Éva Gyürüs

Incidence trends for childhood type 1 diabetes in Europe during 1989-2003 and predicted new cases 2005-20: a multicentre prospective registration study

BACKGROUND The incidence of type 1 diabetes in children younger than 15 years is increasing. Prediction of future incidence of this disease will enable adequate fund allocation for delivery of care to be planned. We aimed to establish 15-year incidence trends for childhood type 1 diabetes in European centres, and thereby predict the future burden of childhood diabetes in Europe. METHODS 20 population-based EURODIAB registers in 17 countries registered 29 311 new cases of type 1 diabetes, diagnosed in children before their 15th birthday during a 15-year period, 1989-2003. Age-specific log linear rates of increase were estimated in five geographical regions, and used in conjunction with published incidence rates and population projections to predict numbers of new cases throughout Europe in 2005, 2010, 2015, and 2020. FINDINGS Ascertainment was better than 90% in most registers. All but two registers showed significant yearly increases in incidence, ranging from 0.6% to 9.3%. The overall annual increase was 3.9% (95% CI 3.6-4.2), and the increases in the age groups 0-4 years, 5-9 years, and 10-14 years were 5.4% (4.8-6.1), 4.3% (3.8-4.8), and 2.9% (2.5-3.3), respectively. The number of new cases in Europe in 2005 is estimated as 15 000, divided between the 0-4 year, 5-9 year, and 10-14 year age-groups in the ratio 24%, 35%, and 41%, respectively. In 2020, the predicted number of new cases is 24 400, with a doubling in numbers in children younger than 5 years and a more even distribution across age-groups than at present (29%, 37%, and 34%, respectively). Prevalence under age 15 years is predicted to rise from 94 000 in 2005, to 160 000 in 2020. INTERPRETATION If present trends continue, doubling of new cases of type 1 diabetes in European children younger than 5 years is predicted between 2005 and 2020, and prevalent cases younger than 15 years will rise by 70%. Adequate health-care resources to meet these childrens needs should be made available. FUNDING European Community Concerted Action Program.

Trends in childhood type 1 diabetes incidence in Europe during 1989–2008: evidence of non-uniformity over time in rates of increase

Aims/hypothesisThe aim of the study was to describe 20-year incidence trends for childhood type 1 diabetes in 23 EURODIAB centres and compare rates of increase in the first (1989–1998) and second (1999–2008) halves of the period.MethodsAll registers operate in geographically defined regions and are based on a clinical diagnosis. Completeness of registration is assessed by capture–recapture methodology. Twenty-three centres in 19 countries registered 49,969 new cases of type 1 diabetes in individuals diagnosed before their 15th birthday during the period studied.ResultsAscertainment exceeded 90% in most registers. During the 20-year period, all but one register showed statistically significant changes in incidence, with rates universally increasing. When estimated separately for the first and second halves of the period, the median rates of increase were similar: 3.4% per annum and 3.3% per annum, respectively. However, rates of increase differed significantly between the first half and the second half for nine of the 21 registers with adequate coverage of both periods; five registers showed significantly higher rates of increase in the first half, and four significantly higher rates in the second half.Conclusions/interpretationThe incidence rate of childhood type 1 diabetes continues to rise across Europe by an average of approximately 3–4% per annum, but the increase is not necessarily uniform, showing periods of less rapid and more rapid increase in incidence in some registers. This pattern of change suggests that important risk exposures differ over time in different European countries. Further time trend analysis and comparison of the patterns in defined regions is warranted.

Early mortality in EURODIAB population-based cohorts of type 1 diabetes diagnosed in childhood since 1989

Aims/hypothesisThe aims of this study were to provide a contemporary picture of mortality and causes of death in Europe following a diagnosis of type 1 diabetes made before the 15th birthday, and to examine excess mortality by country for possible links to incidence level or national prosperity.MethodsThirteen population-based EURODIAB registers in 12 countries followed-up 28,887 children diagnosed since 1989, either by record linkage to population registers or through contact with doctors providing care.ResultsThere were 141 deaths in the cohort during 219,061 person-years of follow-up compared with 69.1 deaths expected from national mortality rates, a standardised mortality ratio (SMR) of 2.0 (95% CI 1.7–2.4). The SMR varied from 0 to 4.7 between countries, but showed little relationship with the country’s incidence rate or gross domestic product (US

Twenty-one years of prospective incidence of childhood type 1 diabetes in Hungary - the rising trend continues (or peaks and highlands?)

per capita). The SMR did not change significantly with attained age, calendar period or time since diagnosis. The female SMR (2.7; 95% CI 2.0–3.5) was greater than the male SMR (1.8; 95% CI 1.4–2.2), although absolute numbers of excess deaths were similar in the two sexes. One-third of deaths were classified as directly attributable to diabetes (many with mention of ketoacidosis) and half were unrelated to diabetes. There was a non-significant excess of accidental/violent deaths (48 observed vs 40.7 expected; SMR 1.2; 95% CI 0.9–1.6) but little excess in suicides (11 observed, 10.2 expected; SMR 1.1; 95% CI 0.5–1.9).Conclusions/interpretationBefore the onset of late complications, significant excess mortality existed following the diagnosis of type 1 diabetes in childhood, even in recent years. Variation between countries in this excess could not be explained.

Seasonal variation in month of diagnosis in children with type 1 diabetes registered in 23 European centers during 1989-2008: little short-term influence of sunshine hours or average temperature

Gyurus EK, Patterson C, Soltesz G and the Hungarian Childhood Diabetes Epidemiology Group. Twenty‐one years of prospective incidence of childhood type 1 diabetes in Hungary – the rising trend continues (or peaks and highlands?).

Dynamic changes in the trends in incidence of type 1 diabetes in children in Hungary (1978-98).

The month of diagnosis in childhood type 1 diabetes shows seasonal variation.

“Always up or peaks and highlands?” Incidence of childhood type 1 diabetes in Hungary (1989–2009)

Abstract: Objective:  To determine the recent trends in incidence, to analyze the age and geographic distribution, as well as the seasonal pattern of type 1 diabetes in Hungarian children aged 0–14 yr for the period from 1978 to 1998.

["Constantly rising or peaks and plateaus?" Incidence of childhood type 1 diabetes in Hungary (1989-2009)].

UNLABELLED Aim of this study was to examine secular trends in the incidence of type 1 diabetes in children aged 0-14 years in Hungary over the period 1989-2009. METHODS Newly diagnosed children with type 1 diabetes aged 0-14 years in Hungary were prospectively registered from 1989 to 2009. Standardized incidence rates were calculated and secular trends were estimated using Poisson regression analysis. RESULTS Between 1989 and 2009 a total number of 3432 children were identified, giving a standardized incidence rate of 12.5 (95%CI 12.1-12.9) per 100 000 person/year. The overall incidence rate has doubled from 7.7 (95%CI 6.4-9.15) per 100 000 per year in 1989 to 18.2 (95%CI 15.7-20.9) per 100 000 per year in 2009. A significant linear trend in incidence (p<0.001) has been observed over time, with a mean annual increase of 4.4%. The increase in incidence was present in both genders and in all age groups, with the largest relative increase in the youngest age group (6.2%; p<0.001). CONCLUSION The incidence of type 1 diabetes in Hungarian children continues to increase, with the highest rate in the very young.

Folyamatos emelkedo vagy csúcsok és fennsíkok? A gyermekkori 1-es típusú diabetes incidenciája Magyarországon (1989-2009)

UNLABELLED Aim of this study was to examine secular trends in the incidence of type 1 diabetes in children aged 0-14 years in Hungary over the period 1989-2009. METHODS Newly diagnosed children with type 1 diabetes aged 0-14 years in Hungary were prospectively registered from 1989 to 2009. Standardized incidence rates were calculated and secular trends were estimated using Poisson regression analysis. RESULTS Between 1989 and 2009 a total number of 3432 children were identified, giving a standardized incidence rate of 12.5 (95%CI 12.1-12.9) per 100 000 person/year. The overall incidence rate has doubled from 7.7 (95%CI 6.4-9.15) per 100 000 per year in 1989 to 18.2 (95%CI 15.7-20.9) per 100 000 per year in 2009. A significant linear trend in incidence (p<0.001) has been observed over time, with a mean annual increase of 4.4%. The increase in incidence was present in both genders and in all age groups, with the largest relative increase in the youngest age group (6.2%; p<0.001). CONCLUSION The incidence of type 1 diabetes in Hungarian children continues to increase, with the highest rate in the very young.

[Incidence of type 1 childhood diabetes in Hungary (1978-1997). Hungarian Committee on the Epidemiology of Childhood Diabetes].

UNLABELLED Aim of this study was to examine secular trends in the incidence of type 1 diabetes in children aged 0-14 years in Hungary over the period 1989-2009. METHODS Newly diagnosed children with type 1 diabetes aged 0-14 years in Hungary were prospectively registered from 1989 to 2009. Standardized incidence rates were calculated and secular trends were estimated using Poisson regression analysis. RESULTS Between 1989 and 2009 a total number of 3432 children were identified, giving a standardized incidence rate of 12.5 (95%CI 12.1-12.9) per 100 000 person/year. The overall incidence rate has doubled from 7.7 (95%CI 6.4-9.15) per 100 000 per year in 1989 to 18.2 (95%CI 15.7-20.9) per 100 000 per year in 2009. A significant linear trend in incidence (p<0.001) has been observed over time, with a mean annual increase of 4.4%. The increase in incidence was present in both genders and in all age groups, with the largest relative increase in the youngest age group (6.2%; p<0.001). CONCLUSION The incidence of type 1 diabetes in Hungarian children continues to increase, with the highest rate in the very young.