Global and regional estimates of the morbidity due to type I diabetes among children aged 0-4 years: a systematic review and analysis

Abstract

BackgroundEpidemiology of type 1 diabetes mellitus (T1DM) among children aged 0-4 years globally is not well understood. We aim to assess the incidence of T1DM in low- and middle-income countries (LMIC) by conducting a systematic review of previous reports. We also aim to address possible contribution to child mortality and to identify any temporal trends.MethodsA systematic review was performed using a carefully designed search strategy to explore MEDLINE, EMBASE and Global Health databases. Data was extracted from all studies that satisfied the inclusion criteria –a total of 83 records extracted from 26 830 sources that were analysed. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) process to assess quality of evidence and applied meta-analysis approaches to assess global and regional incidence and time trends.ResultsThe overall pooled incidence of T1DM in children aged 0-4 years globally is 11.2 (95% CI = 10.0-12.3) per 100 000 child years. The regional incidence were the highest for European Region A (EUR A) at 15.5 (95% CI = 13.5-17.5) per 100 000 child years. EUR C had the incidence of 10.0 (95% CI = 6.5-13.6) and EUR B 5.8 (95% CI = 4.7-7.0), Region of the Americas A (AMR A) 11.4 (95% CI = 7.8-14.9), AMR B of 2.5 (95% CI = 0.2-4.8), Eastern Mediterranean Region (EMR B) 7.1 (95% CI = 4.2-10.0) and Western Pacific Region (WPR A) 7.0 (95% CI = 2.9-11.0) per 100 000 child years, while other regions had very low rates or no data. When data points were categorised in the study periods and re-analysed, an increasing trend of the T1DM incidence was observed, with the incidence of 20.9 (95% CI = 7.8-34.1) per 100 000 child years in the years 2010-2015, preceded by 13.2 (95% CI = 11.0-15.5) in 2000-2009 study period, 10.0 (95% CI = 8.4-11.7) in 1990-1999 and 8.3 (95% CI = 5.1-11.6) in 1980-1989, respectively. Although the data are scarce, and variation and uncertainty are large, we estimated that the number of new cases of T1DM among children aged 0-4 years in the world each year is between 100 000 and 150 000.ConclusionsThe identified large variation in incidence estimates for different parts of the world, along with scarcity of information and the identified strong temporal increase in T1DM incidence suggest a clear need for further research into this subject.

Increasing trend of type 1 diabetes incidence in the pediatric population of the Calabria region in 2019–2021

“…A recent systematic review reported that the overall pooled incidence of T1D in children aged 0-4 years globally is 11.2 per 100,000 child-years, accounting for 100,000-150,000 cases among new diagnosis of T1D each year in the world. Highest rates were identified in European countries [6]. In our experience, the crude incidence rate in younger children was higher compared to these data.…”

“…Diabetes-related chronic complications are not uncommon among adolescents and are related to severe impairment of patients' quality of life [5]. Furthermore, mortality from T1D has been reported also in the pediatric population, especially in Africa and many low-and middle-income countries [6]. Although in recent years several clinical trials aimed at preventing T1D onset have been conducted [7,8], established and approved strategies are still lacking and T1D remains a widespread public health concern.…”

“…Few studies on the epidemiology of T1D exist globally and the exact prevalence of the disease is unknown. In many countries, there are no national registries, while in other countries completeness of registries is uncertain as case ascertainments are often under-reported and underestimated [6]. The incidence of T1D is extremely heterogeneous among countries, and even among regions within countries.…”

Clinical characteristics of 683 children and adolescents, aged 0–18 years, newly diagnosed with type 1 diabetes mellitus in Henan Province: a single-center study

“…This conclusion deserves our attention. According to Adeloye D [ 16 ], the incidence of T1DM in children aged 0–4 years is rising worldwide, and was 20.9 (7.8–34.1) per 100,000 child years in 2015. The incidence of T1DM is shifting towards younger age groups.…”

Pathophysiology of Type 1 Diabetes and Gut Microbiota Role

“…T1D is observed more commonly in European people, with Finland reporting >60 cases per 100,000 people each year following Sardinia, around 40 cases per 100,000 people each year [ 19 ]. Across the globe, the incidence of T1D is increasing by 3% every year, although profound reasons for this are unclear [ 20 , 21 , 22 , 23 ].…”