Variation in the incidence of type 1 diabetes mellitus in children and adolescents by world region and country income group: A scoping review

Abstract

Introduction: Around 18.7 million of the 537 million people with diabetes worldwide live in low-income and middle-income countries (LMIC), where there is also an increase in the number of children, adolescents, and young adults diagnosed with type 1 diabetes (T1D). There are substantial gaps in data in the current understanding of the epidemiological patterns and trends in incidence rates of T1D at the global level.

Methods: We performed a scoping review of published studies that established the incidence of T1D in children, adolescents, and young adults aged 0-25 years at national and sub-national levels using PubMed, Embase and Global Health. Data was analyzed using R programming.

Results: The scoping review identified 237 studies which included T1D incidence estimates from 92 countries, revealing substantial variability in the annual incidence of T1D by age, geographic region, and country-income classification. Highest rates were reported in the 5-9 and 10-14 year age groups than in the 0-4 and 15-19 year age groups, respectively. In the 0-14 year age group, the highest incidence was reported in Northern Europe (23.96 per 100,000), Australia/New Zealand (22.8 per 100,000), and Northern America (18.02 per 100,000), while the lowest was observed in Melanesia, Western Africa, and South America (all < 1 per 100,000). For the 0-19 year age group, the highest incidence was reported in Northern Europe (39.0 per 100,000), Northern America (20.07 per 100,000), and Northern Africa (10.1 per 100,000), while the lowest was observed in Eastern and Western Africa (< 2 per 100,000). Higher incidence rates were observed in high-income countries compared to LMICs. There was a paucity of published studies focusing on determining the incidence of T1D in LMICs.

Conclusion: The review reveals substantial variability in incidence rates of T1D by geographic region, country income group, and age. There is a dearth of information on T1D in LMICs, particularly in sub-Saharan Africa, where incidence remains largely unknown. Investment in population-based registries and longitudinal cohort studies could help improve the current understanding of the epidemiological trends and help inform health policy, resource allocation, and targeted interventions to enhance access to effective, efficient, equitable, and responsive healthcare services.

Fig 1. PRISMA flow chart of study selection.

(Source: Authors).

Fig 2. Variation in TlD incidence rates for age groups 0–14 and 0–19 years by region.

[Point sizes are proportional to their weight (i.e. inverse variance). The lines indicate means and shaded areas indicate 95% Cls].

Fig 3. Variation in TlD incidence rates for age groups 0–4, 5–9, 10–14, 15–19 years by region.

[Point sizes are proportional to their weight (i.e. inverse variance). The lines indicate means and shaded areas indicate 95% Cls].

Fig 4. Geographical representation of incidence rates of TlD by income.

[Point sizes are proportional to their weight (i.e. inverse variance). The lines indicate means and shaded areas indicate 95% Cls].