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Incidence of type 1 diabetes mellitus and characteristics when first diagnosed by age category, 2001-2015
Source publication
Abstract Background While the United States has the largest number of children with type 1 diabetes mellitus, less is known regarding adult-onset disease. The present study utilizes nationwide data to compare the incidence of type 1 diabetes in youth (0–19 years) to that of adults (20–64 years). Methods In this longitudinal study, the Clinformatics...
Contexts in source publication
Context 1
... cases included 13,302 youth (0-19 years) and 19,174 adults (20-64 years). The incidence rate of type 1 diabetes was greatest in youth aged 10-14 years, at 45.5 cases per 100,000 person-years ( Table 1). The annual in- cidence rate of type 1 diabetes was 34.3 per 100,000 per- sons for ages 0-19 years and 18.6 per 100,000 persons for ages 20-64 years in this cohort. ...
Context 2
... the 6 month period around diagnosis, ketoacidosis occurred in a small percentage of cases, ranging from 2.5% in those aged 60-64 years to 15.2% in those aged under 5 years (Table 1). Prescriptions for emergency glu- cagon kits were filled most often during childhood (e.g., 79.4% in children aged 5-9 years at diagnosis) and less often in adults (e.g., 4.8% for those aged 50-54 years). ...
Context 3
... there was no significant linear increase in New England youth, the rates fluctuated considerably over time. CIs for the plotted rates are given in Additional file 1: Tables S1-S4. For adult-onset type 1 diabetes, there was a de- crease in the incidence from 2001 to 2015 (−1.3%/year; 95% CI −2.3% to −0.4%; P = 0.007). ...
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Citations
... Patient-centred approaches are established in paediatric T1D care but are less explored in adults [7,8]. Once considered a childhood condition, recent data show similar rates in adults and children [9]. As complications increase with age, there is a need to better understand adult T1D care experiences to inform quality improvement [10,11]. ...
Introduction
User experience design aims to create products and services that are accessible, usable, and enjoyable. The Reshape T1D study aims to apply these principles to understand how individuals living with T1D interact with and experience healthcare to inform T1D clinical quality improvement.
Methods
Using a community‐based participatory research design, we involved four patients and four clinicians as co‐researchers throughout the research. A questionnaire and virtual semi‐structured interview were applied across a purposeful sample of 41 adults living with T1D across Alberta, Canada, between September 2021 and May 2022. Audio recordings were transcribed verbatim and de‐identified before coding. Thematic analysis was conducted on coded participant discourse through multiple coders.
Results
Participants indicated the need for a centralized hub that provides consistent, reliable, and up‐to‐date T1D education and resources and an emphasis on access to mental health resources within T1D care settings. Providing greater flexibility for appointment types (ie. in‐person, virtual, etc.) and after‐hours access contributed to better self‐management and prevented emergency room visits. Participants desired a choice as to who comprises their T1D care team and for teams to address patient needs specific to their reality. We identified that medical trauma had long‐term impacts on perceptions of healthcare and contributed to a reluctance to seek future care. Women expressed challenges in discussing reproductive health with their clinicians. Diabetes online communities provide an adjunct to clinical care through peer support. Cost and access to the latest technology are ongoing barriers for many participants, especially concerning publicly funded programmes that use advanced insulin pump therapy, continuous glucose monitoring, and automated insulin delivery systems. A quality improvement framework emerged through data analysis, and findings were synthesized into actionable recommendations for ongoing clinical quality improvement.
Conclusion
Our findings highlight how important health system user suggestions are for more equitable, accessible, and empathetic healthcare for individuals living with T1D. Further work is needed to explore health system user experiences with clinicians and healthcare administrators to effectively carry out T1D clinical quality improvement.
... Although, it is axiomatically expressed that the USA harbours the greatest number of children with type 1 diabetes, there is data scarcity concerning adult-onset disease. The increase in incidence rate merely in youth is suggestive of youth-onset disease precipitating factors which contrast those of adult-onset disease (Rogers et al., 2017). Among US adults, the benchmark estimates on the national prevalence of type 1 diabetes diagnosed was 0.5% (Xu et al., 2018). ...
Diabetes is one of the most intensively researched disorders presenting several metabolic alterations, but the basic biochemical aberrations or defects have not been clearly elucidated because the disorder is characteristically of autoimmune disposition. In addition, it is an intricately complex disease that exhibits disparate and distinct outlook and magnitude of pathology with grim susceptibility to gene-environment interactions. Hyperglycaemia, glucosuria, polyuria, hunger, thirst, emaciation, ketonuria, acidosis and defect in insulin functionality accompanied in several instances with debilitating sequelae involve blood vessel wall degeneration and ophthalmologic problems. Early or invariable developments of these deteriorating changes culminate in expansive socioeconomic costs. Adequate data regarding type 1 diabetes incidence have been from regions with a high or intermediate incidence, particularly in Europe and North America where numerous registries have been established earlier or since the mid-1980s. There is a paucity of data from Africa Asia, the Caribbean, Central America and South America. The setting up and maintenance of population-based registries in very low-incidence areas such as the Caribbean, Central America, South America, Asia and Africa are expansively cumbersome. If the incidence is lower, then, the surveillance population tends to be larger in order to collate stable estimates for rates. The availability of veritable standardized type 1 diabetes incidence data from these low incidence regions is extremely crucial to establish that the presumed broad variation in incidence pertains, and that a low incidence in those regions is exact and not the resultant impact of underestimated incident cases.
... The higher prevalence of female cases is consistent with data from other countries with lower incidence rates of T1D [16]. Various studies have indicated signi icant variations in the age and gender of individuals presenting with T1D, along with notable differences in the incidence of the disease between urban and rural areas [18][19][20][21]. ...
Type 1 Diabetes Mellitus (T1DM) is a chronic autoimmune disease that primarily aff ects children and adolescents, leading to insulin defi ciency and persistent hyperglycemia. The incidence of T1DM has been rising globally, with signifi cant regional variations. While Europe and North America report the highest rates, Southeast Asia, including Bangladesh, has seen increasing cases. This study aims to compare the sociodemographic and clinical characteristics of newly diagnosed T1DM patients from rural and urban areas of Bangladesh, focusing on factors such as age at diagnosis, family history, and disease presentation. A cross-sectional study was conducted at the Pediatric Diabetes Care and Research Center (PDRC) at BIRDEM Hospital in Dhaka, Bangladesh, from January to December 2019. Retrospective data from 212 newly diagnosed children and adolescents (aged 1-18 years) were analyzed. The study included sociodemographic information (age, sex, residence, family history) and clinical data (DKA at diagnosis, height, weight, fasting blood sugar, HbA1c levels). Most participants (62%) were from rural areas, with a higher proportion from low socioeconomic backgrounds than from urban areas.
... Type 1 diabetes (T1D) is a common chronic metabolic disorder characterized by insulin deficiency and hyperglycemia, with an estimated worldwide prevalence of 95 per 100,000 people (1). Globally, the incidence of T1D is rising, particularly among children, although an estimated 25-50% of new diagnoses occur in adults (2)(3)(4)(5). Managing T1D poses significant health challenges due to the chronic and highly demanding nature of the disease. Despite meticulous management, individuals with T1D remain at risk of developing both acute and long-term complications. ...
Introduction
Type 1 diabetes (T1D) is a chronic condition marked by insulin deficiency and hyperglycemia, with an increasing global incidence, particularly among children. Despite improvements in diabetes management, individuals with T1D continue to experience higher rates of cardiovascular disease (CVD), the leading cause of mortality in this population. Traditional CVD risk factors such as dyslipidemia and poor glycemic control are insufficient to fully explain the elevated risk in T1D, prompting further investigation into additional factors. Emerging evidence suggests that metabolic dysfunction-associated steatotic liver disease (MASLD) plays a critical role in this heightened CVD risk.
Objective
This narrative review aims to explore the relationship between MASLD and CVD in individuals with T1D. The review focuses on the prevalence of MASLD, its contributing risk factors, and the potential impact of liver dysfunction on cardiovascular outcomes in this population.
Methods
A review of existing literature was conducted, focusing on observational studies, cohort studies, and meta-analyses that investigate the prevalence of MASLD in T1D populations and its association with CVD. The review also examines the physiological mechanisms linking MASLD and CVD, including insulin resistance, systemic inflammation, and hepatic dyslipidemia. Key studies were evaluated to identify patterns in MASLD prevalence based on diagnostic modalities and to assess the independent contribution of MASLD to cardiovascular risk in T1D patients.
Conclusion
MASLD is increasingly recognized as a significant contributor to CVD in individuals with T1D, particularly in those with shared risk factors like obesity and insulin resistance. Evidence suggests that MASLD exacerbates hepatic and systemic metabolic dysfunction, increasing CVD risk through mechanisms such as chronic inflammation and atherogenic lipid profiles. Routine liver health assessments and tailored management strategies targeting MASLD should be incorporated into clinical care for individuals with T1D to mitigate long-term cardiovascular complications.
... 38 Additionally, a study on US incidence of T1DM from 2001 to 2015 by Rogers et al used more granular census regions and reported increases in incidence were highest in the East South Central region (3.8% per year), followed by the Mountain division (3.1% per year) and then the East North Central region (2.7% per year). 39 Notably, this study was limited to commercially insured individuals only. By contrast, our broader analysis observed the greatest growth in incidence in the Northeast, at about a 4% increase in incidence annually. ...
Background: Two million Americans have type 1 diabetes (T1DM). Innovative treatments have standardized insulin delivery and improved outcomes for patients, but patients’ access to such technologies depends on social determinants of health, including insurance coverage, proper diagnosis, and appropriate patient supports. Prior estimates of US prevalence, incidence, and patient characteristics have relied on data from select regions and younger ages and miss important determinants. Objectives: This study sought to use large, nationally representative healthcare claims data sets to holistically estimate the size of the current US population with T1DM and investigate geographic nuances in prevalence and incidence, patient demographics, insurance coverage, and device use. This work also aimed to project T1DM population growth over the next 10 years. Methods: We used administrative claims from 4 sources to identify prevalent and incident T1DM patients in the US, as well as various demographic and insurance characteristics of the patient population. We combined this data with information from national population growth projections and literature to construct an actuarial model to project growth of the T1DM population based on current trends and scenarios for 2024, 2029, and 2033. Results: We estimated 2.07 million T1DM patients nationally across all insurance coverages in our 2024 baseline model year: 1.79 million adults (≥20 years) and 0.28 million children. This represents a US T1DM prevalence rate of 617 per 100 000 and an incidence rate of 0.016%. By 2033, we project the US population with T1DM will grow by about 10%, reaching approximately 2.29 million patients. Discussion: Our results showed important differences in T1DM prevalence and incidence across regions, payers, and ethnic groups. This suggests studies based on more geographically concentrated data may miss important variation in prevalence and incidence across regions. It also indicates T1DM prevalence tends to vary by income, consistent with several international studies. Conclusions: Accurate projections of T1DM population growth are critical to ensure appropriate healthcare coverage and reimbursement for treatments. Our work supports future policy and research efforts with 2024, 2029, and 2033 projections of demographics and insurance coverage for people with T1DM.
... These estimates were higher than the incidence observed in youth, which peaked at 31.7 (95% CI 28.2-35.2) per 100,000 people in those aged 0-14 years. A longitudinal study using the Clinformatics Data Mart Database in the USA for 2001-2015 reported an incidence of 29.2 per 100,000 people (95% CI 28.0-30.4) in those aged 60-64 years 15 ; no data were available for ages above 64 years. The incidence was highest in the oldest age group (60-64 years) out of all age groups for ages 20-64 years. ...
Although type 1 diabetes mellitus (T1DM) is traditionally viewed as a youth-onset disorder, the number of older adults being diagnosed with this disease is growing. Improvements in the average life expectancy of people with T1DM have also contributed to the growing number of older people living with this disease. We summarize the evidence regarding the epidemiology (incidence, prevalence and excess mortality) of T1DM in older adults (ages ≥60 years) as well as the genetics, immunology and diagnostic challenges. Several studies report an incidence peak of T1DM in older adults of a similar size to or exceeding that in children, and population prevalence generally increases with increasing age. Glutamic acid decarboxylase antibody positivity is frequently observed in adult-onset T1DM. Guidelines for differentiating T1DM from type 2 diabetes mellitus in older adults recommend measuring levels of C-peptide and autoantibodies, including glutamic acid decarboxylase antibodies. However, there is no gold standard for differentiating T1DM from type 2 diabetes mellitus in people aged 60 years and over. As such, the global variation observed in T1DM epidemiology might be in part explained by misclassification, which increases with increasing age of diabetes mellitus onset. With a growing global population of older adults with T1DM, improved genetic and immunological evidence is needed to differentiate diabetes mellitus type at older ages so that a clear epidemiological picture can emerge.
... Although T1D has a strong genetic component, evidence suggests the substantial impact of environmental factors on the risk of developing the disease, such as the increasing incidence observed in recent decades, that is in the prepandemic period [4], the discordant onset and evolution of T1D in monozygotic twins [5], and the align-ment of disease incidence in migrating populations with the rates of their destination regions [6]. ...
Objective
In this retrospective cohort study, we aimed to provide a snapshot of how the pandemic has affected pediatric type 1 diabetes mellitus (T1D) admissions in our hospital.
Methods
This study included 117 patients aged 0-18 classified based on period (pre-pandemic vs. pandemic period 2020-2022) and type of diagnosis at admission: new-onset T1D (nT1D) or diabetic ketoacidosis (DKA)-decompensated T1D. We investigated the effect of the COVID-19 pandemic on the demographic, clinical, and laboratory characteristics of these patients.
Results
Out of all T1D-related admissions, the proportion of admissions for nT1D increased compared to the pre-pandemic period: 71.6% vs 53.4%, p=0.048. Unrelated to the pandemic, the type of diagnosis at admission was associated with 1) the sex distribution (males – more nT1D admissions, females – more frequent DKA admissions, p=0.01), and 2) hospitalization duration (longer for nT1D admissions than for DKA-decompensated T1D admissions, p=0.001). Blood glucose and HbA1c levels were influenced neither by the pandemic period nor by the type of diagnosis. During the pandemic, a change in the T1D seasonality became apparent. A potential association pattern between new COVID-19 cases, number of T1D admissions, and stringency of restrictions was observed.
Conclusions
During the COVID-19 pandemic, the proportion of nT1D admissions increased, as well as the severity of DKA-decompensated T1D cases. In addition, the pandemic period brought about notable shifts in the seasonality of pediatric T1D.
... T1DM is one of the most prevalent endocrine and metabolic disorders of childhood [4]. The incidence of T1DM is on the rise globally, with a significant impact on global health expenditure, one which has been estimated at 760 billion USD in 2019. ...
Type 1 Diabetes Mellitus (T1DM) is a chronic autoimmune disease that results in the destruction of pancreatic β cells, leading to hyperglycaemia and the need for lifelong insulin therapy. Although genetic predisposition and environmental factors are considered key contributors to T1DM, the exact causes of the disease remain partially unclear. Recent evidence has focused on the relationship between the gut, the oral cavity, immune regulation, and systemic inflammation. In individuals with T1DM, changes in the gut and oral microbial composition are commonly observed, indicating that dysbiosis may contribute to immune dysregulation. Gut dysbiosis can influence the immune system through increased intestinal permeability, altered production of short chain fatty acids (SCFAs), and interactions with the mucosal immune system, potentially triggering the autoimmune response. Similarly, oral dysbiosis may contribute to the development of systemic inflammation and thus influence the progression of T1DM. A comprehensive understanding of these relationships is essential for the identification of biomarkers for early diagnosis and monitoring, as well as for the development of therapies aimed at restoring microbial balance. This review presents a synthesis of current research on the connection between T1DM and microbiome dysbiosis, with a focus on the gut and oral microbiomes in pediatric populations. It explores potential mechanisms by which microbial dysbiosis contributes to the pathogenesis of T1DM and examines the potential of microbiome-based therapies, including probiotics, prebiotics, synbiotics, and faecal microbiota transplantation (FMT). This complex relationship highlights the need for longitudinal studies to monitor microbiome changes over time, investigate causal relationships between specific microbial species and T1DM, and develop personalised medicine approaches.
... In general, DM type 1 disease manifests itself in adolescence. 29 Therefore, patients with type 1 diabetes are expected to have a longer duration of disease. In addition, greater blood glucose imbalance at the time of initial diagnosis and the continuous improvement of medical care through the introduction of new drugs and treatment pro-grams could be reasons for historically poorer blood glucose control in patients with type 1 diabetes. ...
Purpose
Chronic hyperglycemia causes changes in corneal biomechanics that can be measured with the Scheimpflug Analyzer Corvis ST. The diagnostic reliability of the new diabetes mellitus (DM) index developed based on this should be evaluated.
Methods
In a prospective cross-sectional study, the index was initially developed using data from 81 patients with DM and 75 healthy subjects based on logistic regression analysis. The reliability of the DM index was subsequently assessed using data from another 61 patients and 37 healthy individuals. In addition, the dependence of the DM index on indicators of disease severity was analyzed.
Results
The index initially achieved a sensitivity of 79% and specificity of 80% with a cutoff value of 0.58. The evaluation showed a sensitivity of 67% and specificity of 76% with an optimized cutoff of 0.51 (area under the curve = 0.737, P < 0.001). The DM index correlated weakly with the severity of diabetic retinopathy (r = 0.209, P = 0.014). It was increased in the presence of diabetic maculopathy ( P = 0.037) and in type 1 DM compared with patients with type 2 disease ( P = 0.039).
Conclusions
In this first evaluation, the new DM index achieved sufficiently good sensitivity and specificity and was weakly associated with disease-specific factors. With further improvements, it could complement the diagnostic options in DM with a simple, rapid, and noninvasive assessment method.
... From 2001 to 2015, youths 10-14 years old had the highest incidence of new-onset type 1 diabetes. Overall, children and adolescents 0-19 years old had a new-onset rate of 34.3 per 100,000 persons, while adults aged 20-64 had a rate of 18.6 per 100,000 persons [28]. In 2021, an estimated 8.4 million people globally had type 1 diabetes (with a 95% uncertainty interval of 8.1-8.8 million). ...
Background: This longitudinal study examined the early effects of type 1 diabetes on bone mechanical properties and metabolic markers in mature rats, focusing on the natural progression of diabetes-induced changes without external treatments. Methods: Forty-eight 8-month-old male Wistar rats were divided into two groups, with one group receiving a single dose of streptozotocin (STZ, 60 mg/kg). Assessments were performed 2, 4, and 8 weeks post-administration, including serum biochemical analyses, bone marker assessments, and mechanical bone tests. The data were analyzed using two-way ANOVA to evaluate the impact of time and treatment. Results: At 2 weeks, diabetic rats showed increased fasting blood glucose (p < 0.001), decreased insulin levels (p = 0.03), and changes in HOMA markers (p < 0.001), liver enzymes (p < 0.001), inflammatory markers (p < 0.001), and bone metabolism markers (osteocalcin (p < 0.001), OPG (p = 0.006), RANKL (p < 0.001), and OPG/RANKL ratio (p < 0.001)), with initial alterations in bone geometry. By week 4, decreased body weight in the diabetic group (p < 0.001) led to further changes in bone geometry and initial differences in mechanical properties. At 8 weeks, significant declines in body (p < 0.001) and bone (p < 0.001) weights were observed, along with further deterioration in bone geometry and mechanical properties. Conclusions: The study highlights the significant impact of STZ-induced diabetes on bone health as early as two weeks post-STZ administration, with marked temporal changes in biochemical markers and mechanical properties.