Elsevier

The Lancet

Volume 373, Issue 9680, 13–19 June 2009, Pages 2027-2033
The Lancet

Articles
Incidence trends for childhood type 1 diabetes in Europe during 1989–2003 and predicted new cases 2005–20: a multicentre prospective registration study

https://doi.org/10.1016/S0140-6736(09)60568-7Get rights and content

Summary

Background

The incidence of type 1 diabetes in children younger than 15 years is increasing. Prediction of future incidence of this disease will enable adequate fund allocation for delivery of care to be planned. We aimed to establish 15-year incidence trends for childhood type 1 diabetes in European centres, and thereby predict the future burden of childhood diabetes in Europe.

Methods

20 population-based EURODIAB registers in 17 countries registered 29 311 new cases of type 1 diabetes, diagnosed in children before their 15th birthday during a 15-year period, 1989–2003. Age-specific log linear rates of increase were estimated in five geographical regions, and used in conjunction with published incidence rates and population projections to predict numbers of new cases throughout Europe in 2005, 2010, 2015, and 2020.

Findings

Ascertainment was better than 90% in most registers. All but two registers showed significant yearly increases in incidence, ranging from 0·6% to 9·3%. The overall annual increase was 3·9% (95% CI 3·6–4·2), and the increases in the age groups 0–4 years, 5–9 years, and 10–14 years were 5·4% (4·8–6·1), 4·3% (3·8–4·8), and 2·9% (2·5–3·3), respectively. The number of new cases in Europe in 2005 is estimated as 15 000, divided between the 0–4 year, 5–9 year, and 10–14 year age-groups in the ratio 24%, 35%, and 41%, respectively. In 2020, the predicted number of new cases is 24 400, with a doubling in numbers in children younger than 5 years and a more even distribution across age-groups than at present (29%, 37%, and 34%, respectively). Prevalence under age 15 years is predicted to rise from 94 000 in 2005, to 160 000 in 2020.

Interpretation

If present trends continue, doubling of new cases of type 1 diabetes in European children younger than 5 years is predicted between 2005 and 2020, and prevalent cases younger than 15 years will rise by 70%. Adequate health-care resources to meet these children's needs should be made available.

Funding

European Community Concerted Action Program.

Introduction

Wide variation in incidence of type 1 diabetes in children younger than 15 years has been well characterised by registry reports from the EURODIAB study group within Europe1 and the DIAMOND project group worldwide.2 The DIAMOND project also analysed trends by continent in the period 1990–99, and showed increases in every region except Central America and the West Indies. In Europe, where numbers of cases are large enough to enable useful comparisons of rises in incidence in different age-groups, evidence shows that increases in incidence were highest in the youngest age-group.3 Furthermore, analysis of EURODIAB registration data for 1989–98 in regions within Europe shows that rates of increase differed significantly and were highest in central and eastern European countries.1

The emergence of type 2 diabetes in children and adolescents has received much attention, but this issue should not be allowed to overshadow the rapid rises in type 1 diabetes in this age-group. Although in a few countries most cases in children will be type 2 diabetes,4 in most European countries type 1 diabetes is, and will probably remain, the predominant form of this disease.5 Prediction of future numbers is important to facilitate plans for the delivery of care and treatment of complications that might arise in early adulthood in these children. We aim to document trends in incidence of childhood type 1 diabetes in Europe during 1989–2003, and to use this information to predict the future burden of this disease in European children.

Section snippets

Inclusion criteria and region selection

Case inclusion criteria were as previously described for the EURODIAB registers6—new diagnoses of type 1 (insulin-dependent) diabetes mellitus in children younger than 15 years who were usually resident in the geographically defined region. Completeness of registration was estimated separately for three 5-year periods by capture-recapture methods,7 for which independent primary and secondary sources of ascertainment are needed. In most centres, the primary sources of ascertainment were hospital

Results

Table 1 shows the total numbers of cases registered during 1989–2003 in each of the 20 centres and the age-standardised incidence rates in the three 5-year periods. Most centres maintained greater than 90% completeness of ascertainment in all three periods, with many achieving in excess of 95%. For all but two centres, the estimated annual increases in incidence were significant. Use of a log linear trend to summarise these data was considered appropriate because the test for departure from

Discussion

From review of worldwide epidemiology of childhood type 1 diabetes,10 we noted that Europe provides the most informative data about present incidence trends; European estimates of age-group-specific annual increases have narrower CIs than do estimates from other continents, indicating greater precision. We have extended the analysis of European trends to confirm that the highest rates of increase, at least in relative terms, arise in the youngest age-groups. The most striking changes over time

References (31)

  • A Green et al.

    Incidence of childhood-onset insulin-dependent diabetes mellitus: the EURODIAB ACE study

    Lancet

    (1992)
  • A Green et al.

    Trends in the incidence of childhood-onset diabetes in Europe 1989–1998

    Diabetologia

    (2001)
  • Incidence and trends of childhood Type 1 diabetes worldwide 1990–1999

    Diabet Med

    (2006)
  • Variation and trends in incidence of childhood diabetes in Europe

    Lancet

    (2000)
  • FR Kaufman et al.

    Type 2 diabetes in youth; rates, antecedents, treatment, problems and prevention

    Pediatr Diabetes

    (2007)
  • G Soltesz et al.

    Diabetes in the young

  • YMM Bishop et al.

    Discrete multivariate analysis: theory and practice

    (1974)
  • EUROSTAT estimates of 2005 population

  • World Population Prospects: the 2006 Revision Population Database

  • G Soltesz et al.

    Worldwide Childhood Type 1 Diabetes Incidence—what can we learn from epidemiology?

    Pediatr Diabetes

    (2007)
  • G Bruno et al.

    Increasing trend of type 1 diabetes in children and young adults in the province of Turin (Italy). Analysis of age, period and birth cohort effects from 1984 to 1996

    Diabetologia

    (2001)
  • J Svensson et al.

    Increased risk of childhood type 1 diabetes in children born after 1985

    Diabetes Care

    (2002)
  • RG Feltbower et al.

    Type 1 diabetes in Yorkshire: time trends in 0–14 and 15–29 year olds, age at onset and age-period-cohort modelling

    Diabet Med

    (2003)
  • A Pundziute-Lycka et al.

    Time trend of childhood type 1 diabetes incidence in Lithuania and Sweden, 1983-2000

    Acta Paediatr

    (2004)
  • E Moltchanova et al.

    A hierarchical Bayesian birth cohort analysis from incomplete registry data: evaluating trends in the age of onset of insulin-dependent diabetes mellitus (T1DM)

    Stat Med

    (2005)
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