medwireNews: The incidence of type 1 diabetes among children under 15 years of age in Ireland, a high incidence country, is increasing again following a period of stabilisation, particularly among younger age groups, a nationwide study shows.
“This may reflect a more aggressive disease process and has important implications for clinicians and health care providers”, say Edna Roche (Trinity College Dublin, Ireland) and colleagues in the European Journal of Pediatrics.
Between 2019 and 2021, the researchers verified 1027 cases of type 1 diabetes in children younger than 15 years of age reported by clinicians nationally to the Irish Childhood Diabetes National Register.
The direct standardised incidence rates were 31.1, 32.2 and 37.6 per 100,000 people per year in 2019, 2020 and 2021, respectively, an increase of 21% over the 3-year period and an average percentage increase of 10% per year.
This indicates that the “previously observed stabilisation and subsequent minor reduction in the incidence of [type 1 diabetes] in the Irish childhood population, suggesting a saturation in childhood diagnoses, has not been maintained”, the researchers note.
They add: “These findings suggest that the environmental pressure that promotes the development of [type 1 diabetes] has been maintained, if not increased.”
Roche et al point out that a similar pattern has also been seen in other high incidence countries, “particularly Sweden and more recently reported for Finland”.
The increased incidence of type 1 diabetes in Ireland was seen to a similar extent in both boys and girls, although “slightly more marked in males”, the investigators point out. There were 542 (53%) cases reported in boys and 485 (37%) in girls, with respective incidence increases over the 3 years of 22% and 20%.
“This is unusual for autoimmune conditions which tend to be more prevalent in females”, they observe.
The team also highlights that the mean age of diagnosis fell over the 3-year period. While incidence rates were consistently highest in the 10–14-year age category, in 2021, “for the first time”, the incidence rate was highest in the 5–9-year age category.
Specifically, diagnoses in children age 0–4 and 5–9 years increased from 15% to 19% and 34% to 40%, respectively, between 2019 and 2021, whereas they fell from 51% to 40% among children aged 10–14 years.
The other change in type 1 diabetes incidence was related to seasonality. Autumn and winter remained the dominant seasons for diagnosis in 2019 and 2020, but this changed to spring in 2021. The researchers suggest that this change in seasonal pattern is likely to have been influenced by restrictions imposed during the COVID-19 pandemic.
They conclude that in Ireland, “[t]he need for improving awareness of childhood diabetes is apparent”.
By Lucy Piper
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