ESPE Abstracts

Introduction: Global variations in epidemiology of type 1 diabetes (T1D) exist worldwide. This study is designed to determine the demographic and clinical characteristics of T1D in the past three decades, and to analyze changing trends in epidemiology over the past 50 years.

Methods: Epidemiological and clinical characteristics of 925 patients with T1D were analyzed in three decades between 1991 and 2019. In addition, previously published data of 477 patients before 1991 (1969-90) was compared to data of the current study. Study included patients from all over the country. Patients were stratified into two-year periods according to age at diagnosis.

Results: Mean age at diagnosis decreased significantly from 9.5±4.0 to 7.1±3.6 years within the last 50 years (P < 0.001). Age at diagnosis peaked at 12-14 years between 1969-90, and from then on this peak decreased from 10-12 years in the first decade, to 4-6 years in the last two decades (P = 0.005). Boy-to-girl ratio was close to one and didn’t change. The most common season of initial admission was winter and autumn, and 35% of patients had infection at the time of diagnosis. Geographical distribution, seasonality, and the presence of infection at diagnosis were similar during the last 50 years. The most common symptoms were polyuria, polydipsia, and weight loss. Prevalence of enuresis nocturna and vomiting increased with younger age (P < 0.001). In the last 30 years, 47.8% of all patients presented with ketoacidosis, 38.1% with ketosis, 14.1% with only hyperglycemia. Prevalence of ketoacidosis and ketosis as well as severe ketoacidosis at presentation did not change within the last 30 years, although the ratio of mild ketoacidosis increased while that of moderate ketoacidosis decreased over time. Prevalence and severity of DKA were higher among children ≤ 6 years, while duration of symptoms was significantly shorter in comparison to 6-12 and ≥12 year age-groups (P = 0.005, P < 0.001, and P = 0.008 respectively).

Conclusion: The age at diagnosis shifted to younger ages in children with T1D during the last 50 years. Nearly half of the patients had ketoacidosis at the time of diagnosis with no change within the last 30 years. The shift to younger ages in T1D during the last half century, in addition to an unchanging prevalence of DKA suggest that awareness of diabetes should be increased in our community in terms of early diagnosis and treatment.