Epidemiology incidence and prevalence

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T1D is one of the most common chronic diseases of childhood. Even with the recent epidemic of type 2 diabetes, T1D accounts for approximately two thirds of

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doi:10.1016/j.pcl.2005.07.006 pediatric.theclinics.com all cases of diabetes in children [1]. In the United States, more than 150,000 children younger than 18 years old have T1D [2]. The prevalence of T1D in US children is 1.7 to 2.5 cases per 1000 individuals, and the incidence is between 15 and 17 per 100,000/year [3]. In the United States, 10,000 to 15,000 new cases of T1D are diagnosed each year.

It seems that two peaks of T1D presentation occur in childhood: one between 5 and 7 years of age and the other at puberty. The incidence of T1D varies with seasonal changes and geography. Incidence rates are higher in autumn and winter and are lower in the summer. Some studies have suggested that the incidence of this disease is related positively to distance north of the equator; however, obvious exceptions do occur [4]. The incidence and prevalence of T1D varies dramatically around the world, with more than a 400-fold variation in incidence among reporting countries [5]. T1D is uncommon in China, India, and Venezuela, where the incidence is only 0.1 per 100,000. The disease is far more common in Sardinia and Finland, with the incidence approaching 50 cases per 100,000 individuals per year. Rates of more than 20 cases per 100,000 are observed in Sweden, Norway, Portugal, Great Britain, Canada, and New Zealand [5]. Wide variations have been observed between neighboring areas in Europe and North America. Estonia, separated from Finland by less than 75 miles, has a T1D incidence less than one third that of Finland. Puerto Rico has an incidence similar to the mainland United States (17 cases per 100,000), whereas neighboring Cuba has an incidence of less than 3 cases per 100,000 [5].

The incidence of T1D is increasing throughout the world, with marked changes especially being observed in young children from countries with historically high incidence rates (eg, children younger than 5-7 years of age in Norway). Sweden and Norway have reported a 3.3% annual increase in T1D rates, and Finland has observed a 2.4% annual rise in incidence [3]. Increases in T1D incidence rates cannot be explained by mere changes in socioeconomic status. Although many autoimmune diseases disproportionately affect women, T1D seems to affect men and women equally. Some reports indicate a modest excess in T1D cases in male patients younger than 20 years, however [6,7]. Taken collectively, differences in disease prevalence and changes in incidence rates suggest that a combination of multiple genetic and environmental factors contribute to T1D risk [5].

Economics of health care

As of 2002, the total costs attributable to diabetes care in the United States were estimated at $132 billion, whereas the direct costs of diabetes care were estimated at $91.8 billion [8]. Patients with diabetes were responsible for 1 in every $5.40 spent on health care in the United States, and individuals with diabetes had medical expenditures 2.4 times higher than patients without diabetes [8]. Although a disproportionate amount of these resources can be accounted for by adults with diabetes-related complications and patients requiring inpatient treatment, children faced with a lifetime of frequent glucose monitoring and insulin injections still have health care costs twice as high as children who do not have diabetes [9]. As a result, arguments have suggested that the economic strategy of the US health care system involve investment in intensive diabetes management to reduce the enormous future costs of long-term diabetes-related complications. Although the Diabetes Control and Complications Trial demonstrated that intensive therapy reduces the risk of complications, such an approach has not proved feasible for many patients with the disease [10]. As a result, some clinicians question the practical implementation of intensive therapy because mandating multiple daily insulin injections, frequent blood glucose monitoring, and altered nutritional and exercise practices substantially affects patients' and families' lifestyles.

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