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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...
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... 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 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.
... 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.
... Data specific to adults older than this are an important unmet need. Epidemiological data show that, overall, type 1 diabetes is diagnosed more frequently in adulthood than in childhood (98)(99)(100)(101), at a median of more than 35 years of age (102,103). Despite this, misdiagnoses of type 1 diabetes in adults remain common and are increasingly likely with age (60), setting the scene for development of DKA. ...
In the article cited above, incorrect affiliation information was given for author Linda A. DiMeglio. The correct affiliation for Linda A. DiMeglio is Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN.
The online version of the article (https://doi.org/10.2337/dci24-0042) has been updated to correct the error.
... India and the United States have the most estimated incidence cases of T1D. 6 In the United States, over 1.8 million people (1.6 million adults as well as 244,000 children and adolescents <20 years of age) have T1D, with an approximated annual increase of 1.9% (although rates vary across regions) and greater increases in younger and minority populations. [7][8][9] According to the Centers for Disease Control and Prevention, primary care visits accounted for 50.3% of all medical office visits in the US in 2019. Often the first point of contact for patients, primary care practitioners provide critical aspects of care, such as disease monitoring and secondary complication management. ...
... 30 A longitudinal study demonstrated that of the 64,000 individuals diagnosed annually with T1D in the US, 58% (n=37,000) are 20-64 years old. 9 Because not all adults require insulin at diagnosis, new-onset T1D may be misdiagnosed in approximately 40% of the adults; this risk of misdiagnosis increases with age. 30 To preserve endogenous insulin production for as long as possible and enable individuals to access appropriate modern therapies including immunotherapy, proper diagnosis and staging must be accomplished promptly. ...
Plain Language Summary
Type 1 diabetes (T1D) is a life-long condition where the body’s immune system (which normally fights infection) mistakenly attacks cells in the pancreas that make insulin. Insulin allows one to use energy from food and controls blood sugar levels. Without early recognition and treatment, high blood sugar can cause serious symptoms and life-threatening complications, such as diabetic ketoacidosis (DKA). DKA happens when there is very low insulin, and if not spotted early, it can cause coma and death. T1D can occur at any age. The chance of getting T1D is higher if another family member has it. T1D progresses silently for months or years before symptoms appear such as increased thirst, frequent urination, and unintentional weight loss. Healthcare providers can now screen and identify people who are at early stages of T1D (without symptoms) with blood tests called autoantibodies. Early detection through screening allows people to 1) learn about the disease before symptoms start and insulin is needed, 2) potentially receive treatments that delay T1D progression, and 3) participate in research trials. By detecting T1D at early stages, people can connect with the right care team and develop the skills needed to manage later stage T1D. Early detection has been shown to prevent hospitalization and life-threatening conditions. Screening for T1D will help people maximize their opportunities to delay T1D onset while preparing for diabetes care.
... Data specific to adults older than this are an important unmet need. Epidemiological data show that, overall, type 1 diabetes is diagnosed more frequently in adulthood than in childhood [98][99][100][101], at a median of more than 35 years of age [102,103]. Despite this, misdiagnoses of type 1 diabetes in adults remain common and are increasingly likely with age [60], setting the scene for development of DKA. ...
Given the proven benefits of screening to reduce diabetic ketoacidosis (DKA) likelihood at the time of stage 3 type 1 diabetes diagnosis, and emerging availability of therapy to delay disease progression, type 1 diabetes screening programmes are being increasingly emphasised. Once broadly implemented, screening initiatives will identify significant numbers of islet autoantibody-positive (IAb⁺) children and adults who are at risk of (confirmed single IAb⁺) or living with (multiple IAb⁺) early-stage (stage 1 and stage 2) type 1 diabetes. These individuals will need monitoring for disease progression; much of this care will happen in non-specialised settings. To inform this monitoring, JDRF in conjunction with international experts and societies developed consensus guidance. Broad advice from this guidance includes the following: (1) partnerships should be fostered between endocrinologists and primary-care providers to care for people who are IAb⁺; (2) when people who are IAb⁺ are initially identified there is a need for confirmation using a second sample; (3) single IAb⁺ individuals are at lower risk of progression than multiple IAb⁺ individuals; (4) individuals with early-stage type 1 diabetes should have periodic medical monitoring, including regular assessments of glucose levels, regular education about symptoms of diabetes and DKA, and psychosocial support; (5) interested people with stage 2 type 1 diabetes should be offered trial participation or approved therapies; and (6) all health professionals involved in monitoring and care of individuals with type 1 diabetes have a responsibility to provide education. The guidance also emphasises significant unmet needs for further research on early-stage type 1 diabetes to increase the rigour of future recommendations and inform clinical care.
Graphical Abstract
