5293 HC were included. The age and sex-matched HC consisted of persons free of disease and not under any medication while clinical subjects of < 40 years were included. 28 risk factors were grouped into six primary outcome models, all of which favoured the T1D synonymous with a high risk of CVD.

CONCLUSION

Our findings have strong implications for improving the quality of life and health economics related to vascular disease in T1D. HbA1c% is the most effective biomarker, followed by FBG, LDL-c, AI%, sICAM-1, and FMD% which could be evaluated with a simple blood test or non-invasive techniques. These may serve dual purposes as biomarkers of rapid diagnosis that could offer prospective tailor-made therapeutics for T1D. (Protocol registered at https://www.crd.york.ac.uk/prospero/CRD42022384636 ).

Epidemiological assessment of diabetes mellitus in children of Ukraine during the last 20 years (2002-2021) of peacetime

Objectives

Nowadays, there is a global trend towards an increase in the prevalence and incidence of diabetes mellitus, including among children, which is a significant health problem in many countries. The analysis of data on diabetes among children is important for training medical personnel and planning preventive measures. The aim is to determine the trends in the prevalence and incidence of diabetes mellitus, as well as the gender and age structure among the paediatric population of different regions of Ukraine over the last 20 years (2002-2021) of peacetime.

Methods

The results of statistical evaluation and epidemiological analysis of the data of the Centre for Medical Statistics of the Ministry of Health of Ukraine on the prevalence and incidence of diabetes mellitus among children during 2002-2021 are presented. Statistical processing of the results was carried out using MS Excel (Microsoft Corporation, USA), XLSTAT-Pro (Addinsoft, USA).

Results

According to the Ministry of Health of Ukraine, as of 2021, 11,193 children aged 0-17 years inclusive with diabetes mellitus were registered, which is 15.0 cases per 10 thousand of the relevant population. Compared to 2002, the prevalence and incidence rates increased by 93% and 80%, respectively; the fastest rates were among children aged 0-6 years, and the lowest among adolescents aged 15-17 years. In 2021, the highest incidence of diabetes among infants over the past 15 years was recorded (0.05 per 1000 of the relevant population).

Conclusions

In Ukraine, over the past 20 years (2002-2021) of peacetime, there has been an annual gradual increase in the prevalence and incidence of diabetes mellitus among children in all age groups with gender balance, which generally corresponds to the global trend.

TNF-α inhibitors for type 1 diabetes: exploring the path to a pivotal clinical trial

Type 1 diabetes (T1D) is an autoimmune disease characterized by the destruction of insulin-producing β-cells in the pancreas. This destruction leads to chronic hyperglycemia, necessitating lifelong insulin therapy to manage blood glucose levels. Typically diagnosed in children and young adults, T1D can, however, occur at any age. Ongoing research aims to uncover the precise mechanisms underlying T1D and to develop potential interventions. These include efforts to modulate the immune system, regenerate β-cells, and create advanced insulin delivery systems. Emerging therapies, such as closed-loop insulin pumps, stem cell-derived β-cell replacement and disease-modifying therapies (DMTs), offer hope for improving the quality of life for individuals with T1D and potentially moving towards a cure. Currently, there are no disease-modifying therapies approved for stage 3 T1D. Preserving β-cell function in stage 3 T1D is associated with better clinical outcomes, including lower HbA1c and decreased risk of hypoglycemia, neuropathy, and retinopathy. Tumor Necrosis Factor alpha (TNF-α) inhibitors have demonstrated efficacy at preserving β-cell function by measurement of C-peptide in two clinical trials in people with stage 3 T1D. However, TNF-α inhibitors have yet to be evaluated in a pivotal trial for T1D. To address the promising clinical findings of TNF-α inhibitors in T1D, Breakthrough T1D convened a panel of key opinion leaders (KOLs) in the field. The workshop aimed to outline an optimal clinical path for moving TNF-α inhibitors to a pivotal clinical trial in T1D. Here, we summarize the evidence for the beneficial use of TNF-α inhibitors in T1D and considerations for strategies collectively identified to advance TNF-α inhibitors beyond phase 2 clinical studies for stage 3 T1D.

Early-Life Factors Associated With Adult-Onset Type 1 Diabetes: A Swedish Nationwide Cohort and Family-Based Study

OBJECTIVE

Childhood-onset type 1 diabetes (T1D) is associated with perinatal factors, but data related to adult-onset T1D are scarce. This study aimed at investigating the association between early-life factors and adult-onset T1D in a Swedish nationwide cohort and family-based study.

RESEARCH DESIGN AND METHODS

We included 1,813,415 individuals aged ≥18 years, born in Sweden 1983 to 2002, followed until 2020. T1D diagnosis (n = 3,283) was identified from the National Diabetes, Patient and Prescribed Drugs Registers, and perinatal exposures were obtained from the Medical Birth Register. We performed Cox proportional hazard (hazard ratio [95% CI]) regression with mutual adjustment for perinatal exposures, sex, birth year, and parental sociodemographic background and history of diabetes. We also compared T1D risks among siblings' groups identified from the Multiple Generation Register.

RESULTS

The incidence rate of adult-onset T1D was 18.8 per 100,000 person-years. Year of birth (1.06 [1.01-1.10], per five additional years) and history of maternal (4.10 [3.09-5.43]) and paternal (6.24 [5.10-7.64]) T1D were associated with a higher incidence of adult-onset T1D, whereas female sex (0.69 [0.64-0.74]) and having parents born outside Sweden were associated with a lower incidence. Regarding perinatal exposures, only non-full-term birth (<39 weeks vs. ≥39 weeks) was associated with a higher incidence of adult-onset T1D (1.12 [1.04-1.22]). The sibling cohort results were consistent with the full cohort analysis.

CONCLUSIONS

Perinatal factors seem to play a minor role in the development of adult-onset T1D compared with childhood-onset T1D, suggesting that triggers or accelerators of autoimmunity occurring later in life are more significant.

Auto-immuno-deficiency syndromes

Autoimmune diseases constitute a broad, heterogenous group with many diverse and often overlapping symptoms. Even so, they are traditionally classified as either systemic, rheumatic diseases or organ-directed diseases. Several theories exist about autoimmune diseases, including defective self-recognition, altered self, molecular mimicry, bystander activation and epitope spreading. While there is no consensus about these theories, it is generally accepted that genetic, pre-disposing factors in combination with environmental factors can result in autoimmune disease. The relative contribution of genetic and environmental factors varies between diseases, as does the significance of individual contributing factors within related diseases. Among the genetic factors, molecules involved in antigen (Ag) recognition, processing, and presentation stand out (e.g., MHC I and II) together with molecules involved in immune signaling and regulation of cellular interactions (i.e., immuno-phenotypes). Also, various immuno-deficiencies have been linked to development of autoimmune diseases. Among the environmental factors, infections (e.g., viruses) have attracted most attention, but factors modulating the immune system have also been the subject of much research (e.g., sunlight and vitamin D). Multiple sclerosis currently stands out due to a very strong and proven association with Epstein-Barr virus infection, notably in cases of late infection and in cases of EBV-associated mononucleosis. Thus, a common picture is emerging that both systemic and organ-directed autoimmune diseases may appropriately be described as auto-immuno-deficiency syndromes (AIdeSs), a concept that emphasizes and integrates existing knowledge on the role of immuno-deficiencies and chronic infections with development of overlapping disease syndromes with variable frequencies of autoantibodies and/or autoreactive T cells. This review integrates and exemplifies current knowledge on the interplay of genetically determined immuno-phenotypes and chronic infections in the development of AIdeSs.

The increase in diabetes in children from underdeveloped countries

PURPOSE OF REVIEW

The incidence of type 1 diabetes (T1D) in children and adolescents has been increased over decades worldwide. Recent studies showed that the trend of T1D incidences were different between developed and underdeveloped countries. This review aimed to summarize the changes of childhood T1D incidences in underdeveloped countries over the past decade.

RECENT FINDINGS

Majority of the underdeveloped countries lacked of nationwide population-based studies on childhood T1D. We reviewed the trend of childhood T1D in important underdeveloped countries with available data in recent years. The incidences of childhood T1D in underdeveloped countries were low decades ago, but it increased significantly recently, particularly in the sub-Saharan African, Middle East and North African regions.

SUMMARY

The incidences of childhood T1D increased significantly in underdeveloped countries, especially in the sub-Saharan African, Middle East and North African regions. T1D registry and population-based studies are helpful to understand the situation and characteristic of childhood T1D in underdeveloped countries.

CTSG polymorphisms in Chinese children with type 1 diabetes mellitus

Cathepsin G (CTSG) plays an important role in the regulation of immune processes. Accumulated studies show that CTSG is involved in the onset and development of type 1 diabetes mellitus (T1DM). As the genetic background of T1DM varies widely among populations, we aimed to study the relationship between genetic polymorphisms in CTSG and T1DM susceptibility in Chinese populations. A total of 141 patients with T1DM and 200 healthy controls were enrolled in the study. Serum CTSG expression was detected using enzyme-linked immunosorbent assay (ELISA). Genotyping of two selected single nucleotide polymorphisms (SNPs) (rs2236742 and rs2070697) of CTSG was performed using PCR and Sanger sequencing. CTSG expression in patients with T1DM was significantly higher than in the control group. Alleles C and T of CTSG SNP rs2236742 were increased in T1DM. No significant associations were found for the SNP rs2070697. Our results indicate that the CTSG rs2236742 allele (C/T) is associated with T1DM in Chinese children and may serve as a new biomarker for predicting T1DM susceptibility.

Cardiovascular disease in type 1 diabetes, an underestimated danger: Epidemiological and pathophysiological data

Cardiovascular disease (CV) is a common complication of type 1 diabetes (T1D) and a leading cause of death. T1D patients are more likely to develop CV disease (CVD) early in life and show a reduction of life expectancy of at least 11 years. Patients with a young age of T1D onset have a substantially higher CV risk. The reasons for increased atherosclerosis in T1D patients are not entirely explained. In addition to the typical CV risk factors, long-term hyperglycemia has a significant impact by inducing oxidative stress, vascular inflammation, monocyte adhesion, arterial wall thickening and endothelial dysfunction. Additionally, CVD in T1D is also associated with nephropathy. However, CVD risk is still significantly increased in T1D patients, in good glycemic control without additional CV risk factors, indicating the involvement of supplementary potential factors. By increasing oxidative stress, vascular inflammation, and endothelial dysfunction, hypoglycemia and glucose variability may exacerbate CVD. Moreover, significant qualitative and functional abnormalities of lipoproteins are present in even well-controlled T1D patients and are likely to play a role in the development of atherosclerosis and the promotion of CVD. According to recent research, immune system dysfunction, which is typical of auto-immune T1D, may also promote CVD, likely via inflammatory pathways. In addition, T1D patients who are overweight or obese exhibit an additional CV risk due to pathophysiological mechanisms that are similar to those seen in T2D.

Living with and managing type 1 diabetes in humanitarian settings: A qualitative synthesis of lived experience and stakeholder tacit knowledge

Humanitarian health actors are beginning to better consider and manage non-communicable diseases, such as diabetes, in emergency and protracted crisis settings. However, a focus on the more globally prevalent type 2 diabetes (T2D) dominates. Blind spots prevail in the unmet needs for type 1 diabetes (T1D), a chronic autoimmune condition where individuals are unable to produce insulin, thereby dependent on lifelong insulin therapy and blood glucose management. Although some T1D management requirements overlap with those of T2D, the immediate risk of fatal complications following insulin therapy disruption, the earlier age of onset during childhood, adolescence or young adulthood, and its lower prevalence compared to T2D within communities and local health systems mean that T1D requires nuanced consideration and targeted interventions. Intending to inform program and policy design for people with T1D (PWT1D), we synthesized themes of lived experience from PLWT1D and their caregivers, and the tacit working knowledge of health providers and policymakers in the context of local humanitarian operations. Through a strategic search of health databases (up to July 2023), we identified 11 articles that include interview excerpts from PWT1D, caregivers, healthcare providers and policymakers about T1D management in humanitarian settings. We used reflexive thematic analysis to guide data extraction, coding, and synthesis, resulting in the identification of four overarching themes: food and insulin security, family relations, knowledge translation, and response to diagnosis. The narratives highlight harsh trade-offs made by PWT1D and their families in the face of insulin and food insecurity, as well as the damaging impact of low T1D education in families, communities and health systems. Targeted family and community-based solutions are urgently required, alongside systemic reforms and international collaboration to enable better T1D coping and management in humanitarian settings.

The PLOS Global Public Health Staff. Correction: Variation in the incidence of type 1 diabetes mellitus in children and adolescents by world region and country income group: A scoping review

[This corrects the article DOI: 10.1371/journal.pgph.0001099.].

Implementation factors of non-communicable disease policies and programmes for children and youth in low-income and middle-income countries: a systematic review

INTRODUCTION

Despite declared life-course principles in non-communicable disease (NCD) prevention and management, worldwide focus has been on older rather than younger populations. However, the burden from childhood NCDs has mounted; particularly in low-income and middle-income countries (LMICs). There is limited knowledge regarding the implementation of paediatric NCD policies and programmes in LMICs, despite their disproportionate burden of morbidity and mortality. We aimed to understand the barriers to and facilitators of paediatric NCD policy and programme implementation in LMICs.

METHODS

We systematically searched medical databases, Web of Science and WHOLIS for studies on paediatric NCD policy and programme implementation in LMICs. Screening and quality assessment were performed independently by researchers, using consensus to resolve differences. Data extraction was conducted within the WHO health system building-blocks framework. Narrative thematic synthesis was conducted.

RESULTS

93 studies (1992-2020) were included, spanning 86 LMICs. Most were of moderate or high quality. 78% reported on paediatric NCDs outside the four major NCD categories contributing to the adult burden. Across the framework, more barriers than facilitators were identified. The most prevalently reported factors were related to health service delivery, with system fragmentation impeding the continuity of age-specific NCD care. A significant facilitator was intersectoral collaborations between health and education actors to deliver care in trusted community settings. Non-health factors were also important to paediatric NCD policies and programmes, such as community stakeholders, sociocultural support to caregivers and school disruptions.

CONCLUSIONS

Multiple barriers prevent the optimal implementation of paediatric NCD policies and programmes in LMIC health systems. The low sociopolitical visibility of paediatric NCDs limits their prioritisation, resulting in fragmented service delivery and constraining the integration of programmes across key sectors impacting children, including health, education and social services. Implementation research is needed to understand specific contextual solutions to improve access to paediatric NCD services in diverse LMIC settings.

A multi-ancestry genome-wide association study in type 1 diabetes

Type 1 diabetes (T1D) is an autoimmune disease caused by destruction of the pancreatic β-cells. Genome-wide association (GWAS) and fine mapping studies have been conducted mainly in European ancestry (EUR) populations. We performed a multi-ancestry GWAS to identify SNPs and HLA alleles associated with T1D risk and age at onset. EUR families (N = 3223), and unrelated individuals of African (AFR, N = 891) and admixed (Hispanic/Latino) ancestry (AMR, N = 308) were genotyped using the Illumina HumanCoreExome BeadArray, with imputation to the TOPMed reference panel. The Multi-Ethnic HLA reference panel was utilized to impute HLA alleles and amino acid residues. Logistic mixed models (T1D risk) and frailty models (age at onset) were used for analysis. In GWAS meta-analysis, seven loci were associated with T1D risk at genome-wide significance: PTPN22, HLA-DQA1, IL2RA, RNLS, INS, IKZF4-RPS26-ERBB3, and SH2B3, with four associated with T1D age at onset (PTPN22, HLA-DQB1, INS, and ERBB3). AFR and AMR meta-analysis revealed NRP1 as associated with T1D risk and age at onset, although NRP1 variants were not associated in EUR ancestry. In contrast, the PTPN22 variant was significantly associated with risk only in EUR ancestry. HLA alleles and haplotypes most significantly associated with T1D risk in AFR and AMR ancestry differed from that seen in EUR ancestry; in addition, the HLA-DRB1*08:02-DQA1*04:01-DQB1*04:02 haplotype was 'protective' in AMR while HLA-DRB1*08:01-DQA1*04:01-DQB1*04:02 haplotype was 'risk' in EUR ancestry, differing only at HLA-DRB1*08. These results suggest that much larger sample sizes in non-EUR populations are required to capture novel loci associated with T1D risk.

Epigenetic Modulation of GPER Expression in Gastric and Colonic Smooth Muscle of Male and Female Non-Obese Diabetic (NOD) Mice: Insights into H3K4me3 and H3K27ac Modifications

Type 1 diabetes (T1D) affects gastrointestinal (GI) motility, favoring gastroparesis, constipation, and fecal incontinence, which are more prevalent in women. The mechanisms are unknown. Given the G-protein-coupled estrogen receptor's (GPER) role in GI motility, we investigated sex-related diabetes-induced epigenetic changes in GPER. We assessed GPER mRNA and protein expression levels using qPCR and Western blot analyses, and quantified the changes in nuclear DNA methyltransferases and histone modifications (H3K4me3, H3Ac, and H3K27Ac) by ELISA kits. Targeted bisulfite and chromatin immunoprecipitation assays were used to evaluate DNA methylation and histone modifications around the GPER promoter by chromatin immunoprecipitation assays in gastric and colonic smooth muscle tissues of male and female control (CTR) and non-obese diabetic (NOD) mice. GPER expression was downregulated in NOD, with sex-dependent variations. In the gastric smooth muscle, not in colonic smooth muscle, downregulation coincided with differences in methylation ratios between regions 1 and 2 of the GPER promoter of NOD. DNA methylation was higher in NOD male colonic smooth muscle than in NOD females. H3K4me3 and H3ac enrichment decreased in NOD gastric smooth muscle. H3K4me3 levels diminished in the colonic smooth muscle of NOD. H3K27ac levels were unaffected, but enrichment decreased in NOD male gastric smooth muscle; however, it increased in the NOD male colonic smooth muscle and decreased in the female NOD colonic smooth muscle. Male NOD colonic smooth muscle exhibited decreased H3K27ac levels, not female, whereas female NOD colonic smooth muscle demonstrated diminished enrichment of H3ac at the GPER promoter, contrary to male NOD. Sex-specific epigenetic mechanisms contribute to T1D-mediated suppression of GPER expression in the GI tract. These insights advance our understanding of T1D complications and suggest promising avenues for targeted therapeutic interventions.

Effect of diabetes self-management education on health-related quality of life of Tunisian children with type1 diabetes mellitus and their parents: A randomized controlled trial

AIM

To assess the effect of diabetes self-management education (DSME) on health related quality of life (HRQoL) of Tunisian children/adolescents with type 1 diabetes mellitus and their parents.

METHODS

This monocentral study used a randomized controlled trial design, during five-month intervention and five-month follow-up and including 110 patients (54 in the DSME intervention group and 56 in the Individual Education by Pediatrician (IEP) control group) and their parents. Pediatric Generic Core Quality-of-Life Inventory 4.0-Scale (PedsQL4.0) evaluated HRQoL.

RESULTS

At baseline, both groups had similar clinical features and PedsQL4.0 scores (p>0.05). In DSME, clinical outcomes were significantly improved from baseline to follow-up (p<0.001), while in the IEP group, which received no intervention, these outcomes remained unchanged. During follow-up, DSME showed higher PedsQL4.0 scores in parents' proxy-report and children/adolescents self-report (p<0.001). According to parents' proxy-report, PedsQL4.0 scores were significantly higher during follow-up compared to baseline in DSME (p<0.001) while they remained the same in IEP (p>0.05). DSME had higher percentage of change in the PedsQL4.0 scores than IEP (p<0.01). The median change varied from -5.01% to 0% vs 5.41% to 36.36% in IEP and DSME, respectively.

CONCLUSION

Encouraging healthcare professionals to incorporate these interventions could enhance the HRQoL of diabetic children and bolster their self-esteem.

Metabolic and Clinical Outcomes in Type 1 Diabetes in the COVID-19 Pre- and Post-Vaccination Periods in Spain: The COVID-SED1 Study

Aims: To evaluate the metabolic and clinical outcomes in the Spanish type 1 diabetes mellitus (T1D) population before and after COVID-19 vaccination. Methods: A retrospective observational study was carried out in Spanish public hospitals previously enrolled in the SED1 study. Adults and children with T1D were included and their clinical electronic records were reviewed. Clinical, laboratory, and glucometric parameters from continuous glucose monitoring (CGM) data corresponding to the periods before and after administering the first COVID-19 vaccination were analyzed. Results: A total of 26 centers and 228 patients participated in this new phase of the SED1 study and 187 were finally evaluable (mean age 37.5 ± 15.6 years, 56.7% women). Overall, 94.6% of the sample was vaccinated, and this percentage increased with higher levels of education (p-value = 0.027). In the pre- and post-vaccination periods, respectively, the number of patients with acute hyperglycemic decompensation was 6/161 (3.7%) and 7/161 (4.3%) (p = 1) and with acute hypoglycemic decompensation was 6/161 (3.7%) and 6/161 (3.7%) (p = 1). The HbA1c level was lower in the post-vaccination period(mean ± SD, mg/dL): pre-vaccination 7.4 ± 0.9; post-vaccination 7.2 ± 1.0, (-0.19; p-value = 0.0006). A total of 31.9% of patients (95% CI: 24.7-39.7) in the pre-vaccination period and 45.0% (IC95%: 37.1-53.1) in the post-vaccine period had HbA1c < 7% (p-value < 0.001). Glucometrics from CGM data also showed numerical improvements post-vaccination. Conclusions: The COVID-19 vaccination was highly accepted in the Spanish T1D population, with hesitancy about the COVID-19 vaccine being higher in those with lower educational levels. A mildly better glycemic control was observed in the post-vaccination period.

Incidence of type 1 diabetes mellitus in children and adolescents under 20 years of age across 55 countries from 2000 to 2022: A systematic review with meta-analysis

AIMS

The aim of this study was to determine the global incidence of type 1 diabetes mellitus (T1DM) in children and adolescents under 20 years of age from 2000 to 2022.

MATERIALS AND METHODS

Two reviewers searched three electronic databases (PubMed, Web of Science, and CINAHL) for studies published between January 2000 and November 2022. Pooled estimates of T1DM incidence with a 95% confidence interval (CI) per 100,000 person-years were calculated by country/region, sex, age, and COVID-19 pandemic period (pre-COVID-19 and pandemic).

RESULTS

The study included 126 studies from 55 countries and 18 regions. The incidence rate (IR) of T1DM from 2000 to 2022 was 14.07 (95%CI, 12.15-16.29) per 100,000 person-years. Finland and high-income North America had the highest IR, with 56.81 (95%CI, 55.91-57.73) and 28.77 (95%CI, 26.59-31.13) per 100,000 person-years, respectively. The IR was 13.37 (95%CI, 10.60-16.88) per 100,000 person-years in boys and 13.87 (95%CI, 11.51-16.70) per 100,000 person-years in girls. There were statistically significant differences among different age ranges: 0-4 versus 5-9 and 10-14 years old (p < 0.001); 5-9 versus 15-19 (p < 0.001) and 10-14 versus 15-19 years old (p = 0.003). Finally, during the pandemic period (2020-2022), the IR was 24.84 (95%CI, 17.16-35.96) per 100,000 person-years, which was higher but not significant compared with the prepandemic period (2017-2019) of 13.56 (95%CI, 7.49-24.56) per 100,000 person-years (p = 0.090).

CONCLUSIONS

The IR of T1DM in children and adolescents under 20 years of age is substantial, especially during the pandemic period, although it varies across regions. More reliable data from additional countries are needed to determine the worldwide incidence of T1DM.

Diabetes Management Support in Preschool and Primary School: A Qualitative Ideation Study Presenting Recommendations for Improved Communicative Practice

Diabetes care in institutional settings is a significant challenge that affects the whole family as well as care workers and teachers. The present study is the ideation part of a rigorous development process in the KIds with Diabetes in School (KIDS) project. We have previously conducted a thorough three-part needs assessment in which we explored the problem area from the viewpoints of (1) municipal administrative staff, (2) preschool and school staff and (3) families. Based on the identified needs and to a great extent on the contents and shortcomings of existing guidelines, the objective of the present study is to explore and develop possible solutions and recommendations for addressing the challenges and problems. To meet this objective, we held comprehensive multistakeholder participatory workshops in each of the five Danish regions. Five main themes with multiple subthemes were identified as areas to be addressed: (1) training and knowledge, (2) communication and collaboration, (3) the designated contact/support person, (4) national guidelines, and (5) the Diabetes Coordinator. Our findings demonstrate that communicative structures and dynamics are at the very heart of the identified problems and challenges and that the possible solutions should revolve around improving existing structures and highlighting the importance of constantly working on understanding and developing communication strategies. We propose a set of recommendations for practice based on these communicative needs.

The Incidence Trend of Type 1 Diabetes among Children and Adolescents 0-14 Years of Age in the West, South, and Tripoli Regions of Libya (2009-2018)

Objective

To estimate the incidence rates (IR) and analyse the trend in type 1 diabetes (T1D) among children aged 0-14 years in the West, South, and Tripoli regions of Libya.

Methods

A retrospective study was conducted on Libyan children aged 0-14 years with a new diagnosis of T1D who were admitted and/or had their follow-up at Tripoli Children’s Hospital during the period 2004 to 2018. The data were used to estimate the IR and the age-standardized IR per 100,000 population in the studied region for the years 2009-2018. The IRs by sex and age group (0-4, 5-9, 10-14 years) for every calendar year were assessed.

Results

A total of 1,213 children were diagnosed during the study period (2004-2018), 49.1% were males with a male-to-female ratio of 1:1.03. The mean age (±standard deviation) at diagnosis was 6.3±3.8 years. The distribution of incident cases according to age group 0-4, 5-9, and 10-14 years was 38.2%, 37.8%, and 24.1%, respectively. Poisson regression modelling in the period 2009-2018 revealed an overall trend of a 2.1% increase per annum. In the period 2014-2018, the overall age-adjusted IR was 31.7 (95% confidence interval: 29.2-34.2) per 100,000 population, the IRs of age groups 0-4, 5-9, and 10-14 years were 36.0, 37.4, and 21.6 per 100,000, respectively.

Conclusion

The incidence of T1D in Libyan children in the West, South, and Tripoli regions appears to be rising, with a higher rate in the 0-4 and 5-9 year age groups.

Incidence of type 1 and type 2 diabetes before and during the COVID-19 pandemic in Germany: analysis of routine data from 2015 to 2021

BACKGROUND

To date, there is no data available depicting the trend of the incidence of type 1 and type 2 diabetes across all age groups for the COVID-19 pandemic years in Germany.

METHODS

Based on anonymized routine data from nine million persons covered by statutory health insurance, newly diagnosed diabetes cases (ICD diagnosis E10.- to E14.-) in inpatient or (confirmed in two quarters) outpatient setting were estimated for 2015 to 2021, differentiating between type 1 and type 2 diabetes. The data were linked to the German Index of Socioeconomic Deprivation. The results are age-standardised (population as of 31 Dec. 2021).

RESULTS

Between 2015 and 2021, the incidence of type 1 diabetes increased from 9.5 to 11.6 per 100,000 persons (from 7,007 to 8,699 new cases per year). In contrast, the incidence of type 2 diabetes tended to decline between 2015 and 2019. It continued to drop initially in 2020 during the pandemic, and then rose to 740 per 100,000 persons in 2021 (556,318 new cases per year). The diabetes type-specific seasonal pattern of previous years has changed during the pandemic years. The incidence of both type 1 and type 2 diabetes was observed to be higher in regions of high socioeconomic deprivation as compared to regions characterised by low socioeconomic deprivation.

CONCLUSIONS

The increase in the incidence of type 1 and type 2 diabetes in 2021 may possibly be related to the COVID-19 pandemic. The high incidence and the differences by regional socioeconomic deprivation indicate that there is a need for targeted prevention strategies.

Epidemiology of type 1 diabetes mellitus in children in Kazakhstan: Data from unified national electronic health system 2014-2021

The epidemiology of type 1 diabetes mellitus (T1DM) in children aged 0-17 in Kazakhstan was explored using aggregated large-scale healthcare data from the unified national electronic health system (UNEHS) in 2014-2021. Incidence, period prevalence, and mortality rates per 100,000 population at risk were calculated. Cox proportional hazards regression modelling and Kaplan-Meier methodology were used. The follow-up period was from the initial date of T1DM until death or the end of the follow-up (31 December 2021). Among the 11,088 patients, the incidence rate of T1DM decreased from 28.1 to 24.5 per 100,000 population, whereas the period prevalence rate increased from 48.8 to 179.1, and the mortality rate rose from 0.18 to 0.67. Diagnosis at age 0-1 years (hazards ratio [HR] 4.42), presence of nephropathy (HR 8.94) or neoplasms (HR 1.64) were associated with a higher risk of death, while the presence of retinopathy (HR 0.31) was associated with a lower risk of death.

The incidence of type 1 diabetes in children under 15 years of age is rising again-a nationwide study

International incidence rates (IRs) and trends of childhood type 1 diabetes (T1D) vary. Recent data from Ireland and other high incidence countries suggested a stabilisation in IRs of T1D in children aged under 15 years. Our primary objective was to report the IR of T1D in children in Ireland from 2019 to 2021 and evaluate if age, sex and season of diagnosis had changed. Incident cases of T1D in those aged under 15 years were identified prospectively by clinicians nationally and reported to the Irish Childhood Diabetes National Register (ICDNR). Following case verification, capture-recapture methodology was applied, and IRs calculated. Numbers of children including age, sex and season of diagnosis per year were evaluated. There were 1027 cases, 542 males (53%). The direct standardised incidence rates (SIRs) increased by 21% overall and were 31.1, 32.2 and 37.6/100,000/year, respectively, with no significant sex difference. The highest IRs were in the 10-14-year category until 2021, then changed to the 5-9-year category (40% of cases). Whilst autumn and winter remain dominant diagnostic seasons, seasonality differed in 2021 with a greater number presenting in spring.

CONCLUSION

The incidence of childhood T1D in Ireland is increasing, observed prior to the COVID-19 pandemic, and shifting to an earlier age at diagnosis for the first time. The pattern of seasonality also appears to have changed. This may reflect an increased severity of diabetes with important implications for healthcare providers.

WHAT IS KNOWN

• Ireland has a very high incidence of T1D in childhood, which had stabilised following a rapid rise, similar to other high incidence countries. • The incidence rate is consistently highest in older children (10-14 years).

WHAT IS NEW

• Irish IR is no longer stable and has increased again, with the highest incidence occurring in the younger 5-9 age category for the first time. • The seasonality of diagnosis has changed during the COVID-19 pandemic years of 2020-2021.

Physical activity patterns in type 1 diabetes in Spain: The SED1 study

AIMS

To describe the physical activity (PA) frequency and intensity in the Spanish type 1 diabetes mellitus (T1D) population and its association with their glycemic control.

METHODS

A cross-sectional observational study was carried out in 75 Spanish public hospitals (the SED1 study). T1D patients over 14years of age self-completed the International Physical Activity Questionnaire (IPAQ) to determine their level of exercise. The relationship between PA frequency and intensity in T1D patients and glycemic control and the diabetes therapeutic education received were analyzed.

RESULTS

A total of 592 patients were evaluable. A 6.8% of the sample performed light PA, 20.9% moderate and 72.3% vigorous. Estimated PA presented a high inter-individual variability. Men consumed more energy (METS) than women, these differences being more noticeable in vigorous METS (2865.80 in men vs 1352.12 in women). Women invested more min/week in the domestic and garden area (639.03 vs 344.39, p = 0,022). A correlation between glycemic control and the METs was not observed.

CONCLUSIONS

The Spanish T1D population performed PA in a higher frequency and intensity than the general population. A relationship between PA and glycemic control couldn´t be shown. However, limitations of the study should be kept in mind to discard a long-term positive influence.