Clinical Incidence and Characteristics of Newly Diagnosed Type 1 Diabetes in Chinese Children and Adolescents: A Nationwide Registry Study of 34 Medical Centers

Abstract

ObjectiveTo investigate the clinical incidence and characteristics of type 1 diabetes mellitus (T1DM) of children and adolescents at the time of initial diagnosis in China.MethodsData on all pediatric patients with newly diagnosed T1DM were retrospectively collected from 34 medical centers in 25 major cities in China from January 2015 to January 2020. Patients were classified into three age groups: <5 years, 5 to <10 years, and ≥10 years of age. The same patient population was also categorized into diabetic ketoacidosis (DKA) and non-DKA groups based on clinical criteria.ResultsThe mean annual clinical incidence of T1DM was 3.16/100,000 from the years 2015 to 2019. A total of 6,544 patients with newly diagnosed T1DM aged 0–16 years (median 7.84 ± 3.8) were studied [ages <5 years (29.3%), 5 to <10 years (38.7%), and ≥10 years (32%)], 52.4% of them were women. In total, 90.5% of the cases were occurred in individuals without a family history. Patients had lower C-peptide (CP) and body mass index (BMI) z scores when compared with healthy children, 41.8% of them had measurable T1DM-related antibodies and 52.7% had DKA. Among all three age groups, the <5 years group had the lowest BMI z score, CP, and glycated hemoglobin (HbA1c) on average, while it had the highest incidence rate of DKA (56.9%). Compared to the non-DKA group, the DKA group was significantly younger, with a lower BMI z score and CP, higher antibody positive rate, HbA1c, and the rate of insulin pump therapy.ConclusionThe clinical incidence of T1DM in children and adolescents in China was 3.16/100,000. Patients with DKA at the first diagnosis of T1DM have a worse β-cell function. Public health measures for the prevention and treatment of T1DM should focus on preschoolers (aged <5 years) in particular, considering the severity and the highest frequency of DKA in this age group. More efforts should be dedicated to early screening and diagnosis of the T1DM.

Characterization of Newly Diagnosed Type 1 Diabetes in Children and Adolescents from 2017–2022 in China: A Single-center Analysis

“…We found that the mean annual incidence of T1DM in children and adolescents in Hubei Province in 2017-2022 was 4.25/100,000, and that this rate gradually increased over the study period. This nding is consistent with previous studies conducted in China [15], which indicates that our data re ect the incidence of T1DM in the general population. However, in both 2020 and 2021, the clinical incidence of T1DM in China was markedly elevated, while the clinical incidence was decreased in 2022.…”

“…However, the frequency of DKA was not higher in patients with idiopathic T1DM than in patients with immune-mediated T1DM, contrary to the hypothesis that SARS-CoV-2 infection leads to a signi cant increase in newly diagnosed autoimmune-negative T1DM [11]. In this study, we also found no increase in the frequency of DKA in the cohort from the COVID-19 pandemic, consistent with the incidence rate of DKA at the onset of T1DM in China [15]. During the COVID-19 pandemic, the Chinese Society of Pediatric Endocrinology and Metabolism developed recommendations regarding the identi cation and treatment of children with critical diabetes, including an e cient and effective treatment plan [24].…”

“…In our study, the number of newly diagnosed T1DM patients with auto-antibody positivity did not signi cantly increase in children and adolescents during the COVID-19 pandemic in China compared to the years preceding the pandemic. Moreover, during the COVID-19 pandemic there was no signi cant increase in newly diagnosed T1DM with auto-antibody negativity, although this may have been related to the small number of infected children and adolescents (~ 171 patients) and the low incidence of T1DM in children and adolescents in China (~ 3.16/100,000) [15,20]. It is not clear whether COVID-19 infection triggers late adaptive immunity, which results in progressive pancreatic β cell death and an accelerated clinical course in patients with positive antibodies.…”

“…The diagnosis of DKA was based on recent International Society for Pediatric and Adolescent Diabetes guidelines: hyperglycaemia (blood glucose ≥ 11 mmol/L), metabolic acidosis (venous blood pH < 7.3 or serum bicarbonate < 15 mmol/L), and ketosis (presence of ketones in the blood or urine) [4,14]. The clinical incidence of T1DM was calculated by summing the numbers of children and adolescents newly diagnosed each year, and then dividing by the annual number of outpatient and emergency visits to Tongji hospital (Hubei Province, China) [15].…”

Care, control and complications of hospitalised patients with type 1 diabetes in China: A nationwide‐based registry study

“…4 However, it is important to note that the knowledge acquired from studies based on these registries cannot be directly applied to the Chinese population due to differences in the incidence of T1D, the associations of genetic background, the frequency of islet-related autoantibodies, and the distribution of clinical subtypes between East Asian and Caucasian populations. [5][6][7][8][9][10][11][12][13][14][15][16][17] Several regional studies have been conducted within China, including the Guangdong Provincial Translational Medicine of Type 1 Diabetes, 7 a single-centre retrospective hospital study in Henan, 8 and the 3C study in Beijing and Shantou. 9 These studies have reported the demographic and informatics features, clinical characteristics at onset, complications, and comorbidities of Chinese T1D patients.…”