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The Incidence of Type 1 Diabetes in the Age Group 0–39 Years Has Not Increased in Antwerp (Belgium) Between 1989 and 2000

Evidence for earlier disease manifestation

¹ Diabetes Research Center, Free University, Brussels, Belgium
² Departments of Endocrinology and Pediatrics, University of Antwerp, Antwerp, Belgium
³ Department of Endocrinology, Catholic University, Leuven, Belgium
⁴ Department of Endocrinology, University of Ghent, Ghent, Belgium
⁵ Department of Endocrinology, Civil Hospital of Charleroi, Charleroi, Belgium
⁶ Department of Pediatric Endocrinology, CHR la Citadelle, Liège, Belgium
⁷ Belgian Diabetes Registry, Brussels, Belgium

OBJECTIVE—A worldwide increase in the incidence of childhood type 1 diabetes has been observed. Because in various countries the majority of new type 1 diabetic patients are diagnosed in adulthood, we investigated whether the rising incidence of this disorder in children reflects a global increase in the incidence of diabetes or a shift toward earlier clinical presentation.

RESEARCH DESIGN AND METHODS—The incidence of type 1 diabetes presenting before age 40 years was prospectively measured in the Antwerp district over a 12-year period (1989–2000). The completeness of ascertainment was evaluated by the capture-recapture method. Trends in incidence during the study period were analyzed by Poisson regression.

RESULTS—The incidence of type 1 diabetes diagnosed before age 40 years remained constant over the 12-year period, averaging 9.9 cases per 100,000 individuals per year. The incidence was similar in both sexes under age 15 years, but a marked male excess was noted for adult-onset disease, in particular after age 20 years, resulting in a male-to-female ratio of 0.9 under age 15 years vs. 1.6 thereafter (P = 0.001). During the 12-year observation period, there was a significant tendency toward increasing incidence under age 15 years at the expense of a decreasing incidence between ages 15 and 40 years (P = 0.025). The annual increase in incidence averaged 1.8% under age 15 years and 5.0% under age 5 years (P = 0.06).

CONCLUSIONS—Our results indicate that in Belgium, the increasing incidence of childhood type 1 diabetes—especially for children under age 5 years—is not attributable to a global increase in disease incidence, but rather to earlier clinical manifestation. The results suggest that an environmental factor may preferentially accelerate the subclinical disease process in young diabetes-prone subjects.

Abbreviations: BDR, Belgian Diabetes Registry • DIAMOND, DIAbetes MONDiale study • EURODIAB, EUROpe and DIABetes study • IAA, insulin autoantibody • IDA, Insulin-dependent Diabetes in young Adults study • GADA, glutamate decarboxylase antibody • RR, risk ratio

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