Cases of type 1 diabetes in children under five years across Europe will double by 2020 (from 2005 levels) if present trends continue. Numbers in children older than five will also increase substantially. The findings are discussed in an Article published Online First and in an upcoming edition of The Lancet, written by Dr Chris Patterson, Queen's University, Belfast, UK, and Prof Gyula Soltész, Pécs University, Pécs, Hungary, and colleagues.
Type 1 diabetes is caused by insulin deficiency (and thus must be treated with insulin injections), whereas type 2 diabetes is caused by reduced insulin sensitivity along with some insulin deficiency. In the general population, type 1 diabetes cases represent only 10% of total diabetes cases. However among children the numbers of cases of type 1 diabetes is higher than type 2 in most countries. To predict the future burden of type 1 diabetes, the authors analysed diabetes data from 20 centres in 17 European countries, which had registered 29311 cases of type 1 diabetes during the period 1989-2003.
The researchers found that the overall increase in incidence of type 1 diabetes was 3.9% per year; while the annual increase in the 0—4 years age group was 5.4%, with a 4.3% rise in the 5—9 years age group, and a 2.9% rise in 10—14—year-olds. There were estimated to have been approximately 15,000 new cases in Europe in 2005, divided among the 0—4 years, 5—9 years, and 10—14 in the ratio 24%, 37% and 34% respectively. A total of 24,400 new cases is predicted in 2020, with a doubling in the number of cases in children aged under 5 years and a more even distribution across age groups than at present (29%, 37%, and 34% respectively). If present trends continue, the total number of cases (new and existing) in European children under 15 years is predicted to rise from 94,000 in 2005 to 160,000 in 2020—a 70% increase.
The changes over time are so rapid, say the authors, that they clearly cannot be because of genetic factors alone. They discuss modern lifestyle habits as possible contributory factors, such as increased weight and height development and increased caesarean section births. The higher increases are seen in Eastern Europe, where lifestyle habits are also changing more rapidly than in the richer European countries.
The authors conclude: "The predicted rise in childhood type 1 diabetes in Europe during the next 20 years, and the raised proportion of cases diagnosed at younger ages than were before, could result in more cases presenting with ketoacidosis and needing hospital admission. More patients with severe diabetes complications presenting at younger ages than before are also likely, and appropriate care from diagnosis, and maintenance of good metabolic control are crucial for delay or prevention of these adverse complications. In the absence of any effective means to prevent type 1 diabetes, European countries need to ensure appropriate planning of services and that resources are in place to provide high-quality care for the increased numbers of children who will be diagnosed with diabetes in future years."
In an accompanying Comment, Dr Dana Dabelea, Colorado School of Public Health, University of Colorado, Denver, CO, USA, says the findings from this and other studies suggest 'that the incidence of type 1 diabetes is increasing even faster than before, pointing towards harmful changes in the environment in which contemporary children live'. She also discusses the findings specific to children under 5, and the concerns that younger age of onset of type 1 diabetes is usually associated with more acute symptoms. The consequences of longer exposure to altered metabolism due to diabetes and the increasing economic costs of the disease are also looked at.
She concludes: "It is imperative that efforts directed at surveillance of diabetes in young people continue and expand, not only to understand its complex aetiology, but also because of its increasing public health importance."
Dr Chris Patterson, Queen's University, Belfast, UK T) +44 (0)28 9063 2688 E) c.patterson@qub.ac.uk
Prof Gyula Soltész, Pécs University, Pécs, Hungary T) +36 72 535-900 E) gyula.soltesz@aok.pte.hu
Dr Dana Dabelea, Colorado School of Public Health, University of Colorado, Denver, CO, USA E) Dana.Dabelea@ucdenver.edu
For full Article and Comment, see: http://press.thelancet.com/childtype1.pdf
Note to editors: *ketoacidosis: this is a common complication of type 1 diabetes in which the liver breaks down fats and proteins to provide energy in an unregulated fashion, leading to such a high concentration of ketone acids in the blood that the acidity of the blood is increased. Severe ketoacidosis is potentially life threatening if not treated promptly.
Journal
The Lancet