Ascertainment Of Type Diabetes Cases

The ascertainment of Type 1 diabetes cases has not always been complete in many epidemiological studies for several reasons. Type 1 diabetes represents only 4-6% of all cases of diabetes and thus we are dealing with small numbers of affected subjects. Type 1 diabetes may have been misdiag-nosed or misclassified in some circumstances. Health policy and the lack of regional or national registries has been a serious disadvantage for accurate case ascertainment.

Until the beginning of the 1980s different methods were applied to Type 1 diabetes ascertainment. Classical Type 1 diabetes rarely poses a diagnostic problem. However, most studies of the incidence and prevalence of diabetes in young people have not clearly discriminated between Type 1 diabetes and Type 2 diabetes cases. Almost all studies of Type 1 diabetes limit themselves to cases diagnosed before 30 years of age, although Type 1 diabetes can also occur after the age of 30

Figure 7A.1 Age-specific incidence (per 100 000 population) of Type 1 diabetes in children aged 14 years or under. Data for boys and girls have been pooled. The populations are arranged in ascending order according to the incidence. Data from Diamond Centers 1990-1994. Adapted from (28) by permission.

Figure 7A.1 Age-specific incidence (per 100 000 population) of Type 1 diabetes in children aged 14 years or under. Data for boys and girls have been pooled. The populations are arranged in ascending order according to the incidence. Data from Diamond Centers 1990-1994. Adapted from (28) by permission.

years. In ideal circumstances, the necessary conditions for epidemiological studies and a high level of case ascertainment are uniformity of population, lack of migration and an established high rate of cooperation of health care personnel. Effective public health care systems, the existence of computer systems for recording diagnoses, national registries, the involvement of a central person registry or any other means of tracing individuals throughout the country are remarkable tools that will help the epidemiologist perform a good prevalence or incidence study. Type 1 diabetes is a relatively infrequent disorder that needs a large population sample for its study to avoid under- or overestimation of incidence or prevalence, consequently the true incidence or prevalence rates cannot be established by population-based studies. Different methods were applied to Type 1 diabetes ascertainment until the beginning of the 1980s. Traditional methods for monitoring Type 1 diabetes have been too expensive or too inaccurate for broad accurate national programs. It has been therefore rather difficult to compare results from different surveys carried out before the early 1980s.

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