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Explosive increase in type 1 diabetes predicted
Patterson CC, G Dahlquist GG, Gyürüs E, et al: the EURODIAB Study Group. Incidence trends for childhood type 1 diabetes in Europe during 1989—2003 and predicted new cases 2005—20: a multicentre prospective registration study. The Lancet, 2009 Early Online Publication, 28 May 2009 doi:10.1016/S0140-6736(09)60568-7 SummaryBackground 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 children's needs should be made available. |
COMMENT: 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 researchers say they are uncertain about the precise causes for the increase in incidence and earlier age of onset of type 1 diabetes. But they shouldn't be. See http://www.second-opinions.co.uk/diabetes-7.html.
What have been the major environmental changes of the last quarter of a century? The biggest one, most likely to affect diabetes and obesity, is 'healthy eating' which was introduced in the 1980s and has been aggressively promoted ever since.
And, as Eastern European
countries have joined the EU and come under the
influence of Western European dietary paradigms, it is
not surprising that the consequent dramatic change of
diet should cause an equally dramatic increase in
'western' diseases such as diabetes.
Last updated 20 May 2009
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