Worldwide differences in childhood type 1 diabetes: The SWEET experience
Open accessAbstract
OBJECTIVE: To study worldwide differences in childhood diabetes, comparing relevant indicators among five regions within the SWEET initiative. SUBJECTS: We investigated 26 726 individuals with type 1 diabetes (T1D) from 54 centers in the European region; 7768 individuals from 30 centers in the Asia/Middle East/Africa region; 2642 people from five centers in Australia/New Zealand; 10 839 individuals from seven centers in North America, and 1114 patients from five centers in South America. METHODS: The SWEET database was analyzed based on the following inclusion criteria: T1D, time period 2015-2019, and age < 21 years, with analysis of the most recent documented year of therapy. For the statistical analysis, we used multivariable linear and logistic regression models to adjust for age (<6 years, 6- < 12 years, 12- < 18 years, 18- < 21 years), gender, and duration of diabetes (<2 years, 2- < 5 years, 5- < 10 years, ≥10 years). RESULTS: Adjusted HbA1c means ranged from 7.8% (95%-confidence interval: 7.6-8.1) in Europe to 9.5% (9.2-9.8) in Asia/Middle East/Africa. Mean daily insulin dose ranged from 0.8 units/kg in Europe (0.7-0.8) and Australia/New Zealand (0.6-0.9) to 1.0 unit/kg 0.9-1.1) in Asia/Middle East/Africa. Percentage of pump use was highest in North America (80.7% [79.8-81.6]) and lowest in South America (4.2% [3.2-5.6]). Significant differences between the five regions were also observed with regards to body mass index SD scores, frequency of blood glucose monitoring and presence of severe hypoglycaemia. CONCLUSIONS: We found significant heterogeneity in diabetes care and outcomes across the five regions. The aim of optimal care for each child remains a challenge.
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Regional differences in insulin requirements exist, with higher insulin doses observed in Asia, the Middle East, and African populations.
“Regional differences in insulin requirements have been described, with higher insulin doses being observed in Asia, the Middle East, and African populations 17 .”
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Miller, K. M., Beck, R. W., Bergenstal, R. M., Goland, R. S., Haller, M. J., McGill, J. B., Rodriguez, H., Simmons, J. H., Hirsch, I. B., & for the T1D Exchange Clinic Network (2013) · Diabetes Care · doi:10.2337/dc12-1770 · Cited by 505 · see citing works
McKnight, J. A., Wild, S. H., Lamb, M. J. E., Cooper, M. N., Jones, T. W., Davis, E. A., Hofer, S., Fritsch, M., Schober, E., Svensson, J., et al. (2015) · Diabetic Medicine · doi:10.1111/dme.12676 · Cited by 343 · see citing works
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Research works printed but not linked: 18
- International Diabetes Federation. IDF diabetes atlas ninth edition 2019. https://www.diabetesatlas.org/en/ accessed July 2020
- DiMeglio LA, Acerini CL, Codner E, et al. ISPAD clinical practice con- sensus guidelines 2018: glycemic control targets and glucose moni- toring for children, adolescents, and young adults with diabetes. Pediatr Diabetes. 2018;19:105-114.
- GD O, JE v O, AC M, R H, TJ O. Levels of type 1 diabetes care in chil- dren and adolescents for countries at varying resource levels. Pediatr Diabetes. 2019;20:93-98.
- Codner E, Acerini CL, Craig ME, Hofer SE, Maahs DM. ISPAD clinical practice consensus guidelines 2018: limited care guidance appendix. Pediatr Diabetes. 2018;19:328-338.
- Klatman EL, Jenkins AJ, Ahmedani MY, Ogle GD. Blood glucose meters and test strips: global market and challenges to access in low- resource settings. Lancet Diab Endocrinol. 2019;7:150-160.
- Klatman EL, McKee M, Ogle GD. Documenting and visualising pro- gress towards universal health coverage of insulin and blood glucose test strips for people with diabetes. Diabetes Res Clin Pract. 2019;157: 107859.
- Zacharin M, Chanoine JP, Cassorla F, et al. Promoting excellence in the care of pediatric endocrine diseases in the developing world. Pedi- atrics. 2013;131:573.
- Charalampopoulos D, Hermann JM, Svensson J, et al. Exploring varia- tion in glycemic control across and within eight high-income coun- tries: a cross-sectional analysis of 64,666 children and adolescents with type 1 diabetes. Diabetes Care. 2018;41:1180-1187.
- Maahs DM, Hermann JM, DuBose SN, et al. Contrasting the clinical care and outcomes of 2,622 children with type 1 diabetes less than 6 years of age in the United States T1D exchange and German/ Austrian DPV registries. Diabetologia. 2014;57:1578-1585.
- Sherr JL, Hermann JM, Campbell F, et al. Use of insulin pump therapy in children and adolescents with type 1 diabetes and its impact on metabolic control: comparison of results from three large, transatlan- tic paediatric registries. Diabetologia. 2016;59:87-91.
- Danne T, Hanas R. The Mission of SWEET: harmonize care to opti- mize outcomes of children with diabetes worldwide. Pediatr Diabetes. 2016;17:3-6.
- Pacaud D, Schwandt A, de Beaufort C, et al. A description of clinician reported diagnosis of type 2 diabetes and other non-type 1 diabetes included in a large international multicentered pediatric diabetes reg- istry (SWEET). Pediatr Diabetes. 2016;17:24-31.
- Witsch M, Kosteria I, Kordonouri O, et al. Possibilities and challenges of a large international benchmarking in pediatric diabetology-the SWEET experience. Pediatr Diabetes. 2016;17:7-15.
- Pacaud D, Lemay J, Richmond E, et al. Contribution of SWEET to improve paediatric diabetes care in developing countries. Pediatr Dia- betes. 2016;17:46-52.
- Abraham MB, Jones TW, Naranjo D, et al. Assessment and manage- ment of hypoglycemia in children and adolescents with diabetes. Pediatr Diabetes. 2018;19:178-192.
- Marshall SL, Edidin DV, Arena VC, et al. Glucose control in Rwandan youth with type 1 diabetes following establishment of systematic, HbA1c based, care and education. Diabetes Res Clin Pract. 2015;107: 113-122.
- Phelan H, Foster NC, Schwandt A, et al. Longitudinal trajectories of BMI z-score: an international comparison of 11,513 Australian, Amer- ican and German/Austrian/Luxembourgian youth with type 1 diabe- tes. Pediatr Obes. 2019;15:e12582.
- Ziegler R, Heidtmann B, Hilgard D, et al. Frequency of SMBG corre- lates with HbA1c and acute complications in children and adolescents with type 1 diabetes. Pediatr Diabetes. 2011;12:11-17.
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Takagi, E., Kaga, H., Mori, R., Fujikawa, S., Nagashima, H., Kogai, T., Koshibu, M., Sato, J., Nishida, Y., Ikeda, F., et al. (2026) · Journal of Diabetes Investigation · doi:10.1111/jdi.70463
“Regional differences in insulin requirements have been described, with higher insulin doses being observed in Asia, the Middle East, and African populations 17 .”
- Authors
- Saiyed, M., Hasnani, D., Alonso, G. T., Richmond, E., Besançon, S., Cotterill, A., Ngwu, U., Mazza, C., Rottembourg, D., Lanzinger, S., & SWEET study group
- Affiliations
- Diabetes Care & Hormone Clinic (IN)
- IQVIA (India) (IN)
- Barbara Davis Center for Diabetes Denver Colorado USA
- Hospital Nacional de Niños (CR)
- Hôpital du Mali (ML)
- Queensland Paediatric Endocrinology Brisbane Queensland Australia
- Sherwood Forest Hospitals NHS Foundation Trust (GB)
- Garrahan Hospital (AR)
- Université de Sherbrooke (CA)
- Universität Ulm (DE)
- Corresponding author
- Lanzinger, Stefanie
- ORCID
- Venue
- Pediatric Diabetes
- Publisher
- Wiley
- Published
- 2020-10-22
- Volume
- 22
- Issue
- 2
- Pages
- 207-214
- ISSN
- 1399-543X (ISSN-L)
- 1399-5448
- OpenAlex
- W3091901853
- Cited by
- 29
- References
- 2
- Citations by year
- 2026: 4 · 2025: 3 · 2024: 12 · 2023: 2 · 2022: 5 · 2021: 3
- FWCI
- 1.89
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Pediatric Diabetes (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Funders
- Abbott Laboratories
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Keywords
- type 1 diabetes, pediatric diabetes, cross-national comparison, glycemic control, HbA1c, insulin dose, insulin pump therapy, blood glucose monitoring, severe hypoglycemia, body mass index, diabetes care quality
- MeSH terms
- Adolescent, Africa, Asia, Australia, Child, Child, Preschool, Diabetes Mellitus, Type 1, Europe, Female, Humans, Male, New Zealand, North America, Registries, South America, Age Distribution, Sex Distribution, Young Adult
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