Epidemiology of type 1 diabetes mellitus in children and adolescents: A 50-year, single-center experience

IF 3 2区医学 Q2 ENDOCRINOLOGY & METABOLISM

Journal of Diabetes Pub Date : 2024-04-25 DOI:10.1111/1753-0407.13562

Nurgun Kandemir, Dogus Vuralli, Alev Ozon, Nazlı Gonc, Didem Ardicli, Lala Jalilova, Omer Nazim Gulcek, Ayfer Alikasifoglu

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Abstract

Background

Global variations in epidemiology of type 1 diabetes mellitus (T1DM) exist. This study is designed to examine demographic and clinical features of T1DM over the past 3 decades as well as evolving trends in epidemiology over last 50 years.

Methods

Clinical characteristics of 925 patients with T1DM over last 30 years (1990–2019) were evaluated and compared to previously published data of 477 patients diagnosed between 1969 and 1990 from one of the major referral centers for diabetes in Turkey.

Results

Mean age at diagnosis decreased from 9.5 ± 4.0 to 7.1 ± 3.6 years within the past 50 years (p < .001). Age at diagnosis peaked at 12–14 years between 1969 and 1990, then fell to 10–11.9 years between 1990 and 1999, and to 4–5.9 years between 2000–2009 and 2010–2019 (p = .005). Although the percentage of patients diagnosed <6 years of age is gradually increasing, the percentage between the ages of 6 and 11.9 years is decreasing, and the percentage diagnosed ≥12 years remained stable. A total of 47.5% of patients had ketoacidosis, 38.2% had ketosis, and 14.3% had only hyperglycemia. 23% of patients had severe diabetic ketoacidosis (DKA), whereas 42% had moderate. Over last 3 decades, there has been no change in frequency of ketoacidosis at presentation, but there has been significant decline in severity (p = .865, and p < .001, respectively). Although the frequency of patients with mild DKA increased over time, frequency of patients with moderate DKA decreased; however, no significant difference was observed among patients with severe ketoacidosis. DKA was more frequent and severe in patients <6 years of age (p = .005, and p < .001, respectively).

Conclusion

Age at diagnosis shifted to younger ages in T1DM in the past 50 years. Half of patients had ketoacidosis at diagnosis and frequency of presentation with DKA did not decrease, but severity decreased slightly. Increase in prevalence of T1DM in the younger age group and the fact that half of patients present with DKA indicate that awareness should be increased in terms of early diagnosis and treatment.

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儿童和青少年 1 型糖尿病的流行病学：长达 50 年的单一中心经验

背景 1 型糖尿病（T1DM）的流行病学存在全球性差异。本研究旨在探讨过去 30 年间 T1DM 的人口统计学和临床特征，以及过去 50 年间流行病学的演变趋势。方法对过去 30 年（1990-2019 年）925 名 T1DM 患者的临床特征进行评估，并与之前发表的土耳其一家主要糖尿病转诊中心在 1969 年至 1990 年期间确诊的 477 名患者的数据进行比较。结果在过去 50 年中，确诊时的平均年龄从 9.5 ± 4.0 岁降至 7.1 ± 3.6 岁（p < .001）。确诊年龄在 1969 年至 1990 年间达到 12-14 岁的峰值，随后在 1990 年至 1999 年间降至 10-11.9 岁，在 2000-2009 年和 2010-2019 年间降至 4-5.9 岁（p = .005）。虽然确诊患者年龄为6岁的比例逐渐上升，但6-11.9岁的比例却在下降，确诊患者年龄≥12岁的比例保持稳定。47.5%的患者有酮症酸中毒，38.2%的患者有酮症，14.3%的患者仅有高血糖。23%的患者有严重的糖尿病酮症酸中毒（DKA），42%的患者有中度酮症酸中毒。在过去的 30 年中，出现酮症酸中毒的频率没有变化，但严重程度却显著下降（分别为 p = .865 和 p <.001）。虽然随着时间的推移，轻度 DKA 患者的发病率有所上升，但中度 DKA 患者的发病率有所下降；不过，在重度酮症酸中毒患者中没有观察到明显的差异。6 岁患者的 DKA 发生率更高，病情更严重（分别为 p = .005 和 p <.001）。结论在过去的 50 年中，T1DM 患者的确诊年龄向年轻化转变。半数患者在确诊时患有酮症酸中毒，出现 DKA 的频率没有降低，但严重程度略有下降。T1DM发病率在年轻群体中的增加以及半数患者出现 DKA 的事实表明，应提高对早期诊断和治疗的认识。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Diabetes ENDOCRINOLOGY & METABOLISM-

CiteScore

6.50

自引率

2.20%

发文量

审稿时长

>12 weeks

期刊介绍： Journal of Diabetes (JDB) devotes itself to diabetes research, therapeutics, and education. It aims to involve researchers and practitioners in a dialogue between East and West via all aspects of epidemiology, etiology, pathogenesis, management, complications and prevention of diabetes, including the molecular, biochemical, and physiological aspects of diabetes. The Editorial team is international with a unique mix of Asian and Western participation. The Editors welcome submissions in form of original research articles, images, novel case reports and correspondence, and will solicit reviews, point-counterpoint, commentaries, editorials, news highlights, and educational content.