Hacettepe University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey.
Hacettepe University Faculty of Medicine, Department of Pediatrics, Ankara, Turkey.
J Diabetes. 2024 May;16(5):e13562. doi: 10.1111/1753-0407.13562.
Global variations in epidemiology of type 1 diabetes mellitus (T1DM) exist. This study is designed to examine demographic and clinical features of T1DM over the past 3 decades as well as evolving trends in epidemiology over last 50 years.
Clinical characteristics of 925 patients with T1DM over last 30 years (1990-2019) were evaluated and compared to previously published data of 477 patients diagnosed between 1969 and 1990 from one of the major referral centers for diabetes in Turkey.
Mean age at diagnosis decreased from 9.5 ± 4.0 to 7.1 ± 3.6 years within the past 50 years (p < .001). Age at diagnosis peaked at 12-14 years between 1969 and 1990, then fell to 10-11.9 years between 1990 and 1999, and to 4-5.9 years between 2000-2009 and 2010-2019 (p = .005). Although the percentage of patients diagnosed <6 years of age is gradually increasing, the percentage between the ages of 6 and 11.9 years is decreasing, and the percentage diagnosed ≥12 years remained stable. A total of 47.5% of patients had ketoacidosis, 38.2% had ketosis, and 14.3% had only hyperglycemia. 23% of patients had severe diabetic ketoacidosis (DKA), whereas 42% had moderate. Over last 3 decades, there has been no change in frequency of ketoacidosis at presentation, but there has been significant decline in severity (p = .865, and p < .001, respectively). Although the frequency of patients with mild DKA increased over time, frequency of patients with moderate DKA decreased; however, no significant difference was observed among patients with severe ketoacidosis. DKA was more frequent and severe in patients <6 years of age (p = .005, and p < .001, respectively).
Age at diagnosis shifted to younger ages in T1DM in the past 50 years. Half of patients had ketoacidosis at diagnosis and frequency of presentation with DKA did not decrease, but severity decreased slightly. Increase in prevalence of T1DM in the younger age group and the fact that half of patients present with DKA indicate that awareness should be increased in terms of early diagnosis and treatment.
1 型糖尿病（T1DM）的全球流行病学存在差异。本研究旨在调查过去 30 年来 T1DM 的人口统计学和临床特征，以及过去 50 年来流行病学的变化趋势。
评估了过去 30 年（1990-2019 年）925 例 T1DM 患者的临床特征，并将其与土耳其主要糖尿病转诊中心之一在 1969 年至 1990 年期间诊断的 477 例患者的先前发表数据进行了比较。
在过去的 50 年里，诊断时的平均年龄从 9.5±4.0 岁降至 7.1±3.6 岁（p<0.001）。1969 年至 1990 年期间，诊断时的年龄峰值在 12-14 岁，然后在 1990 年至 1999 年降至 10-11.9 岁，在 2000-2009 年和 2010-2019 年降至 4-5.9 岁（p=0.005）。尽管诊断为<6 岁的患者比例逐渐增加，但 6-11.9 岁的患者比例在减少，而诊断为≥12 岁的患者比例保持稳定。共有 47.5%的患者有酮症酸中毒，38.2%有酮症，14.3%仅有高血糖。23%的患者有严重糖尿病酮症酸中毒（DKA），42%有中度。在过去的 30 年中，就诊时酮症酸中毒的频率没有变化，但严重程度显著下降（p=0.865，p<0.001）。尽管轻度 DKA 的患者频率随着时间的推移而增加，但中度 DKA 的患者频率却有所下降；然而，严重酮症酸中毒患者之间没有观察到显著差异。6 岁以下患者的 DKA 更频繁且更严重（p=0.005，p<0.001）。
在过去的 50 年里，T1DM 的诊断年龄向更年轻的年龄转移。一半的患者在诊断时就有酮症酸中毒，DKA 的就诊率没有下降，但严重程度略有下降。在年轻人群中 T1DM 的患病率增加，以及一半的患者出现 DKA 表明，应该提高对早期诊断和治疗的认识。
