Incidence, prevalence and mortality of diabetes in children and adolescents aged under 20 years in the Republic of Maldives

Abstract

Aim: There is little published data on diabetes in youth in the Maldives. This study aimed to determine incidence, prevalence and mortality of diabetes in children and adolescents <20 years. Methods: Data on all known existing cases in 2009 and all new cases from 2009 to 2018 was collected from the Diabetes Society of the Maldives registry. Results: Thirty-nine subjects <20 years were known to have diabetes at the start of 2009 and 92 new cases were diagnosed from 2009 to 2018. Of the 92 new cases, 76 had type 1 diabetes (T1D), 15 type 2 diabetes (T2D) and one secondary diabetes. Of the 76 new T1D cases, 64 were diagnosed <15 years. Mean age of onset for T1D <20 years was 10 AE 4.6 years, with 42 (55.3%) female. Ten (13.2%) were diagnosed 0-4 years, 27 (35.5%) 5-9 years, 27 (35.5%) 10-14 years and 12 (15.8%) 15-19 years. Annual T1D mean incidence rates/per 100 000 subjects for <15/<20 years, respectively, increased from 3.6/2.7 in 2009 to 11.0/9.1 in 2018, representing 12.0%/13.0% annualised increases (P = 0.01 for both). T1D prevalence in 2018 for <15 and <20 years was 47.1/100 000 and 52.0/100 000, respectively. No young person with T1D died during this period, with a total of 262 patient-years of follow-up for T1D cases. The child with secondary diabetes died of other causes. Conclusion: T1D incidence in Maldives is higher than that reported from other South Asian countries, and an increasing trend was observed. T2D also occurs relatively frequently. A zero mortality rate was observed for children and young adults with T1D and T2D from 2009 to 2018.

Rapid increases in observed incidence and prevalence of Type 1 diabetes in children and youth in Mali, 2007–2016

“…1,28,29 Although there are suggestions that incidence has stabilized in some countries, 29 higher annual rates of increase have been seen from some middle-income countriessuch as 13.4% Chile, 30 12.0% in China 31 , and 12.0%-13.0% in the Maldives. 32 However, the 18.0% annualized increase in this article is highly unlikely to be mostly due to changing environmental factorswe hypothesize that case recognition has increased as well. This is supported by the peak in total number of diagnoses and observed incidence (0.80 per 100,000 <25 years) being seen in the year after a poster public health campaign showing pictograms of the six classic symptoms/ signs of T1D in youth (polyuria, polydipsia, bed-wetting, weight loss, tiredness and becoming very ill).…”

“…Annual increases of 3%–5% have been reported from a number of high‐income countries 1,28,29 . Although there are suggestions that incidence has stabilized in some countries, 29 higher annual rates of increase have been seen from some middle‐income countries – such as 13.4% Chile, 30 12.0% in China 31 , and 12.0%–13.0% in the Maldives 32 . However, the 18.0% annualized increase in this article is highly unlikely to be mostly due to changing environmental factors – we hypothesize that case recognition has increased as well.…”