Endocrinology and Metabolism Clinics of North America
Epidemiology of Type 1 Diabetes
Section snippets
Incidence and prevalence of T1D
The current prevailing paradigm on the cause of T1D hypothesizes that environmentally triggered autoimmune destruction of pancreatic beta cells occurs against the background of genetic risk,6 although alternate hypotheses exist.7, 8 It follows that global variation in the incidence, prevalence, and temporal trends in T1D are reported. In this section, findings from large T1D registry studies such as the World Health Organization Multinational Project for Childhood Diabetes, known as the DIAMOND
Incidence: temporal trends
An updated report from the DIAMOND Project examined the trends in incidence of T1D from 1990 to 1999 in 114 populations from 57 countries. Based on 43,013 cases of T1D from a study population of 84 million children aged 14 years or less,10the average annual increase in incidence in this time period was 2.8% (95% CI 2.4%–3.2%) with a slightly higher rate in the period 1995 to 1999, 3.4% (95% CI 2.7%–4.3%) than in the period 1990 to 1994, 2.4% (95% CI 1.3%–3.4%). These trends for increased
Risk factors for development of T1D
Various risk factors for development of T1D such as age, sex, race, genotype, geographic location, and seasonality are reviewed in this section.
Seasonality of onset and birth
Patterns in the seasonality for both the month of birth and the month of diagnosis of T1D have been reported. Although the seasonality of T1D diagnosis seems intuitively obvious given the well-documented environmental role in T1D's pathogenesis, it is also hypothesized that the seasonal environment at birth may have an influence on diabetes incidence later in life. Among 9737 youth with T1D in the SEARCH study, the percentage of observed to expected births differed across the months with a
Other risk factors
Epidemiologic studies have identified that environmental factors operating early in life seem to trigger the immune-mediated process in genetically susceptible individuals. That nongenetic factors play a role in the development of T1D is shown by migration studies, increasing incidence within genetically stable populations, and twin studies. The environmental triggers that initiate pancreatic beta cell destruction remain largely unknown.
Nutritional factors that have been investigated include
Clinical course
The clinical course of T1D is typically characterized by the acute onset of the classic symptoms of diabetes: polyuria, polydipsia, and weight loss. However, given the increased awareness of T1D as well as research studies in which at-risk children are screened for diabetes autoantibodies, some youth present with sufficient residual beta cell function to be maintained on low doses of insulin, often once daily, at the time of diagnosis. The course of autoimmune diabetes is characterized by
Treatment and management
Several therapeutic options for persons with T1D currently exist and include multiple daily injections of rapid-acting insulin with meals combined with a daily basal insulin as well as continuous subcutaneous insulin infusion via an insulin pump. Other regimens such as premixed insulin are also used in certain clinical situations. Guidelines for the care of T1D in children83 and adults84 have been published. In addition, screening recommendations exist to monitor for the microvascular
Prevalence of complications
The DCCT showed that intensive glycemic control reduces the long-term vascular complications of hyperglycemia in T1D. Unfortunately, diabetic complications continue to be a major cause of morbidity and mortality in persons with T1D and cardiovascular disease (CVD) is the leading cause of death.97 Moreover, intensively controlled blood glucose often comes at the cost of increased hypoglycemia compared with less intensive (or pre-DCCT conventional) management.89, 98 Specifically, improved
Summary
Data from large epidemiologic studies worldwide indicate that the incidence of T1D has been increasing by 2% to 5% worldwide and that the prevalence of T1D is approximately 1 in 300 in the United States by 18 years of age. Research on risk factors for T1D is an active area of research to identify genetic and environmental triggers that could potentially be targeted for intervention. Although significant advances have been made in the clinical care of T1D with resultant improvements in quality
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This work was supported in part by K23 DK075360 from the National Institutes of Health.