Estimating the total incidence of type 1 diabetes in children and adolescents aged 0-19 years from 1990 to 2050: a global simulation-based analysis

Zachary J Ward; Jennifer M Yeh; Che L Reddy; Apoorva Gomber; Carlo Ross; Thanitsara Rittiphairoj; Jennifer Manne-Goehler; Asmahan T Abdalla; Mohamed Ahmed Abdullah; Abdurezak Ahmed; Amos Ankotche; Kishwar Azad; Silver Bahendeka; Naby Baldé; Sunil M Jain; Jean Clovis Kalobu; Catherine Karekezi; Hero Kol; K M Prasannakumar; Sai Kham Leik; Jean Claude Mbanya; Maïmouna Ndour Mbaye; Babacar Niang; Vishnupriya Rao Paturi; Palany Raghupathy; Kaushik Ramaiya; Bipin Sethi; Bedowra Zabeen; Rifat Atun

doi:10.1016/S2213-8587(22)00276-5

Estimating the total incidence of type 1 diabetes in children and adolescents aged 0-19 years from 1990 to 2050: a global simulation-based analysis

Lancet Diabetes Endocrinol. 2022 Dec;10(12):848-858. doi: 10.1016/S2213-8587(22)00276-5. Epub 2022 Nov 10.

Authors

Zachary J Ward¹, Jennifer M Yeh², Che L Reddy³, Apoorva Gomber³, Carlo Ross⁴, Thanitsara Rittiphairoj⁵, Jennifer Manne-Goehler⁶, Asmahan T Abdalla⁷, Mohamed Ahmed Abdullah⁸, Abdurezak Ahmed⁹, Amos Ankotche¹⁰, Kishwar Azad¹¹, Silver Bahendeka¹², Naby Baldé¹³, Sunil M Jain¹⁴, Jean Clovis Kalobu¹⁵, Catherine Karekezi¹⁶, Hero Kol¹⁷, K M Prasannakumar¹⁸, Sai Kham Leik¹⁹, Jean Claude Mbanya²⁰, Maïmouna Ndour Mbaye²¹, Babacar Niang²², Vishnupriya Rao Paturi²³, Palany Raghupathy²⁴, Kaushik Ramaiya²⁵, Bipin Sethi²⁶, Bedowra Zabeen²⁷, Rifat Atun²⁸

Affiliations

¹ Center for Health Decision Science, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA; Health Systems Innovation Lab, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA. Electronic address: zward@hsph.harvard.edu.
² Health Systems Innovation Lab, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA; Division of General Pediatrics, Boston Children's Hospital, Harvard Medical School, Harvard University, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Harvard University, Boston, MA, USA.
³ Health Systems Innovation Lab, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.
⁴ Health Systems Innovation Lab, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA; Academic Foundation Programme, Manchester University NHS Foundation Trust, Manchester, UK.
⁵ Health Systems Innovation Lab, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA; Division of Health Systems Management, Department of Community Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
⁶ Health Systems Innovation Lab, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA; Division of Infectious Diseases, Brigham and Women's Hospital, Harvard Medical School, Harvard University, Boston, MA, USA; Medical Practice Evaluation Center, Massachusetts General Hospital, Harvard Medical School, Harvard University, Boston, MA, USA.
⁷ International University of Africa, College of Medicine, Khartoum, Sudan.
⁸ International University of Africa, College of Medicine, Khartoum, Sudan; Sudanese Childhood Diabetes Association, Khartoum, Sudan.
⁹ Department of Internal Medicine, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
¹⁰ Department of Internal Medicine, Endocrinology and Geriatrics, Unit of Training and Research, Medical Science of Abidjan, University of Côte D'Ivoire, Abidjan, Ivory Coast.
¹¹ BIRDEM and Ibrahim Medical College, Dhaka, Bangladesh.
¹² Department of Internal Medicine, MKPGMS Uganda Martyrs University, Kampala, Uganda.
¹³ Department of Endocrinology, University Hospital, Conakry, Guinea.
¹⁴ TOTALL Diabetes Hormone Institute, Indore, Madhya Pradesh, India.
¹⁵ Memisa, Kinshasa, DR Congo.
¹⁶ Kenya Diabetes Management and Information Centre, Nairobi, Kenya.
¹⁷ Department of Preventive Medicine, Ministry of Health, Phnom Penh, Cambodia.
¹⁸ Centre for Diabetes and Endocrine Care, Bengaluru, India.
¹⁹ Department of Social, Economic, and Adminstrative Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand.
²⁰ Department of Internal Medicine and Specialties, Faculty of Medicine and Biomedical Sciences, University of Yaoundé, Yaoundé, Cameroon.
²¹ Centre du Diabète Marc Sankalé, Dakar, Senegal; Faculty of Medicine, Cheikh Anta Diop University, Dakar, Senegal.
²² Centre Hospitalier National d'Enfants Albert Royer, Dakar, Sénégal.
²³ DiabetOmics, Hyderabad, India.
²⁴ Paediatric and Adolescent Endocrinology, Indira Gandhi Institute of Child Health, Bangalore, India.
²⁵ Shree Hindu Mandal Hospital, Dar es Salaam, Tanzania.
²⁶ Care Hospital, Hyderabad, India.
²⁷ Department of Paediatrics, Bangladesh Institute of Research & Rehabilitation in Diabetes, Endocrine & Metabolic Disorders, Dhaka, Bangladesh; Changing Diabetes in Children Programme, Diabetic Association of Bangladesh, Dhaka, Bangladesh.
²⁸ Health Systems Innovation Lab, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA; Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA; Department of Health Policy and Management, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA; Department of Global Health and Social Medicine, Harvard Medical School, Harvard University, Boston, MA, USA.

PMID: 36372070
DOI: 10.1016/S2213-8587(22)00276-5

Abstract

Background: Previous studies of type 1 diabetes in childhood and adolescence have found large variations in reported incidence around the world. However, it is unclear whether these reported incidence levels are impacted by differences in country health systems and possible underdiagnosis and if so, to what degree. The aim of this study was to estimate both the total and diagnosed incidence of type 1 diabetes globally and to project childhood type 1 diabetes incidence indicators from 1990 to 2050 for each country.

Methods: We developed the type 1 diabetes global microsimulation model to simulate the natural history and diagnosis of type 1 diabetes for children and adolescents (aged 0-19 years) in 200 countries and territories, accounting for variability in underlying incidence and health system performance. The model follows an open population of children and adolescents in monthly intervals and simulates type 1 diabetes incidence and progression, as well as health system factors which influence diagnosis. We calibrated the model to published data on type 1 diabetes incidence, autoantibody profiles, and proportion of cases diagnosed with diabetic ketoacidosis from 1990 to 2020 and assessed the predictive accuracy using a randomly sampled test set of data withheld from calibration.

Findings: We estimate that in 2021 there were 355 900 (95% UI 334 200-377 300) total new cases of type 1 diabetes globally among children and adolescents, of which 56% (200 400 cases, 95% UI 180 600-219 500) were diagnosed. Estimated underdiagnosis varies substantially by region, with over 95% of new cases diagnosed in Australia and New Zealand, western and northern Europe, and North America, but less than 35% of new cases diagnosed in west Africa, south and southeastern Asia, and Melanesia. The total number of incident childhood cases of type 1 diabetes is projected to increase to 476 700 (95% UI 449 500-504 300) in 2050.

Interpretation: Our research indicates that the total global incidence of childhood and adolescent type 1 diabetes is larger than previously estimated, with nearly one-in-two children currently undiagnosed. Policymakers should plan for adequate diagnostic and medical capacity to improve timely type 1 diabetes detection and treatment, particularly as incidence is projected to increase worldwide, with highest numbers of new cases in Africa.

Funding: Novo Nordisk.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Child
Computer Simulation
Diabetes Mellitus, Type 1* / epidemiology
Europe / epidemiology
Forecasting
Global Health
Humans
Incidence