Increase in Type 1 Diabetes Expected

Around 15,000 new cases of Type 1 diabetes were recorded across the whole of Europe in 2005. Of these, 24% were children up to the age of four, 37% children aged five to nine and 34% children aged 10 to 14.

Researchers found that the overall incidence of the disease was increasing by 3.9% per year. The increase in the 0-4 age group was 5.4%, with a 4.3% rise in the 5-9 age group and a 2.9% increase among 10 to 14-year-olds. A total of 24,400 new cases were forecast for 2020, with a doubling in the number of cases of children aged five and under since 2005, just for Europe.

Numbers of child sufferers older than five were also expected to increase substantially. Scientists say the changes are too fast to be explained by genetic factors alone.

They suggest lifestyle factors may be partly responsible, including a trend towards women having bigger babies and increased numbers of Caesarean section births. Higher increases were seen in eastern Europe, where lifestyle habits were changing more rapidly than in the richer European countries.

The incidence of Type 1 diabetes among very young children will double from 2005 levels in a little over a decade if present trends continue, a new study shows. The prediction is based on Type 1 diabetes trends in Europe, but experts say there is every reason to believe that the U.S. will see a similar dramatic increase in the disease.

They are also convinced that environmental exposures are driving the increase, but it is far from clear what those exposures are.

Once known as juvenile diabetes, Type 1 diabetes is much less common than Type 2 diabetes, except among children and adolescents.

Epidemiologist Christopher C. Patterson, PhD, of Ireland’s Queen’s University, states that, “The most common age of diagnosis has been the early teen years, but that burden may be shifting toward younger children.”

“We are likely to see more children with severe diabetes complications presenting at earlier ages if we fail to recognize and adequately treat disease in very young patients,” he says.

In the latest issue of The Lancet, Patterson and colleagues concluded that rates of Type 1 diabetes among children and young teens are increasing faster than previous predictions suggested.

Patterson and colleagues analyzed data from European registries, which included information on more than 29,000 children with Type 1 diabetes, enrolled between 1989 and 2003.

They found that:

• The overall increase in incidence of Type 1 diabetes was 3.9% per year.
• The increase was greatest among children under 5, who saw increases of 5.4% per year compared to an annual increase of 4.3% among children between the ages of 5 and 9 and 2.9% among children between the ages of 10 and 14.
• If present trends continue, total cases of disease are projected to rise by 70% by 2020 and rates among children under 5 will double.

Since the increases are occurring so quickly, it is likely that environmental influences are driving the trend, Patterson says.
Researchers are examining a wide range of possible environmental triggers, including early-life diet, viral infection, and even C-section delivery. But they still have more questions than answers.

“Being born to an older mom and C-section birth seem to be associated with slight increases in risk, but neither one of these is sufficient to explain the increases we are seeing,” he says.

Epidemiologist Dana Dabelea, MD, PhD, from the University of Colorado, stated that one of the key areas of interest is rapid early growth due to improved early-life nutrition.

Dabelea is a co-investigator on the SEARCH for Diabetes in Youth Study, which is following children with Type 1 and Type 2 diabetes in different areas in the U.S. in an effort to better understand diabetes trends in non-adults.

In 2007, Dabelea and colleagues reported higher-than-predicted rates of Type 1 diabetes. The increase was most pronounced among non-Hispanic white children.

In an editorial accompanying the new study, Dabelea called for more research on Type 1 and Type 2 diabetes in children.
“It is imperative that efforts directed at surveillance of diabetes in young people continue and expand, not only to understand its complex etiology, but also because of the increasing public health importance,” she writes.

Patterson, C. The Lancet, May 28; online edition. Christopher C. Patterson, PhD, epidemiology research group, Queen’s University Belfast. Dana Dabelea, MD, PhD, associate professor, department of epidemiology, Colorado School of Public Health, University of Colorado, Denver. Dabelea  D. The Journal of the American Medical Association, June 27, 2007; vol 297: pp 2716-2724.

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