Burden of Type 1 Diabetes

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Presentation transcript:

Burden of Type 1 Diabetes

Incidence and Prevalence of Type 1 Diabetes T1D 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 T1D, type 1 diabetes. Maahs DM, et al. Endocrinol Metab Clin North Am. 2010;39:481-497.

Diabetes in Children and Young Adults In the past, diabetes in youth was almost always T1D, but more T2D is no longer “adult onset” diabetes only Nearly all children with diabetes diagnosed <10 years have T1D Majority of non-Hispanic youth with diabetes diagnosed have T1D However, among US children 10-19 years at diagnosis Half of African-American and Hispanic patients have T2D More than half of Asian/Pacific Islanders and American Indians have T2D T1D, type 1 diabetes; T2D, type 2 diabetes. Dabelea D, et al. JAMA. 2007;297:2716-2724.

Annual Incidence of Diabetes in US Children and Adolescents Rate (per 100,000 per year) <10 years 10-19 years AI, American Indians; API, Asians/Pacific Islanders; H, Hispanics; non-Hispanic blacks; NHW, non-Hispanic whites; NHB. CDC. National diabetes statistics report, 2014. http://www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf

Immunological Changes and Incidence of Type 1 Diabetes Rising incidence of T1D 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 T1D is now characterized by a more intense humoral autoimmune response IAA, autoantibodies to insulin; GADA, GAD; IA-2A, islet antigen-2; T1D, type 1 diabetes; ZnT8A, zinc transporter 8. Long AE, et al. Diabetes. 2012;61:683-686.

Postulated Contributing Factors for T1D Risk Infections* Early childhood diet (dietary proteins)* Vitamin D exposure Environmental pollutants Increased height velocity Obesity Insulin resistance* *Evidence strengthening for an association T1D, type 1 diabetes. Forlenza GP, Rewers M. Curr Opin Endocrinol Diabetes Obes. 2011;18:248-251.

Mortality in Childhood-Onset T1D Mortality rate: 2.2/1000 person-years Most common cause of death <30 years of age Acute metabolic complications of diabetes (eg, diabetic ketoacidosis) Most common cause of death >30 years of age Cardiovascular disease Skrivarhaug T, et al. Diabetologia. 2006;49:298-305. Patterson CC, et al. Diabetologia. 2007;50:2439-2442. Libby P, et al. Circulation. 2005;111:3489-3493.

Development of Microalbuminuria and Macroalbuminuria in T1D Hovind P, et al. BMJ. 2004;328:1105.

T1D Mortality Correlates With Renal Function FinnDiane Study (N=4201) Hazard Ratio for Death Risk of mortality in individuals with T1D associated each level of albuminuria and end-stage kidney disease. Groop P, et al. Diabetes. 2009;58:1651-1658.

Mortality in Patients With T1D Swedish National Diabetes Register (n=33,915 with T1D; n=169,249 without diabetes) Mortality Risk vs Patients Without Diabetes Mortality Risk by A1C Level Hazard ratio* Hazard ratio* A1C (%) *Adjusted for age, diabetes duration, sex, birthplace, education, CVD status, and cancer status. CVD, cardiovascular disease; T1D, type 1 diabetes. Lind M, et al. N Engl J Med. 2014;371:1972-1982.

T1D-Related Mortality Swedish National Diabetes Register (n=33,915) Cause of Diabetes-Related Death, All Patients DKA Mortality Patients (%) Patients (%) T1D Complication Age (years) DKA, diabetic ketoacidosis; T1D, type 1 diabetes. Lind M, et al. N Engl J Med. 2014;371:1972-1982.

Rates of DKA Over 12 Month Period in Adults with T1D T1D Exchange (N=7012) P<0.001 Patients (%) Mean A1C in past year (%) DKA, diabetic ketoacidosis; T1D, type 1 diabetes. Weinstock RS, et al. J Clin Endocrinol Metab. 2013;98:3411-3419.

Type 1 Diabetes Is Costly Expected Lifetime Medical and Indirect Costs Attributed to T1D (2005 Dollars) Age of onset Number of new patients Medical (millions) Income loss (millions) 3-9 6,483 $746 $1,208 10-19 11,980 $1,489 $2,923 20-29 3,528 $337 $1,130 30-39 3,976 $395 $1,279 40-45 2,464 $309 $776 Total 28,430 $3,276 $7,316 T1D, type 1 diabetes. Tao BT, Taylor DG. Endocrinol Metab Clin North Am. 2010;39:499-512.

Intensive Therapy Reduces Diabetes Complications Rates DCCT (N=1441) and Pittsburgh Epidemiology of Diabetes Complications Study (N=161) DCCT, Diabetes Control and Complications Trial; PEDC, Pittsburgh Epidemiology of Diabetes Complications cohort. Nathan DM, et al. Arch Intern Med. 2009;169:1307-1316.