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The Burden of Type 1 Diabetes

The Burden of Type 1 Diabetes. Incidence and Prevalence of Type 1 Diabetes. Type 1 diabetes mellitus (T1DM) is the major type of diabetes in youth Accounts for ≥85% of all diabetes cases in patients <20 years of age Incidence is increasing by 2% to 5% worldwide

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The Burden of Type 1 Diabetes

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  1. The Burden of Type 1 Diabetes

  2. Incidence and Prevalence of Type 1 Diabetes • Type 1 diabetes mellitus (T1DM) is the major type of diabetes in youth • Accounts for ≥85% of all diabetes cases in patients <20 years of age • Incidence is increasing by 2% to 5% worldwide • Prevalence is approximately 1 in 300 in the United States by 18 years of age Maahs DM, et al. Endocrinol Metab Clin North Am. 2010;39:481-497.

  3. Diabetes in Children and Young Adults • In the past, diabetes in youth was almost always T1DM, but more T2DM is no longer “adult onset” diabetes only • Nearly all children with diabetes diagnosed <10 years have T1DM • Majority of non-Hispanic youth with diabetes diagnosed have T1DM • However, among US children 10-19 years at diagnosis • Half of African-American and Hispanic patients have T2DM • More than half of Asian/Pacific Islanders and American Indians have T2DM Dabelea D, et al. JAMA. 2007;297:2716-2724.

  4. Annual Incidence of Type 1 vs Type 2 Diabetes in Children and Adolescents in the United States NHW, non-Hispanic whites; NHB, non-Hispanic blacks; H, Hispanics; API, Asians/Pacific Islanders; AI, American Indians. CDC. National diabetes fact sheet, 2011. http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf.

  5. Immunological Changes and Incidence of Type 1 Diabetes • Rising incidence of T1DM is associated with altered immunophenotype at diagnosis • Prevalence of IA-2A and ZnT8A has increased significantly • IAA and GADA prevalence and levels have not changed • Suggests T1DM is now characterized by a more intense humoral autoimmune response • IAA, autoantibodies to insulin; GADA, GAD; IA-2A, islet antigen-2; ZnT8A, zinc transporter 8. • Long AE, et al. Diabetes. 2012;61:683-686.

  6. Postulated Contributing Factors for T1DM Risk • Infections* • Early childhood diet (dietary proteins)* • Vitamin D exposure • Environmental pollutants • Increased height velocity • Obesity • Insulin resistance* * Evidence strengthening for an association Forlenza GP, Rewers M. Curr Opin Endocrinol Diabetes Obes. 2011;18:248-251.

  7. Mortality in Childhood-onset T1DM • Mortality rate: 2.2/1000 person-years1 • Most common cause of death <30 years of age1 • Acute metabolic complications of diabetes (eg, diabetic ketoacidosis)1,2 • Most common cause of death >30 years of age • Cardiovascular disease1,3 1.Skrivarhaug T, et al. Diabetologia. 2006;49:298-305. 2.Patterson CC, et al.Diabetologia. 2007;50:2439-2442. 3..Libby P, et al. Circulation. 2005;111:3489-3493.

  8. Development of Microalbuminuria and Macroalbuminuria in T1DM Hovind P, et al. BMJ. 2004;328:1105.

  9. T1DM Mortality Correlates With Renal Function Risk of mortality in individuals with type 1 diabetes from the FinnDiane study associated each level of albuminuria and end-stage kidney disease Groop P, et al. Diabetes. 2009;58:1651-1658.

  10. T1DM Is Costly Expected Lifetime Medical and Indirect Costs Attributed to T1DM, 2005 dollars Tao BT,Taylor DG. Endocrinol Metab Clin North Am. 2010;39:499-512.

  11. Improvements in Diabetes Complication Rates With More Intensive Therapy DCCT, Diabetes Control and Complications Trial;EDIC, Epidemiology of Diabetes Interventions and Complications Study . Nathan DM, et al. Arch Intern Med. 2009;169:1307-1316.

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