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11-28-2018 | Epidemiology | News

Childhood type 1 diabetes incidence still rising in Europe


medwireNews: The incidence of childhood type 1 diabetes continues to increase across Europe, with the number of cases potentially doubling in the next 20 years, an analysis of 25 years of EURODIAB registry data shows.

Using information for more than 84,000 children aged 0–14 years diagnosed with type 1 diabetes at 26 European centers in 22 countries during 1989–2013, Christopher Patterson (Queens University Belfast, UK) and colleagues calculated that the incidence rate during this period increased by an average of 3.4% per year.

There was some indication of a reduced rate of increase, from 4.1% per year during 1999–2003 to 1.1% per year during 2004–2008, but this rose again, to 2.7%, in the 2009–2013 period.

The rate of increase was significantly greater than zero in all but two small centers, and ranged from 0.5% per year in Spain–Catalonia to 6.6% per year in Poland–Katowice.

The researchers also found that six centers (Finland, Norway, UK–Oxford, UK–Northern Ireland, Czechia, and Poland) had higher rates of increase in the early period, which began to slow from 2002 onwards. They say that this confirms previous reports of slowing incidence rate increases in some high-incidence areas.

When the data were analyzed by sex and age, the team observed similar rates of increase between boys and girls aged 0–4 years (3.7 vs 3.7% per year) and 5–9 years (3.4 vs 3.7% per year), but higher rates in boys than girls aged 10–14 years (3.3 vs 2.6% per year).

The researchers also investigated previously published claims of cyclical variation in incidence rates. They noted significant 4-year periodicity at just four centers (Germany–Saxony, Germany North Rhine–Westphalia, Switzerland, and UK–Oxford), with three showing that the most recent peak in fitted incidence rate occurred in 2012.

However, there was no evidence of 5- or 6-year periodicity and Patterson et al say that “no plausible explanation” could be given for the cyclical 4-year variation.

Writing in Diabetologia, the investigators highlight that the steadily increasing number of children with type 1 diabetes “has important implications” for healthcare planners and providers.

“Taking into account the uncertainty associated with our overall incidence rate increase of 3.4% […] we may expect to see a doubling in European incidence in between 18 and 25 years if the trends evident in the last 25 years are maintained,” Patterson and co-authors remark.

They add: “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.”

“Key to this is the improvement in glycaemic control that will be achieved not only by more sophisticated methods of insulin delivery, but also by an increased investment in services to support well- trained and dedicated care teams in sufficient numbers to meet the growing needs of this group of children and their families,” the team concludes.

By Laura Cowen

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