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Cited by 1,092Diabetes and associated disordersDiabetes Management and ResearchDiabetes, Cardiovascular Risks, and Lipoproteins

Epidemiology of type 1 diabetes

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Maahs, David M., West, Nancy A., Lawrence, Jean M., Mayer-Davis, Elizabeth J.·2010·Endocrinology and Metabolism Clinics of North America
DOI 10.1016/j.ecl.2010.05.011PMC PMC2925303
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Abstract

Synopsis This chapter describes the epidemiology of type 1 diabetes mellitus (T1D) around the world and across the lifespan. Epidemiologic patterns of T1D by demographic, geographic, biologic, cultural and other factors in populations are presented to gain insight about the etiology, natural history, risks, and complications of T1D. Data from large epidemiologic studies worldwide indicate that the incidence of T1D has been increasing by 2–5% worldwide and that the prevalence of T1D is approximately 1 in 300 in the US by 18 years of age. Research on risk factors for T1D is an active area of research to identify genetic and environmental triggers that could potentially be targeted for intervention. While significant advances have been made in the clinical care of T1D with resultant improvements in quality of life and clinical outcomes, much more needs to be done to improve care of, and ultimately find a cure for T1D. Epidemiologic studies have an important on-going role to investigate the complex causes, clinical care, prevention, and cure of T1D.

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  • Premisecitation

    Recent studies show that environmental factors have a stronger effect on individuals with lower-risk genotypes than on those at higher genetic risk.

    “Furthermore, they note recent studies17–19 demonstrate environmental factors have a stronger effect on individuals with lower risk genotypes as compared to those at higher risk genetically.”
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    • cites [17] Hermann, 2003, Temporal changes in the frequencies of HLA genotypes in patients with type 1 diabetes–indication of an increased environmental pressure?, Diabetologia source

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    • cites [18] Kaila, 2003, HLA, day care attendance, and socio-economic status in young patients with type 1 diabetes, Diabet Med source

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    • cites [19] Gillespie, 2004, The rising incidence of childhood type 1 diabetes and reduced contribution of high-risk HLA haplotypes, Lancet source

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  • Premisecitation

    The EURODIAB ACE study ascertained 16,362 type 1 diabetes cases in 44 centers in Europe and Israel covering about 28 million children during 1989-94.

    “The EURODIAB ACE study group ascertained 16,362 cases of T1D in 44 centers throughout Europe and Israel covering a population of ~28 million children during the period 1989–9411.”
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    • cites [11] 2000, Variation and trends in incidence of childhood diabetes in Europe. EURODIAB ACE Study Group, Lancet source

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  • Premisenone given

    In the US, the prevalence of type 1 diabetes is about 1 in 300 by 18 years of age.

    “the prevalence of T1D is approximately 1 in 300 in the US by 18 years of age”
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      “the prevalence of T1D is approximately 1 in 300 in the US by 18 years of age”
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  • Premisecitation

    SEARCH type 1 diabetes incidence was slightly higher in females than males, with a relative risk of 1.028 (95% CI 1.025-1.030).

    “were slightly higher in females as compared to males (RR, 1.028; 95% CI, 1.025–1.030)”
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    • cites [3] Dabelea, 2007, Incidence of diabetes in youth in the United States, JAMA source

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  • Premisecitation

    SEARCH type 1 diabetes incidence rates were highest in non-Hispanic white youth compared with other race/ethnicities.

    “Rates were highest in non-Hispanic white youth as compared to other race/ethnicities”
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    • cites [3] Dabelea, 2007, Incidence of diabetes in youth in the United States, JAMA source

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    Premisecitation

    In most DIAMOND populations, type 1 diabetes incidence increased with age and was highest in 10-14 year olds.

    “The incidence of T1D increased with age in most populations with the highest incidence observed in the 10–14 year olds.”
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    • cites [9] Karvonen, 2000, Incidence of childhood type 1 diabetes worldwide. Diabetes Mondiale (DiaMond) Project Group, Diabetes Care source

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    Premisecitation

    Type 1 diabetes has historically been and remains the most common diabetes type in children and adolescents, though type 2 diabetes is increasingly diagnosed in youth.

    “T1D has been historically, and continues to be, the most common type of diabetes in children and adolescents, although type 2 diabetes (T2D) is increasingly diagnosed in youth2,3.”
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    • cites [2] Liese, 2006, The burden of diabetes mellitus among US youth: prevalence estimates from the SEARCH for Diabetes in Youth Study, Pediatrics source

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    • cites [3] Dabelea, 2007, Incidence of diabetes in youth in the United States, JAMA source

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    Premisecitation

    Among children under 10 years, type 1 diabetes accounted for almost all reported diabetes cases, whereas in youth 10-19 years the proportion with type 2 diabetes ranged from 6% in non-Hispanic whites to 76% in American Indians.

    “Among children <10 years of age, T1D accounted for almost all of the reported cases of diabetes, whereas in youth ages 10–19 years, the proportion with T2D out of the total sample of youth with diabetes ranged from 6% (in non-Hispanic whites) to 76% (in American Indians).”
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    • cites [2] Liese, 2006, The burden of diabetes mellitus among US youth: prevalence estimates from the SEARCH for Diabetes in Youth Study, Pediatrics source

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    Premisecitation

    The DIAMOND project found more than a 350-fold difference in type 1 diabetes incidence among 100 populations worldwide, with age-adjusted rates from 0.1 per 100,000 per year in China and Venezuela to 36.5 per 100,000 in Finland and 36.8 per 100,000 in Sardinia.

    “A greater than 350-fold difference in the incidence of T1D among the 100 populations worldwide was reported with age-adjusted incidences ranging from a low of 0.1/100,000 per year in China and Venezuela to a high of 36.5/100,000 in Finland and 36.8/100,000 per year in Sardinia.”
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    • cites [9] Karvonen, 2000, Incidence of childhood type 1 diabetes worldwide. Diabetes Mondiale (DiaMond) Project Group, Diabetes Care source

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    Premisecitation

    Type 1 diabetes represents 5-10% of all diabetes cases globally.

    “T1D accounts for 5–10% of the total cases of diabetes worldwide1”
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    • cites [1] American Diabetes Association, 2009, Diagnosis and classification of diabetes mellitus, Diabetes Care source

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    Premisecitation

    SEARCH type 1 diabetes incidence in 2002-03 peaked at ages 5-9 and 10-14 years, with rates per 100,000 person-years of 14.3 for 0-4, 22.1 for 5-9, 25.9 for 10-14, and 13.1 for 15-19 years.

    “The incidence rate of T1D in 2002–03 peaked in the age groups 5–9 years and 10–14 years and incidence per 100,000 person years by age group were as follows: 0–4 years, 14.3; 5–9 years, 22.1; 10–14 years 25.9; 15–19 years, 13.1.”
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    • cites [3] Dabelea, 2007, Incidence of diabetes in youth in the United States, JAMA source

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    Premisecitation

    In Colorado, type 1 diabetes incidence was 14.8 per 100,000 per year (95% CI 14.0-15.6) in 1978-88 and 23.9 per 100,000 per year (95% CI 22.2-25.6) in 2002-04.

    “The incidence of T1D was 14.8/100,000 per year (95% CI 14.0–15.6) in 1978–88 and was 23.9/100,000 per year (95% CI 22.2–25.6) in 2002–04 for the state of Colorado.”
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    • cites [20] Vehik, 2007, Increasing incidence of type 1 diabetes in 0- to 17-year-old Colorado youth, Diabetes Care source

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    Premisecitation

    EURODIAB found an annual increase in type 1 diabetes incidence of 3.4% (95% CI 2.5-4.4%), with higher increases in some central European countries.

    “In this time period, the annual increase in the incidence rate of T1D was 3.4% (95% CI 2.5–4.4%) although the rate of increase was noted to be higher in some central European countries.”
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    • cites [11] 2000, Variation and trends in incidence of childhood diabetes in Europe. EURODIAB ACE Study Group, Lancet source

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    Premisecitation

    EURODIAB rates of increase were highest in the youngest age group: 6.3% (95% CI 1.5-8.5%) for ages 0-4, 3.1% (1.5-4.8%) for 5-9, and 2.4% (1.0-3.8%) for 10-14 years.

    “The rates of increase were found to be the highest in the youngest age group: ages 0–4 years (6.3%, 95% CI 1.5–8.5%), 5–9 years (3.1%, 95% CI 1.5–4.8%), and 10–14 years (2.4%, 95% CI 1.0–3.8%)”
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    • cites [11] 2000, Variation and trends in incidence of childhood diabetes in Europe. EURODIAB ACE Study Group, Lancet source

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    Premisecitation

    During a 26-year period, Colorado type 1 diabetes incidence increased by 2.3% (95% CI 1.6-3.1) per year, with significant increases in non-Hispanic white and Hispanic youth.

    “During this 26 year period, the incidence of T1D increased by 2.3% (95% CI 1.6–3.1) per year with significant increases for both non-Hispanic white and Hispanic youth.”
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    • cites [20] Vehik, 2007, Increasing incidence of type 1 diabetes in 0- to 17-year-old Colorado youth, Diabetes Care source

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    Premisecitation

    Within-country variation in type 1 diabetes incidence was reported, with rates 3-5 times higher in Sardinia than continental Italy and similar variation within Portugal, New Zealand, and China.

    “Within country variation was also reported with rates 3–5 times higher in Sardinia than in continental Italy, with similar variation reported within Portugal, New Zealand, and China.”
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    • cites [9] Karvonen, 2000, Incidence of childhood type 1 diabetes worldwide. Diabetes Mondiale (DiaMond) Project Group, Diabetes Care source

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    Premisecitation

    An updated DIAMOND report found an average annual increase in type 1 diabetes incidence of 2.8% (95% CI 2.4-3.2%) from 1990-1999, with a higher rate in 1995-1999 (3.4%) than in 1990-1994 (2.4%).

    “the average annual increase in incidence over this time period was 2.8% (95% CI 2.4–3.2%) with a slightly higher rate in the period 1995–1999, 3.4% (95% CI 2.7–4.3%), than in the period 1990–1994, 2.4% (95% CI 1.3–3.4%).”
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    • cites [10] DIAMOND Project Group, 2006, Incidence and trends of childhood type 1 diabetes worldwide 1990–1999, Diabet Med source

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    Premisecitation

    The lowest type 1 diabetes incidence in DIAMOND was below 1 per 100,000 per year in China and South America, while the highest exceeded 20 per 100,000 per year in Sardinia, Finland, Sweden, Norway, Portugal, the UK, Canada, and New Zealand.

    “The lowest incidence (<1/100,000 per year) was reported in the populations from China and South America and the highest incidence (>20/100,000 per year) was reported in Sardinia, Finland, Sweden, Norway, Portugal, the UK, Canada, and New Zealand.”
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    • cites [9] Karvonen, 2000, Incidence of childhood type 1 diabetes worldwide. Diabetes Mondiale (DiaMond) Project Group, Diabetes Care source

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    Premisecitation

    In SEARCH, type 1 diabetes prevalence was 2.28 per 1,000 in youth under 20 years, corresponding to 5,399 cases in a population of about 3.5 million.

    “In the SEARCH study, the prevalence of T1D was 2.28/1000 in youth less than age 20 years or 5,399 cases in a population of ~3.5 million2.”
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    • cites [2] Liese, 2006, The burden of diabetes mellitus among US youth: prevalence estimates from the SEARCH for Diabetes in Youth Study, Pediatrics source

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    Interpretationreasoning

    The reported increases in type 1 diabetes incidence cannot be attributed to genetic shifts over such a short period, so causative agents should be sought in the environment or gene-environment interaction.

    “Such reported increases cannot be attributed to genetic shifts in such a short period of time and the authors state that causative agents should be investigated in the environment or the gene-environment interaction.”
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    • cites [10] DIAMOND Project Group, 2006, Incidence and trends of childhood type 1 diabetes worldwide 1990–1999, Diabet Med source

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    Premisecitation

    The prevailing etiologic paradigm holds that environmentally triggered autoimmune destruction of pancreatic beta cells occurs on a background of genetic risk.

    “The current prevailing paradigm on the etiology of T1D hypothesizes that environmentally triggered autoimmune destruction of pancreatic beta cells occurs against the background of genetic risk6”
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    • cites [6] Eisenbarth, 1986, Type I diabetes mellitus. A chronic autoimmune disease, N Engl J Med source

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    Premisecitation

    Type 1 diabetes incidence generally increases from birth and peaks between ages 10 and 14 during puberty.

    “In general, the incidence rate increases from birth and peaks between the ages of 10–14 years during puberty3,10,11.”
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    • cites [3] Dabelea, 2007, Incidence of diabetes in youth in the United States, JAMA source

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    • cites [10] DIAMOND Project Group, 2006, Incidence and trends of childhood type 1 diabetes worldwide 1990–1999, Diabet Med source

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    • cites [11] 2000, Variation and trends in incidence of childhood diabetes in Europe. EURODIAB ACE Study Group, Lancet source

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    Premisecitation

    DIAMOND trends for increased type 1 diabetes incidence were seen across the world, with 4.0% in Asia, 3.2% in Europe, and 5.3% in North America, except Central America and the West Indies, where incidence decreased by 3.6%.

    “These trends for increased incidence of T1D were seen across the world in the populations studied (4.0% in Asia, 3.2% in Europe, and 5.3% in North America) with the exception of Central American and the West Indies, where T1D is less prevalent, and where the trend was a decrease of 3.6%.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [10] DIAMOND Project Group, 2006, Incidence and trends of childhood type 1 diabetes worldwide 1990–1999, Diabet Med source

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    Study design and conductnone given

    Ascertainment techniques differ between studies and must be considered when comparing type 1 diabetes incidence rates.

    “However, ascertainment techniques differ by study and must be considered when comparing incidence rates by study.”
    Quote in the paperNot a substantial claim

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    Premisecitation

    A statistically significant male-to-female excess in type 1 diabetes incidence was reported in 3 centers, and no population reported a female excess.

    “A statistically significant male-to-female excess in incidence was reported in 3 centers, but no populations reported a female excess.”
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    • cites [9] Karvonen, 2000, Incidence of childhood type 1 diabetes worldwide. Diabetes Mondiale (DiaMond) Project Group, Diabetes Care source

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    Premisecitation

    Poor glycemic control, high LDL-cholesterol, and high triglycerides were common in Hispanic SEARCH youth with type 1 diabetes, and 44% were overweight or obese.

    “Poor glycemic control as well as high LDL-cholesterol and triglycerides were common and 44% of these youth with T1D were overweight or obese.”
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    • cites [38] Lawrence, 2009, Diabetes in Hispanic American youth: prevalence, incidence, demographics, and clinical characteristics: the SEARCH for Diabetes in Youth Study, Diabetes Care source

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    Premisecitation

    Monozygotic twins have a type 1 diabetes concordance rate above 60% if followed long enough, whereas dizygotic twins have a concordance rate of 6% to 10%.

    “Monozygotic twins have a concordance rate of > 60% if followed long enough47 whereas dizygotic twins have a concordance rate of 6% to 10%.”
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    • cites [47] Redondo, 2001, Heterogeneity of type I diabetes: analysis of monozygotic twins in Great Britain and the United States, Diabetologia source

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    Premisecitation

    In the US, individuals with a first-degree relative with type 1 diabetes have a 1 in 20 lifetime risk of developing type 1 diabetes, compared with a 1 in 300 lifetime risk in the general population.

    “In the United States, individuals with a first-degree relative with T1D have a 1 in 20 lifetime risk of developing T1D, compared to a 1 in 300 lifetime risk for the general population46.”
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    • cites [46] Redondo, 2008, Concordance for islet autoimmunity among monozygotic twins, N Engl J Med source

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    Premisecitation

    In African American SEARCH youth, type 1 diabetes prevalence was 0.57 per 1,000 (95% CI 0.47-0.69) for ages 0-9 and 2.04 per 1,000 (95% CI 1.85-2.26) for ages 10-19.

    “In African American youth in the SEARCH study, the prevalence of T1D was 0.57/1,000 (95% CI 0.47– 0.69) for youth age 0–9 years and 2.04/1,000 (1.85–2.26) for youth 10–19 years.”
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    • cites [37] Mayer-Davis, 2009, Diabetes in African American youth: prevalence, incidence, and clinical characteristics: the SEARCH for Diabetes in Youth Study, Diabetes Care source

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    Premisecitation

    Vitamin D deficiency has been associated with type 1 diabetes, and use of cod liver oil during pregnancy and during the first year of life has been associated with lower risk of type 1 diabetes.

    “Vitamin D deficiency has been associated with T1D64,65 and the use of cod liver oil (a rich source of vitamin D) during pregnancy66 and the first year of life67 has been associated with a lower risk of T1D.”
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    • cites [64] Mohr, 2008, The association between ultraviolet B irradiance, vitamin D status and incidence rates of type 1 diabetes in 51 regions worldwide, Diabetologia source

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    • cites [65] Stene, 2000, Use of cod liver oil during pregnancy associated with lower risk of type I diabetes in the offspring, Diabetologia source

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    • cites [66] Stene, 2003, Use of cod liver oil during the first year of life is associated with lower risk of childhood-onset type 1 diabetes: a large, population-based, case-control study, Am J Clin Nutr source

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    • cites [67] Kumar, 2009, Prevalence and associations of 25-hydroxyvitamin D deficiency in US children: NHANES 2001–2004, Pediatrics source

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    Premisecitation

    The SEARCH birth month effect was not observed in southern centers (South Carolina, Hawaii, Southern California) but only in northern latitudes (Colorado, Washington, Ohio).

    “This birth month effect was not observed in youth recruited from the centers in the more southern locations (South Carolina, Hawaii, Southern California), but only in the more northern latitudes (Colorado, Washington, and Ohio)54.”
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    • cites [54] Vaiserman, 2007, Seasonality of birth in children and young adults (0–29 years) with type 1 diabetes in Ukraine, Diabetologia source

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    Premisecitation

    Offspring of affected mothers have a 2% to 3% risk of type 1 diabetes, whereas offspring of affected fathers have a 7% risk.

    “The offspring of affected mothers have a 2% to 3% risk, whereas offspring of affected fathers have a 7% risk51.”
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    • cites [51] Tsirogianni, 2009, Specificity of islet cell autoantibodies and coexistence with other organ specific autoantibodies in type 1 diabetes mellitus, Autoimmun Rev source

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    Premisenone given

    Type 1 diabetes incidence rates decline after puberty and appear to stabilize in young adulthood (15-29 years).

    “Incidence rates decline after puberty and appear to stabilize in young adulthood (15–29 years).”
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    Premisecitation

    Non-Hispanic white youth with type 1 diabetes had adverse cardiometabolic risk profiles: more than 40% had elevated LDL, fewer than 3% met saturated fat recommendations, and 18% of those aged 15 years or older were current smokers.

    “These youth had adverse cardiometabolic risk profiles (>40% with elevated LDL, <3% met dietary recommendations for saturated fat, and among those ≥15 years of age 18% were current smokers)”
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    • cites [36] Bell, 2009, Diabetes in non-Hispanic white youth: prevalence, incidence, and clinical characteristics: the SEARCH for Diabetes in Youth Study, Diabetes Care source

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    Premisecitation

    A recent Swedish report on more than 5,800 patients aged 15-34 found higher type 1 diabetes incidence during January-March and lowest during May-July, with no difference by gender.

    “a recent report from Sweden on more than 5800 patients 15–34 years of age found the higher incidence during January–March and the lowest during May–July with no difference by gender70.”
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    • cites [70] Pundziute-Lycka, 2000, Infections and risk of type I (insulin-dependent) diabetes mellitus in Lithuanian children, Diabetologia source

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    Premisenone given

    Beta cell destruction in adults appears to occur much more slowly than in young type 1 diabetes cases, often delaying the need for insulin therapy after diagnosis.

    “beta cell destruction in adults appears to occur at a much slower rate than in young T1D cases, often delaying the need for insulin therapy after diagnosis.”
    Quote in the paperNot a substantial claim

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    Premisecitation

    Among 9,737 SEARCH youth with type 1 diabetes, the percentage of observed to expected births differed across months, with a deficit of November-February births and an excess of April-July births.

    “Among 9,737 youth with T1D in the SEARCH study, the percentage of observed to expected births differed across the months with a deficit of November-February births and an excess in April–July births.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [54] Vaiserman, 2007, Seasonality of birth in children and young adults (0–29 years) with type 1 diabetes in Ukraine, Diabetologia source

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    Premisecitation

    Type 1 diabetes incidence is lower in adults than in children, although about one fourth of people with type 1 diabetes are diagnosed as adults.

    “The incidence of T1D in adults is lower than in children, although approximately one fourth of persons with T1D are diagnosed as adults24.”
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    • cites [24] Haller, 2005, Type 1 diabetes mellitus: etiology, presentation, and management, Pediatr Clin North Am source

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    Premisecitation

    Among African American SEARCH youth with type 1 diabetes who attended the research visit, 50% of those aged 15 years or older had A1c ≥9.5% and 44.7% were overweight or obese.

    “Of the African American youth that attended the research visit with T1D, 50% of those ≥15 years had A1c ≥9.5% and 44.7% were either overweight or obese.”
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    • cites [37] Mayer-Davis, 2009, Diabetes in African American youth: prevalence, incidence, and clinical characteristics: the SEARCH for Diabetes in Youth Study, Diabetes Care source

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    Premisecitation

    Although 90-95% of young children with type 1 diabetes carry either or both HLA susceptibility haplotypes, approximately 5% or fewer people with HLA-conferred genetic susceptibility develop clinical disease.

    “Although 90–95% of young children with T1D carry either or both susceptibility haplotypes, approximately 5% or fewer persons with HLA-conferred genetic susceptibility actually develop clinical disease42.”
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    • cites [42] Virtanen, 2003, Nutritional risk predictors of beta cell autoimmunity and type 1 diabetes at a young age, Am J Clin Nutr source

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    Premisecitation

    Reports suggest a recent temporal trend of fewer high-risk HLA genotypes in youth diagnosed with type 1 diabetes, suggesting an increased influence of environmental factors during recent decades.

    “A number of reports suggest a recent temporal trend of fewer high-risk HLA genotypes in youth diagnosed with T1D, suggesting an increased influence of environmental factors in the development of T1D during the past few decades19,44,45.”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites [19] Gillespie, 2004, The rising incidence of childhood type 1 diabetes and reduced contribution of high-risk HLA haplotypes, Lancet source

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    • cites [44] Vehik, 2008, Trends in high-risk HLA susceptibility genes among Colorado youth with type 1 diabetes, Diabetes Care source

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    • cites [45] Redondo, 2001, Genetics of type 1A diabetes, Recent Prog Horm Res source

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  • May combine two claims.

    Premisecitation

    Regions with high type 1 diabetes incidence, mainly populations of European origin, have a male excess, whereas low-incidence regions of non-European origin report a female excess.

    “A distinctive pattern has been observed such that regions with a high incidence of T1D (populations of European origin) have a male excess, whereas regions with a low incidence (populations of non-European origin) report a female excess29,30.”
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    • cites [29] Green, 1992, Incidence of childhood-onset insulin-dependent diabetes mellitus: the EURODIAB ACE Study, Lancet source

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    • cites [30] Karvonen, 1997, Sex difference in the incidence of insulin-dependent diabetes mellitus: an analysis of the recent epidemiological data. World Health Organization DIAMOND Project Group, Diabetes Metab Rev source

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    Premisecitation

    Type 1 diabetes is present in Navajos but is infrequent, with estimated prevalence below 0.5 per 1,000 and incidence below 5 per 100,000 per year in Navajo youth.

    “The authors state that T1D is present in Navajos, but that it is infrequent and estimate that the prevalence of T1D in Navajo youth is <0.5/1,000 and the incidence <5/100,000 per year.”
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    • cites [40] Dabelea, 2009, Diabetes in Navajo youth: prevalence, incidence, and clinical characteristics: the SEARCH for Diabetes in Youth Study, Diabetes Care source

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    Premisecitation

    In non-Hispanic white SEARCH youth, type 1 diabetes prevalence was 2.0 per 1,000 and incidence was 23.6 per 100,000, with a slightly higher incidence in males than females (24.5 vs 22.7 per 100,000, p=0.04).

    “In the non-Hispanic white population the prevalence of T1D was 2.0/1,000 and the incidence was 23.6/100,000 (with a slightly higher incidence rate for males than females [24.5 v 22.7 per 100,000, respectively, p=0.04]).”
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    • cites [36] Bell, 2009, Diabetes in non-Hispanic white youth: prevalence, incidence, and clinical characteristics: the SEARCH for Diabetes in Youth Study, Diabetes Care source

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  • May combine two claims.

    Premisecitation

    In a JDRF-funded CGM trial among children and adults with type 1 diabetes and A1c ≥7.0% at enrollment, a significant reduction in A1c was observed in adults aged 25 years or older but not in participants aged 5-14 or 15-24 years when CGM users were compared with controls.

    “Among children and adults with T1D with a A1c ≥ 7.0% at enrollment in the study, a significant reduction in A1c was observed in adults (≥ 25 years) but not in participants 5–14 years or 15–24 years when subjects assigned to the CGM use were compared to the controls95.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [95] Juvenile Diabetes Research Foundation Continuous Glucose Monitoring Study Group, 2010, Effectiveness of continuous glucose monitoring in a clinical care environment: evidence from the Juvenile Diabetes Research Foundation continuous glucose monitoring (JDRF-CGM) trial, Diabetes Care source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Diabetic ketoacidosis, defined as pH<7.3, was reported in 42% of children at type 1 diabetes presentation, with 33% having pH between 7.3 and 7.1 and 9% having severe DKA (pH<7.1).

    “DKA, defined as pH<7.3, was reported in 42% of children, with 33% having pH between 7.3 and 7.1 and 9% with severe DKA (<7.1).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12] Levy-Marchal, 2001, Geographical variation of presentation at diagnosis of type I diabetes in children: the EURODIAB study. European and dibetes, Diabetologia source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Hypertension and dyslipidemia are important vascular disease risk factors, with extensive data supporting their role as targets to improve cardiovascular health in people with type 1 diabetes.

    “In addition to glycemic control, hypertension and dyslipidemia are also important vascular disease risk factors with extensive data to support their role as targets to improve cardiovascular health in people with T1D 120.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [120] Skrivarhaug, 2006, Long-term mortality in a nationwide cohort of childhood-onset type 1 diabetic patients in Norway, Diabetologia source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Evidence on whether early introduction of cow's milk or protective effects of breast milk contribute to childhood type 1 diabetes is equivocal and may depend on genetic susceptibility.

    “Evidence regarding early introduction of cow’s milk (or protective effects of breast milk consumption) in infants contributing to the development of childhood T1D is equivocal73–76 and may depend on genetic susceptibility77.”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [73] Virtanen, 1998, Cow's milk consumption, disease-associated autoantibodies and type 1 diabetes mellitus: a follow-up study in siblings of diabetic children. Childhood Diabetes in Finland Study Group, Diabet Med source

      Not checked in the free run.

    • cites [74] Bodington, 1994, Cow's milk and type 1 childhood diabetes: no increase in risk, Diabet Med source

      Not checked in the free run.

    • cites [75] Mayer, 1988, Reduced risk of IDDM among breast-fed children. The Colorado IDDM Registry, Diabetes source

      Not checked in the free run.

    • cites [76] Vaarala, 1999, Cow's milk formula feeding induces primary immunization to insulin in infants at genetic risk for type 1 diabetes, Diabetes source

      Not checked in the free run.

    • cites [77] Norris, 2003, Timing of initial cereal exposure in infancy and risk of islet autoimmunity, JAMA source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Interpretationnone given

    The environmental triggers that initiate pancreatic beta cell destruction remain largely unknown.

    “The environmental triggers which initiate pancreatic beta cell destruction remain largely unknown.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    UK data report a hazard ratio of 3.7 for annual mortality rates for people with type 1 diabetes compared with non-diabetics (8.0 vs 2.4 per 100,000 person-years), with cardiovascular disease as the predominant cause of death.

    “Similarly, data from the UK report a hazard ratio of 3.7 for annual mortality rates for people with T1D compared to non-diabetics (8.0 v. 2.4/100,000 person-years) with CVD as the predominant cause of death125.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [125]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    EURODIAB reported that polyuria was the most common presenting symptom (96%), followed by weight loss (61%) and fatigue (52%) in children at type 1 diabetes diagnosis.

    “Polyuria was the most common presenting symptom (96%), followed by weight loss (61%) and fatigue (52%).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [12] Levy-Marchal, 2001, Geographical variation of presentation at diagnosis of type I diabetes in children: the EURODIAB study. European and dibetes, Diabetologia source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    A Norwegian cohort of 1,906 type 1 diabetes patients diagnosed before age 15 between 1973 and 1982 (46,147 person-years) reported an all-cause mortality SMR of 4.0 and an SMR of 20 for ischemic heart disease.

    “A Norwegian cohort of 1,906 T1D patients diagnosed at <15 years of age between 1973–1982 (46,147 person-years) reported an SMR for all cause mortality of 4.0 with an SMR of 20 for ischemic heart disease.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [124]

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In SEARCH, insulin pump therapy was more frequently used by older youth, females, non-Hispanic whites, and families with higher income and education (P=.02 for females, P<.001 for others).

    “Insulin pump therapy was more frequently used by older youth, females, non-Hispanic whites, and families with higher income and education (P = .02 for females, P < .001 for others).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [94] Tamborlane, 2008, Continuous glucose monitoring and intensive treatment of type 1 diabetes, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Data suggest that care for type 1 diabetes has improved, as evidenced by reduced rates of microvascular disease in past decades, whereas data on cardiovascular disease suggest substantially less progress in reducing macrovascular disease rates.

    “Furthermore, there are data to suggest that care for T1D has improved as evidenced by reduced rates of microvascular disease in the past decades109–111, whereas data on CVD suggest that substantially less progress has been made in reduction of macrovascular disease rates111–113.”
    Quote in the paperNot a substantial claim0 of 5 sources checked
    • cites [109] Rewers, 2008, Why do people with diabetes die too soon? More questions than answers, Diabetes Care source

      Not checked in the free run.

    • cites [110] American Diabetes Association, 2003, Management of dyslipidemia in children and adolescents with diabetes, Diabetes Care source

      Not checked in the free run.

    • cites [111] Kavey, 2006, Circulation source

      Not checked in the free run.

    • cites [112] McCrindle, 2007, Circulation source

      Not checked in the free run.

    • cites [113] Daniels, 2008, Lipid screening and cardiovascular health in childhood, Pediatrics source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    SEARCH reported a mean A1c of 8.2% in youth with type 1 diabetes, with 17% having an A1c ≥9.5%.

    “Similarly, data from the SEARCH study reports a mean A1c of 8.2% in youth with T1D with 17% having an A1c ≥9.5% 88.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [88] Chase, 2006

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    The clinical course of type 1 diabetes is typically characterized by acute onset of the classic symptoms of diabetes: polyuria, polydipsia, and weight loss.

    “The clinical course of T1D is typically characterized by the acute onset of the classic symptoms of diabetes: polyuria, polydipsia, and weight loss.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Post-DCCT studies show mean A1c levels remained higher than current glycemic goals; the Hvidore study reported a mean A1c of 8.6% in over 2,000 youth with type 1 diabetes worldwide.

    “More recently, studies published post-DCCT have shown that mean levels of A1c have remained higher than current glycemic goals with the Hvidore study reporting a mean A1c of 8.6% in over 2,000 youth with T1D worldwide87.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [87] Petitti, 2009, Glycemic control in youth with diabetes: the SEARCH for Diabetes in Youth Study, J Pediatr source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Diabetic complications continue to be a major cause of morbidity and mortality in type 1 diabetes, and cardiovascular disease is the leading cause of death.

    “Unfortunately, diabetic complications continue to be a major cause of morbidity and mortality in persons with T1D and cardiovascular disease (CVD) is the leading cause of death98.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [98] Nathan, 2005, Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes, N Engl J Med source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Among trial participants with A1c <7.0% at enrollment, about half of whom were under 25 years, the CGM group maintained A1c at baseline values with less biochemical hypoglycemia, whereas A1c rose over time in the control group.

    “Among study participants whose A1c was <7.0% at enrollment in the trial, of which about half were < 25 years of age, the CGM group was able to maintain A1c levels at baseline values with less biochemical hypoglycemia, whereas A1c levels rose over time in the control group97.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [97] Libby, 2005, Report of the National Heart, Lung, and Blood Institute-National Institute of Diabetes and Digestive and Kidney Diseases Working Group on Cardiovascular Complications of Type 1 Diabetes Mellitus, Circulation source

      Not checked in the free run.

54 of 54

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Globally, type 1 diabetes is increasing in incidence and prevalence, with overall annual increases in incidence of about 2-3% per year.

    “Globally, type 1 diabetes is increasing both in incidence and prevalence, with overall annual increases in incidence of about 2–3% per year.29,30”

    From Type 1 diabetes (2018) · cites this paper as [29]

    The Incidence: Temporal Trends section reports a 2.8% average annual increase in type 1 diabetes incidence across studied populations in 57 countries, supporting the approximate 2–3% figure. That estimate concerns children aged 14 or younger, and the cited passages do not establish a global increase in prevalence. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Globally, the incidence and prevalence of type 1 diabetes vary substantially.

    “Globally, the incidence and prevalence of type 1 diabetes vary substantially (figure 1).10”

    From Type 1 diabetes (2014) · cites this paper as [10]

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • SEARCH prevalence conflicts with the stated case count and population

    Major

    The stated 5,399 cases among approximately 3.5 million youth imply a prevalence of about 1.54 per 1,000, not 2.28 per 1,000.

1 of 1

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Authors
Maahs, D. M., West, N. A., Lawrence, J. M., & Mayer-Davis, E. J.
Affiliations
  • University of Colorado Denver (US)
  • Colorado School of Public Health (US)
  • Kaiser Permanente (US)
Corresponding author
Maahs, David M.
ORCID
Venue
Endocrinology and Metabolism Clinics of North America
Publisher
Elsevier BV
Published
2010-09
Volume
39
Issue
3
Pages
481-497
ISSN
0889-8529 (ISSN-L)
DOI
10.1016/j.ecl.2010.05.011
PMC
PMC2925303
OpenAlex
W2095720372
Semantic Scholar
4e7ae960ddf98e1472ce4a4844efb11047056d46
Cited by
1,092
References
131
Citations by year
2026: 34 · 2025: 71 · 2024: 85 · 2023: 109 · 2022: 115 · 2021: 108 · 2020: 97 · 2019: 95 · 2018: 85 · 2017: 72 · 2016: 48 · 2015: 53 · 2014: 39 · 2013: 32 · 2012: 27
FWCI
2.70
Type
journal article
Language
en
Open access
Licence
Locations
  • Endocrinology and Metabolism Clinics of North America (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Diabetes and Digestive and Kidney Diseases (K23DK075360)
Topics
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
Keywords
type 1 diabetes, incidence, prevalence, risk factors, genetic susceptibility, environmental triggers, natural history (disease), diabetes complications, diabetes prevention, diabetes management, global epidemiology
MeSH terms
Adolescent, Child, Diabetes Mellitus, Type 1, Humans, Risk Factors, Comorbidity, Incidence, Prevalence, Age of Onset

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-09-28.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-28.

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