Incidence and modes of presentation of childhood type 1 diabetes mellitus in Malta between 2012 and 2023

Olivier Jessica Borg; Nancy Formosa; John Torpiano; Neville Calleja

Aim: To assess the incidence and mode of presentation of type 1 diabetes mellitus (T1DM) in children and adolescents younger than 16 years of age between January 2012 and December 2023 in Malta. This was done as a follow up study to a previously published paper describing the incidence of T1DM in Malta between 2006-2010.

Methods: A nationwide retrospective study which collected data from newly diagnosed T1DM children who presented to the only paediatric diabetes team in Malta. Incidence rates by age group, gender and year were estimated using population statistics. The degree of ascertainment was estimated to be 100%. Trend analysis was carried out using Poisson’s regression analysis.

Results: From 2012 to 2023, 222 children below the age of 16 residing in Malta were diagnosed with T1DM. The average age – and sex-standardised incidence rate throughout this time was 24.78/1000,000 children/year. There was no statistically significant increase or drop in incidence of T1DM across the years in all age groups. However, there were 2 distinct peaks in incidence in the older age groups (9-16 years) in 2015 and 2020, the latter peak possibly attributed to the COVID-19 global pandemic. The proportion of patients presenting in diabetic ketoacidosis was an average of 36% (range 6-55%) which is higher than the internationally quoted 25%. There is no statistically significant increase in DKA presentation over the years, however the numbers may be too small to detect this. 12% of newly diagnosed T1DM were diagnosed with coeliac disease concurrently. There has been no increase in coeliac detection rate over the years.


Year	Total number of cases	Population 0-16 years	Incidence rate (per 100,000 per year)	95% confidence intervals
2012	15	71419	21	10.38-31.63
2013	17	71293	23.85	12.51-35.18
2014	16	71729	22.31	11.38-33.2
2015	24	72501	33.10	19.86-46.34
2016	14	73375	19.08	9.09-29.07
2017	15	74192	20.22	9.99-30.45
2018	17	75261	22.59	11.85-33.32
2019	21	76855	27.32	15.64-39.01
2020	26	77779	33.43	20.58-46.28
2021	21	78127	26.88	15.38-38.37
2022	17	78453	21.67	11.37-31.97
2023	20	77651	25.76	14.47-37.04

Conclusion: In Malta, our incidence rate is slightly lower than the average European incidence of 30 per 100,00 children as quoted in the International diabetes Federation diabetes atlas 10^th Edition. Rates have remained overall stable over the past 12 years. The percentage of children presenting in DKA is still high, yet this has decreased significantly from the previously documented 41% between 2006-2010.

ESPE Abstracts

P2-74