Skip to main content
SpringerLink
Log in

A review of the recent epidemiological data on the worldwide incidence of Type 1 (insulin-dependent) diabetes mellitus

  • Review
  • Published:
Diabetologia Aims and scope Submit manuscript

Summary

Nearly 70 registries from more than 40 countries have collected and published incidence data of childhood Type 1 (insulin-dependent) diabetes mellitus up to the end of the 1980s. The majority of incidence data comes from regions of high incidence i. e. from Europe and North American. All these published data facilitate the descriptive comparison of incidence and variation of the occurrence of Type 1 diabetes roughly throughout the northern hemisphere. The aim of this paper is to review and compare the most recent epidemiology data on the incidence of Type 1 diabetes among children under the age of 15 years. A clear difference in incidence appeared between northern and southern hemisphere with no countries below the equator having an incidence greater than 15.0 per 100,000. In contrast above the equator the disease is common. Between continents the variation in incidence showed that the lowest incidences were found in Asia, followed by Oceania (Australia and New Zealand), South and North America, and the highest rates were in Europe. The incidence varied from 0.6 per 100,000 in Korea and Mexico to 35.3 per 100,000 in Finland showing prominent worldwide variation in incidence of Type 1 diabetes. The largest intracontinental variation in incidence appeared in Europe, varying from the highest in Finland to the lowest (4.6 per 100,000)_in northern Greece. The highest incidence in the world was in northern Europe, but within the continent scale there were some striking exceptions from the overall level of incidence. In Iceland, the northern-most island nation in Europe, the incidence is only one-half of that in Norway and Sweden and one-third of that in Finland. In contrast, in Sardinia in southern Europe the Type 1 diabetes incidence is virtually the same as in Finland, three times higher than overall incidence in Europe. Large variation was also seen in small “pockets” of countries, particularly in the Baltic sea region. The worldwide variation in incidence reflects the distribution of ethnic populations and demonstrates the importance of the differential genetic susceptibility between populations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Cudworth AG, Wolf E, Gorsuch AN, Festenstein H (1979). A new look at HLA genetics with particular reference to type 1 diabetes. Lancet II: 380–390

    Google Scholar 

  2. Tuomilehto-Wolf E, Tuomilehto J (1991) HLA antigens in insulin-dependent diabetes mellitus. Ann Med 23: 481–488

    CAS  PubMed  Google Scholar 

  3. Meltron L, Palumbo P, Chu C (1983) Incidence of diabetes mellitus by clinical type. Diabetes Care 6: 75–86

    Google Scholar 

  4. Laakso M, Pyörälä K (1985). Age of onset and type of diabetes. Diabetes Care 8: 114–117

    CAS  PubMed  Google Scholar 

  5. Bloom A, Hayes TM, Gamble DR (1975) Register of newly diagnosed diabetic children. BMJ 3: 580–583

    CAS  PubMed  Google Scholar 

  6. Bratlid D (1976) A preliminary study on the incidence of juvenile diabetes mellitus in northern Norway. Arch Med Res Report 15: 54–57

    Google Scholar 

  7. Koivisto VA, Åkerblom HK, Wasz-Höckert O (1976) The epidemiology of juvenile diabetes mellitus in northern Finland. Arch Med Res Report 15: 58–65

    Google Scholar 

  8. Lestradet H, Bessec J (1977) Prevalence et incidence du diabete juvenile insulino-dependant en France. Diabete Metab 3: 229–234

    CAS  PubMed  Google Scholar 

  9. Christan B, Kromann H, Ortved-Andersen O et al. (1977) Incidence, seasonal and geographical patterns of juvenile-onset insulin-dependent diabetes mellitus in Denmark. Diabetologia 13: 281–284

    Google Scholar 

  10. Calnan M, Peckham CS (1977) Incidence of insulin-dependent diabetes mellitus in the first sixteen years of life. Lancet I: 589–590

    Google Scholar 

  11. Sterky G, Holmgren G, Gustavsson KH et al. (1978) The incidence of diabetes mellitus in Swedish children 1970–75. Acta Paediatr Scand 67: 139–143

    CAS  PubMed  Google Scholar 

  12. Rewers M, LaPorte RE, King H, Tuomilehto J for The Diabetes Epidemiology Research International Study Group-DERI (1988) Trends in the prevalence and incidence of diabetes: insulin-dependent diabetes mellitus in childhood. World Health Stat 41: 179

    CAS  Google Scholar 

  13. WHO DIAMOND Project (1990) WHO Multinational project for childhood diabetes. Diabetes Care 13: 1062–1068

    Google Scholar 

  14. Green A, Gale EAM, Patterson CC for the EURODIABACE study (1992) Incidence of childhood-onset insulin-dependent diabetes mellitus: the EURODIAB ACE study. Lancet 339: 905–909

    CAS  PubMed  Google Scholar 

  15. Tuomilehto J, Podar T, Brigis G et al. (1992) Comparison of the incidence of insulin-dependent diabetes mellitus in childhood among five Baltic populations during 1983–1988. Int J Epidemiol 21: 518–527

    CAS  PubMed  Google Scholar 

  16. Diabetes Epidemiology Research International Group (1989) Evaluation of epidemiology and immunogenetics of IDDM in Spanish- and Portuguese-heritage registries. A key to understanding the etiology of IDDM? Diabetes Care 12: 487–493

    Google Scholar 

  17. Diabetes Epidemiology Research International (DERI) Study Group (1990) The epidemiology and immunogenetics of IDDM in Italian-heritage populations. Diabetes Metab Rev 6: 63–69

    Google Scholar 

  18. Diabetes Epidemiology Research International Study Group (1990) Childhood diabetes in Arab countries. Bull WHO 68: 231–236

    Google Scholar 

  19. Diabetes Epidemiology Research International Group (1988) Geographic patterns of childhood insulin-dependent diabetes mellitus. Diabetes 37: 1113–1119

    Google Scholar 

  20. Tuomilehto J, Lounamaa R, Tuomilehto-Wolf E et al. (1992) Epidemiology of childhood diabetes mellitus in Finland-background of a nationwide study of type 1 (insulin-dependent) diabetes mellitus. Diabetologia 35: 70–76

    Article  CAS  PubMed  Google Scholar 

  21. Green A, Andersen PK, Svendsen AJ, Mortensen K (1992) Increasing incidence of early onset type 1 (insulin-dependent) diabetes mellitus: a study of Danish male birth cohorts. Diabetologia 35: 178–182

    Article  CAS  PubMed  Google Scholar 

  22. Nyström L, Dahlquist G, Rewers M, Wall S (1990) The Swedish childhood diabetes study. An analysis of the temporal variation in diabetes incidence 1978–1987. Int J Epidemiol 19: 141–146

    PubMed  Google Scholar 

  23. Joner G, Sovik O (1989) Increasing incidence of diabetes mellitus in Norwegian children 0–14 years of age 1973–1982. Diabetologia 32: 79–83

    Article  CAS  PubMed  Google Scholar 

  24. Helgason T, Danielsen R, Thorsson AV (1992) Incidence and prevalence of type 1 (insulin-dependent) diabetes mellitus in Icelandic children 1970–1989. Diabetologia 35: 880–883

    Article  CAS  PubMed  Google Scholar 

  25. Nyström L, Dahlquist G, Östman J et al. (1992) Risk of developing insulin-dependent diabetes mellitus (IDDM) before 35 years of age: indications of climatological determinants for age at onset. Int J Epidemiol 21: 352–358

    PubMed  Google Scholar 

  26. Hägglöf B, Holmgren G, Wall S (1982) Incidence of insulindependent diabetes mellitus among children in a North-Swedish population 1938–1977. Hum Hered 32: 408–417

    PubMed  Google Scholar 

  27. Reunanen A, Åkerblom HK, Käär ML (1982) Prevalence and ten-year (1970–1979) incidence of insulin-dependent diabetes in children and adolescents in Finland. Acta Paediatr Scand 71: 893–899

    CAS  PubMed  Google Scholar 

  28. Bingley PJ, Gale EAM (1989) Incidence of insulin dependent diabetes in England: a study in the Oxford region, 1985–6. BMJ 298: 558–560

    CAS  PubMed  Google Scholar 

  29. Metcalfe MA, Baum JD (1991) Incidence of insulin-dependent diabetes in children aged under 15 years in the British Isles during 1988. BMJ 302: 443–437

    CAS  PubMed  Google Scholar 

  30. Crow YJ, Alberti KGMM, Parkin JM (1991) Insulin dependent diabetes in childhood and maternal deprivation in northern England, 1977–86. BMJ 303: 158–160

    CAS  PubMed  Google Scholar 

  31. Bruno G, Merletti F, Vuolo A et al (1990) The registry of IDDM in the province of Turin, Italy. Report on a five year (1984–88) incidence survey in the age group 0–29 years. Diabetes Care 13: 1051–1057

    CAS  PubMed  Google Scholar 

  32. Bessaoud K, Boudraa G, Deschamps I, Hors J, Bendouabdallah M, Touhami M (1990) Epidemiology of juvenile insulin dependent diabetes mellitus in Algeria (Department of Oran). Rev Epidém Santé Publ 38: 91–99

    CAS  Google Scholar 

  33. Frazer de Llado T, Hawk B, Vazquez J, Ewos B, Hupka A (1991) Incidence of youth-onset insulin-dependent diabetes mellitus in Southern and Western Puerto Rico. Diabetes 40 [Suppl 1]: 316A (Abstract)

    Google Scholar 

  34. Rewers M, Stone RA, LaPorte RE et al. (1989) Poisson regression modeling of temporal variation in incidence of childhood insulin-dependent diabetes mellitus in Allegheny County, Pennsylvania and Wielkopolska, Poland, 1970–1985. Am J Epidemiol 129: 569–581

    CAS  PubMed  Google Scholar 

  35. Wagenknecht LE, Roseman JM, Alexander WJ (1989) Epidemiology of IDDM in black and white children in Jefferson County, Alabama, 1979–1985. Diabetes 38: 629–633

    CAS  PubMed  Google Scholar 

  36. Tull ES, Roseman JM, Christian CLE (1991) Epidemiology of childhood IDDM in U. S. Virgin Islands from 1979–1988. Evidence of an epidemic in early 1980s and variation by degree of racial admixture. Diabetes Care 14: 558–564

    CAS  PubMed  Google Scholar 

  37. Franco L, Vivolo M (1988) Incidence study of insulin dependent diabetes mellitus (IDDM) in the state of Sao Paulo, Brazil. 13th Int Diabetes Fed Congr, Satellite Congr on Epidemiology of Diabetes, Hobart, Tasmania (Abstract)

  38. Carrasco E, Lopez G, Garcia de los Rios M, Vargas N (1992) Incidencia de diabetes mellitus insulinodependiente en menores de 15 anos. periodo 90–91. Santiago; Chile, Rev Soc Argent de diabetes 26 [Suppl]: 14–15

    Google Scholar 

  39. Seclen S, Rojas MI, Valdivia H et al. (1991) Epidemiology of IDDM in Mestizo populations from Peru. 14th IDF Congress Satellite Symposium Epidemiology of Diabetes and Its Complications, Williamsburg, Virginia, (Abstract)

  40. Shubnikov E, Podar T, Tuomilehto J, Nikitin Y (1992) Low incidence of childhood IDDM in district of Novosibirsk (Russia). Diabetes Care 15: 915–917

    CAS  PubMed  Google Scholar 

  41. Kelly HA, Byrne GC (1992) Incidence of IDDM in Western Australia in children aged 0–14 yr from 1985–1989. Diabetes Care 15: 515–517

    CAS  PubMed  Google Scholar 

  42. Atanasova M, Koprivarova K, Savova R, Konstantinova M, Ivanov I, Angelova B (1992) Incidence of diabetes mellitus type 1 in Bulgarian children. Diabetologia 35 [Suppl 1]: A131 (Abstract)

    Google Scholar 

  43. Schranz AG, Prikatsky V (1989) Type 1 diabetes in the Maltese Islands. Diabetic Med 6: 228–231

    CAS  PubMed  Google Scholar 

  44. Rodrigues FJC, Moura LS, Pinto B, Gomes L, Carvalheiro M, Ruas MMA (1992) Incidence of childhood type 1 (insulin-dependent) diabetes in Coimbra, Portugal, 1987–91. Diabetologia 35 [Suppl 1]: A130 (Abstract)

    Google Scholar 

  45. Lebedev N, Curaeva T, Sergeev A, Gubanov N, Dedov I (1992) Epidemiology of type 1 and type 2 diabetes in the young population of Moscow. Diabetologia 35 [Suppl 1]: A130 (Abstract)

    Google Scholar 

  46. Serrano Rios M, Moy CS, Martin Serrano R et al. (1990) Incidence of type 1 (insulin-dependent) diabetes mellitus in subjects 0–14 years of age in the Comunidad of Madrid, Spain. Diabetologia 33: 422–424

    CAS  PubMed  Google Scholar 

  47. Bodansky HJ, Staines A, Stephenson C, Lilley H, Cartwright RA (1992) The Yorkshire regional childhood diabetes registry. Diabetologa 35 [Suppl 1]: A130 (Abstract)

    Google Scholar 

  48. Kostraba JN, Gay EC, Cai Y (1992) Incidence of insulin-dependent diabetes mellitus in Colorado. Epidemiology 3: 232–238

    CAS  PubMed  Google Scholar 

  49. McLarty DG, Swai ABM, Mugusi F, Ramaiya K (1992) The incidence of youth-onset diabetes in the African population of Dar es Salaam, Tanzania. Diabetic Med 9 [Suppl]: 43A (Abstract)

    Google Scholar 

  50. Elamin A, Omer MIA, Zein K, Tuvemo T (1992) Epidemiology of childhood type I diabetes in Sudan 1987–1990. Diabetes Care 15: 1556–1559

    CAS  PubMed  Google Scholar 

  51. Sasaki A, Okamoto N (1992) Epidemiology of childhood diabetes in Osaka District, Japan, using the documents from the medical benefits system specific for childhood diabetes. Diabetes Res Clin Pract 16: 1–6

    Google Scholar 

  52. Michaelis D, Jutzi E, Heinke P (1993) Inzidenz- und Prävalenztrend des juvenilen Typ-I-Diabetes in der ostdeutschen Bevölkerung. Diabetes und Stoffwechsel (in press)

  53. Diabetes Epidemiology Research International Group (1990) Secular trends in incidence of childhood IDDM in 10 countries. Diabetes 39: 858–864

    Google Scholar 

  54. Hearnshaw JR (1986) Childhood and after—a review of childhood diabetes in an English community 1930–1985. In: Serrano-Rios M, Lefebvre PJ (eds) Diabetes 1985. Elsevier, Amsterdam, pp 31–42

    Google Scholar 

  55. Elliott RB, Pilcher C (1985) Childhood diabetes in the Auckland area. NZ Med J 87: 922–923

    Google Scholar 

  56. Tuomilehto J, Rewers M, Reunanen A et al. (1991) Increasing trend in type 1 (insulin-dependent) diabetes mellitus in childhood in Finland. Analysis of age, calender time and birth cohort effects during 1965–1974. Diabetologia 34: 282–287

    Article  CAS  PubMed  Google Scholar 

  57. Lorenzi M, Cagliero E, Schmidt NJ (1985) Racial difference in incidence of juvenile-onset type I diabetes: epidemiologic studies in Southern California. Diabetologia 28: 734–738

    CAS  PubMed  Google Scholar 

  58. Siemiatycki J, Colle E, Aubert D et al. (1986) The distribution of type I (insulin-dependent) diabetes mellitus by age, sex, secular trends, seasonality, time clusters and space-time clusters: evidence from Montreal 1971–1983. Am J Epidemiol 124: 545–560

    CAS  PubMed  Google Scholar 

  59. Ehrlich RM, Walsh LJ, Falk JA, Middleton PJ, Simpson NE (1982) The incidence of type I (insulin-dependent) diabetes in Toronto. Diabetologia 22: 289–291

    Article  CAS  PubMed  Google Scholar 

  60. Tuomilehto J, Podar T, Reunanen A et al. (1991) Comparison of incidence of IDDM in childhood between Estonia and Finland, 1980–1988. Diabetes Care 14: 982–988

    CAS  PubMed  Google Scholar 

  61. Hours M, Febry J, Siemiatycki J, Francois R (1984) Diabete insulin-dependant juvenile. Etude descriptive dans le Department du Rhone. Rev Epidem Sante Publ 32: 107–112

    CAS  Google Scholar 

  62. Soltesz G, Madacsy L, Bekefi D, Darko I (1988) The incidence of type 1 (insulin-dependent) diabetes in Hungarian children 0–14 years of age, 1976–1985. Diabetologia 31: 545A (Abstract)

    Google Scholar 

  63. de Beaufort CE, Michel G, Glaesener G (1988) The incidence of type 1 (insulin-dependent) diabetes mellitus in subjects aged 0–19 years in Luxembourg: a retrospective study from 1977 to 1986. Diabetologia 31: 758–761

    Article  PubMed  Google Scholar 

  64. Drykoningen CEM, Mulder ALM, Vaandrager GJ, LaPorte RE, Bruining GJ (1992) The incidence of male childhood type 1 (insulin-dependent) diabetes mellitus is rising rapidly in The Netherlands. Diabetologia 35: 139–142

    Article  CAS  PubMed  Google Scholar 

  65. Michalkova D, Cernay J, Rusnak M, Raisova A, Fandakova M (1992) The incidence of childhood diabetes mellitus type 1 in Slovakia. Diabetologia 35: A131 (Abstract)

    Google Scholar 

  66. Schober E, Frisch H (1988) Incidence of childhood diabetes mellitus in Austria 1979–1984. Acta Paediatr Scand 77: 299–302

    CAS  PubMed  Google Scholar 

  67. Patterson CC, Smith PG, Webb J, Heasman MA, Mann JI (1988) Geographical variation in the incidence of diabetes mellitus in Scottish children during the period 1977–1983. Diabetic Med 5: 160–165

    CAS  PubMed  Google Scholar 

  68. Matsuura N, Fukushima N, Fujita H et al. (1983) Epidemiologic survey of juvenile-onset insulin-dependent diabetes mellitus (IDDM) in Hokkaido, in Japan, 1973–1981. Tohoku J Exp Med 141 [Suppl]: 181–189

    PubMed  Google Scholar 

  69. Wagenknecht LE, Roseman JM, Herman WH (1991) Increased incidence of insulin-dependent diabetes mellitus following an epidemic of coxsackievirus B5. Am J Epidemiol 133: 1024–1031

    CAS  PubMed  Google Scholar 

  70. Scott RS, Brown LJ (1991) Prevalence and incidence of insulintreated diabetes mellitus in adults in Canterbury, New Zealand. Diabetic Med 8: 443–447

    CAS  PubMed  Google Scholar 

  71. Podar T, Tuomilehto-Wolf E, Tuomilehto J, LaPorte RE, Adojaan B (1992) Insulin-dependent diabetes mellitus in native Estonians and immigrants to Estonia. Am J Epidemiol 135: 1231–1236

    CAS  PubMed  Google Scholar 

  72. World Health Organization DIAMOND Project Group on Epidemics (1992) Childhood diabetes, epidemics, and epidemiology: an approach for controlling diabetes. Am J Epidemiol 135: 803–815

    Google Scholar 

  73. Siemiatycki J, Colle E, Aubert D, Campbell S, Belmonte MM (1986) The distribution of type 1 (insulin-dependent) diabetes mellitus by age, sex, secular trend, seasonality, time clusters, and space-time clusters: evidence from Montreal, 1971–1983. Am J Epidemiol 124: 545–560

    CAS  PubMed  Google Scholar 

  74. Tajima N, LaPorte RE, Hibi I, Kitagawa T, Fujita H, Drash AL (1985) A comparison of the epidemiology of youth-onset insulin-dependent diabetes mellitus between Japan and the United States (Allegheny County, Pennsylvania). Diabetes Care 8 [Suppl 1]: 17–23

    PubMed  Google Scholar 

  75. Gay EC, Cruickshanks KJ, Cook M, Lezotte DC, Klingensmith GJ, Chase HP (1990) Colorado IDDM Registry. Incidence and validation of IDDM in children aged 0–17 yr. Diabetes Care 13: 499–506

    PubMed  Google Scholar 

  76. Ludvigsson J, Afoke AO (1989) Seasonality of type 1 (insulin-dependent) diabetes mellitus: values of C-peptide, insulin antibodies and haemoglobin A1c show evidence of a more rapid loss of insulin secretion in epidemic patients. Diabetologia 32: 84–91

    Article  CAS  PubMed  Google Scholar 

  77. Songini M (1992) Incidence of type I diabetes mellitus in Sardinia. Medicographia 13: 10–13

    Google Scholar 

  78. Ajgaonkaar SA (1980) Epidemiology of diabetes in the tropics—an overview, In: Waldhäusl W (ed) Diabetes 1979. Excerpta Medica, Amsterdam, pp 819–828

    Google Scholar 

  79. McLarty DG, Swai ABM, Kitange HM et al. (1989) Prevalence of diabetes and impaired glucose tolerance in rural Tanzania. Lancet I: 871–874

    Google Scholar 

  80. Hugh-Jones P (1955) Diabetes in Jamaica. Lancet II: 891–897

    Google Scholar 

  81. Glass B, Li CC (1953) The dynamics of racial intermixture: an analysis based on the American Negro. Am J Hum Genet 5: 1–4

    CAS  PubMed  Google Scholar 

  82. MacDonald MJ (1975) Lower frequency of diabetes among hospitalized Negro than white children: theoretical implications. Acta Genet Med Gemellol 24: 119–125

    CAS  Google Scholar 

  83. MacDonald MJ (1980) Hypothesis: the frequencies of juvenile diabetes in American blacks and Caucasians are consistent with dominant inheritance. Diabetes 29: 110–114

    CAS  PubMed  Google Scholar 

  84. Reitnauer PJ, Go RCP, Acton RT et al. (1982) Evidence for genetic admixture as a determinant in the occurrence of insulin-dependent diabetes mellitus in U.S. blacks. Diabetes 31: 532–537

    CAS  PubMed  Google Scholar 

  85. Chakraborty R, Kamboh MI, Nwankwo M, Ferrell R (1992) Caucasian genes in American Blacks: new data. Am J Hum Genet 50: 145–155

    CAS  PubMed  Google Scholar 

  86. Robels SC, Marrett LD, Clarke EA, Rish HA (1988) An application of capture. J Clin Epidemiol 41: 495–501

    Google Scholar 

  87. Coleman MP, Démaret E (1988) Cancer registration in the European Economic Community. Lyon, France. IARC Technical Report No. 3

  88. Thomas D, Langholz B, Clayton D, Pitkäniemi J, Tuomilehto-Wolf E, Tuomilehto J (1992) Emperical Bayes methods for testing associations with large numbers of candidate genes in the presence of environmental risk factors, with applications to HLA associations in IDDM. Ann Med 24: 387–392

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Diabetes Research Center, University of Pittsburgh, Pennsylvania, USA

    I. Libman & R. LaPorte

  2. Department of Epidemiology and Health Promotion, National Public Health Institute, Elimäenkatu 25 A 6th Floor, SF-00510, Helsinki, Finland

    M. Karvonen & J. Tuomilehto

Authors
  1. M. Karvonen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Tuomilehto
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. I. Libman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R. LaPorte
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Karvonen, M., Tuomilehto, J., Libman, I. et al. A review of the recent epidemiological data on the worldwide incidence of Type 1 (insulin-dependent) diabetes mellitus. Diabetologia 36, 883–892 (1993). https://doi.org/10.1007/BF02374468

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02374468

Key words

Search

Navigation