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Prevalence and incidence of type 1 diabetes in the world: a systematic review and meta-analysis

Majid Mobasseri, Masoud Shirmohammadi, Tarlan Amiri and 3 more

Health Promotion Perspectives · 2020 · Review

doi:10.34172/hpp.2020.18

Abstract

Background: Diabetes is referred to a group of diseases characterized by high glucose levels in blood. It is caused by a deficiency in the production or function of insulin or both, which can occur because of different reasons, resulting in protein and lipid metabolic disorders. The aim of this study was to systematically review the prevalence and incidence of type 1 diabetes in the world. Methods: A systematic search of resources was conducted to investigate the prevalence and incidence of type 1 diabetes in the world. The databases of Medline (via PubMed and Ovid),ProQuest, Scopus, and Web of Science from January 1980 to September 2019 were searched to locate English articles. The located articles were screened in multiple levels of title, abstract,and full-text and final studies that met the inclusion criteria were retrieved and included in the study. Results: From 1202 located articles, 193 studies were included in this systematic review. The results of meta-analysis showed that the incidence of type 1 diabetes was 15 per 100,000 people and the prevalence was 9.5% (95% CI: 0.07 to 0.12) in the world, which was statistically significant. Conclusion: According to the results, the incidence and prevalence of type 1 diabetes are increasing in the world. As a result, insulin will be difficult to access and afford, especially in underdeveloped and developing countries.

Full text

From PubMed Central, U.S. National Library of Medicine, as current on Oct 17, 2026. Paragraph numbers are ours, so an answer can point at one.

Introduction

Diabetes is referred to a group of diseases characterized by high glucose levels in blood. It is caused by a deficiency in the production or function of insulin or both, which can occur because of different reasons, resulting in protein and lipid metabolic disorders. The long-term effects of hypoglycemia are tissue and organ damage.

Symptoms of diabetes include polyuria, thirst, vision disorders, and weight loss. In some cases there are more severe forms of diabetic ketoacidosis and hyperosmolar that may lead to stupor and coma. But most symptoms are not severe, which may cause damage or even failure of different organs in the long run and lead to irreparable injuries such as blindness, amputation, stroke and eventually death. Previously, type 1 diabetes was called insulin-dependent diabetes and it could happen at any age but is most common in children and young people.

People with type 1 diabetes are not able to produce enough insulin. This type constitutes about 5%–10% of all cases of diabetes. In this type, the cellular destruction of beta cells occurs in the pancreas. In type 1 diabetes, the pancreas does not release any insulin. Since there is no epidemiologically accurate information on the prevalence and incidence of type 1 diabetes in the world and in the region, therefore, the present study was designed and implemented as a systematic review and meta-analysis, because of geopolitical map of the policy on the prevention and treatment of this disease can be done better.

Materials and Methods

In this systematic review and meta-analysis, a systematic search of resources was conducted by a librarian (N.V.) to investigate the prevalence and incidence of type 1 diabetes (condition) in the people (population) of the world (context). The PICO of study based on the JBI protocol as CoCoPop for prevalence and incidence studies.

Data sources and search strategy

The databases of Medline via (PubMed, Ovid), Embase, Scopus, Web of Science from January 1980 to September 2019 were searched to locate English articles. Also, SID, Magiran, and Barakat databases were searched for Persian studies. The grey literature and ongoing studies were searched using the following: OpenGrey, Google Scholar and for thesis and dissertations ProQuest and studies presented at conferences were also searched. Also, experts and professionals on this subject were reached and their opinions were gathered for information on published and unpublished studies. The search was performed using MESH and free keywords. The keywords selected for the search were: “type 1 diabetes”, “prevalence”, and “incidence” with this search strategy: (((“Diabetes Mellitus, Type 1”[Mesh]) OR ((((((((((((((((((((IDDM[Title/Abstract]) OR T1DM[Title/Abstract]) OR “Type 1 Diabetes”[Title/Abstract]) OR “Autoimmune Diabetes”[Title/Abstract]) OR “Juvenile Onset Diabetes”[Title/Abstract]) OR “Juvenile-Onset Diabetes”[Title/Abstract]) OR “Brittle Diabetes Mellitus”[Title/Abstract]) OR “brittle diabetes”[Title/Abstract]) OR “diabetes mellitus type 1”[Title/Abstract]) OR “diabetes mellitus type I”[Title/Abstract]) OR “diabetes type 1”[Title/Abstract]) OR “diabetes type I”[Title/Abstract]) OR “early onset diabetes mellitus”[Title/Abstract]) OR “insulin dependent diabetes”[Title/Abstract]) OR “juvenile diabetes”[Title/Abstract]) OR “juvenile diabetes mellitus”[Title/Abstract]) OR “type I diabetes”[Title/Abstract]) OR “type I diabetes mellitus”[Title/Abstract]) OR “Insulin Dependent Diabetes Mellitus”[Title/Abstract]) OR “Insulin-Dependent Diabetes Mellitus”[Title/Abstract]))) AND ((((“Prevalence”[Mesh]) OR ((Prevalence[Title/Abstract]) OR Prevalences[Title/Abstract]))) OR ((“Incidence”[Mesh]) OR ((Incidence[Title/Abstract]) OR Incidences[Title/Abstract]))). The complete search strategy of Medline and Embase is in Supplementary file 1.

Inclusion and exclusion criteria

Inclusioncriteria for selecting studies include: 1. Articles published between 1980 and 2019; 2. Articles published in English and Persian. The exclusion criteria were: 1. Studies with no reported sample size; 2. Studies that had low quality; 3. Studies that were published before 1990.

Study selection

The located articles were screened in multiple levels of title, abstract, and full-text and final studies that met the inclusion criteria were retrieved and included in the study. The studies were critically appraised by 2 subject specialists and low-quality studies were excluded. In cases of disagreements between two experts (M.M. and M.S.) at each stage of selection and appraisal, third person opinion was used.

Quality appraisal

Articles were evaluated using the STROBE checklist. In this checklist, the minimum score was 2 and the maximum was 4. Finally, articles that received a score of 4 on checklist questions were included in the research, 128 articles earned 4 score, 46 articles earned 3 score and 19 articles earned 2 score and finally their data were extracted to perform the meta-analysis.

Data extraction and quality assessment

The information extracted from the articles were entered in the extraction form. Extracted data included: first author, year of publication, country of study, sample size, and incidence of diabetes in the studies.

Statistical analysis

Statistical analysis was performed using CMA v.2.0 software and P value less than 0.05 was considered as significant. The binomial distribution was used to calculate the variance. Weighted mean was used to combine the prevalence rate of different studies. Meta-analysis was used to obtain the incidence of type 1 diabetes. The heterogeneity between studies was assessed by Cochran (Q) and I statistics, which expressed the percentage of variation between studies. Random effects model was used to calculate the overall and pooled effect size.

Search results and study characteristics

In a systematic search of sources, 65 765 articles were identified. A total of 58 239 articles were duplicates, and 7107 were excluded after reviewing the title and abstract of the articles. After reviewing the full-text articles, 49 articles were excluded. Finally, 193 studies were included in the systematic review and meta-analysis. Figure 1 shows the identified and retrieved articles in the study. Tables 1, 2 and 3 show the specifications of the articles that were studied.

Prevalence and incidence of type 1 diabetes in Asia

Prevalence and incidence of type 1 diabetes were extracted from meta-analysis studies. In type 1 diabetes incidence, the heterogeneity between studies in the meta-analysis was significant (Q = 50.51; df = 16; P < 0.001; I2 = 68.33), but in the prevalence of diabetes 1, the heterogeneity was not significant (Q = 5220; df = 6; P < 0.001; I2 = 99.88). The incidence of type 1 diabetes in Asia was 15 per 100 000 population, which was statistically significant (Incidence = 0.015, 95% CI = 0.010 to 0.021, P < 0.001), and the prevalence of type 1 diabetes was 6.9 per 10 000 people, which was statistically significant (Prevalence = 0.069, 95% CI = 0.020 to 0.214, P < 0.001). Figures 2A and 2B show the forest plot of prevalence and incidence of type 1 diabetes in Asia.

Prevalence and incidence of type 1 diabetes in Africa

Prevalence and incidence of type 1 diabetes were extracted from meta-analysis studies. In type 1 diabetes incidence, the heterogeneity between studies in the meta-analysis was not significant (Q = 23.79; df = 6; P < 0.001; I2 = 74.78) and in the prevalence of diabetes 1, the heterogeneity was not significant too, (Q = 4.4; df = 1; P < 0.001; I2 = 77.27). The incidence of type 1 diabetes in Africa was 8 per 100 000 population, which was statistically significant (Incidence = 0.008, 95% CI = 0.003 to 0.021 P < 0.001), and the prevalence of type 1 diabetes was 3.5 per 10 000 people, which was not statistically significant (prevalence = 0.035, 95% CI: 0.022 to 0.055, P < 0.001). Figures 3A and 3B show the forest plot of prevalence and incidence of type 1 diabetes in Africa.

Prevalence and incidence of type 1 diabetes in Europe

Prevalence and incidence of type 1 diabetes were extracted from meta-analysis studies. In type 1 diabetes incidence, the heterogeneity between studies in the meta-analysis was significant (Q = 895.56, df = 96, P < 0.001, I2 = 89.28) but in the prevalence of diabetes 1, the heterogeneity was not significant, (Q = 5792.85, df = 15, P < 0.001, I2 = 99.74). The incidence of type 1 diabetes in Europe was 15 per 100 000 population, which was statistically significant (Incidence = 0.015, 95% CI = 0.013 to 0.018, P < 0.001), and the prevalence of type 1 diabetes was 12.2 per 10 000 people, which was statistically significant (Prevalence = 0.122, 95% CI = 0.085 to 0.171, P < 0.001). Figures 4 and 5 show the forest plot of prevalence and incidence of type 1 diabetes in Europe.

Prevalence and incidence of type 1 diabetes in America

Prevalence and incidence of type 1 diabetes were extracted from meta-analysis studies. In type 1 diabetes incidence, the heterogeneity between studies in the meta-analysis was significant (Q = 18.88, df = 16, P = 0.27, I2 = 15.28) and in the prevalence of diabetes 1, the heterogeneity was significant too, (Q = 1120.79, df = 7, P < 0.001, I2 = 99.38). The incidence of type 1 diabetes in America was 20 per 100 000 population, which was statistically significant (Incidence = 0.020, 95% CI = 0.010 to 0.021, P < 0.001), and the prevalence of type 1 diabetes was 12.2 per 10 000 people, which was statistically significant (Prevalence = 0.093, 95% CI = 0.063 to 0.137, P < 0.001). Figures 6A and 6B show the forest plot of prevalence and incidence of type 1 diabetes in America. A sensitivity analysis was done for Incidence of type 1 diabetes in America based on excluding studies with too wide CIs. Sensitivity analysis’s results show that the incidence of type 1 diabetes in America is 19 per 100 000 population, which is statistically significant (Incidence = 0.019, 95% CI = 0.016 to 0.022, P < 0.001).

Prevalence and incidence of type 1 diabetes in the world

Prevalence and incidence of type 1 diabetes were extracted from meta-analysis studies. In type 1 diabetes incidence, the heterogeneity between studies in the meta-analysis was significant (Q = 1020.30, df = 137, P < 0.001, I2 = 86.57) and in the prevalence of diabetes 1, the heterogeneity was significant too, (Q = 14760.32, df = 32, P < 0.001, I2 = 99.78). The incidence of type 1 diabetes in world was 15 per 100 000 population, which was statistically significant (Incidence = 0.015, 95% CI = 0.013 to 0.017, P < 0.001), and the prevalence of type 1 diabetes was 9.5 per 10 000 people, which was statistically significant (prevalence = 0.095, 95% CI = 0.070 to 0.128, P < 0.001). Figure 7 shows the forest plot of prevalence and incidence of type 1 diabetes in the world.

Publication bias

In order to assess the publication bias, Eggers Regression test was used. Based on the results, the population bias between studies was not significant (t-value = 1.26, df 93, P = 0.21).

Meta-Regression

Meta-regression was used to determine the effect of time on type 1 diabetes incidence. The results showed that the incidence of type 1 diabetes has increased over time. The meta-regression plot is shown in Figure 8.

Discussion

The global trend of increasing prevalence of type 1 diabetes, with multiple etiologies, operates through multiple mechanisms. In the present study, data were extracted from 193 articles between 1990 and 2019. The results showed that the incidence of type 1 diabetes in continental subgroups (Asia, Africa, Europe, and America) was 15 per 100 000, 8 per 100 000, 15 per 100 000 and 20 per 100, respectively. Also, the global prevalence of continental subtypes of type 1 diabetes in the above regions was, 6.9 per 10 000, 3.5 per 10 000, and 12.2 per 10 000, respectively.

Relative differences between obtained results and previous statistics may be due to different research time periods and new global population status. Especially in recent years (social, political and economic migration), the changing global climate coupled with new policies and sanctions that have led to poorer middle-income and low-income countries.

The pathogenesis of type 2 diabetes is known, which is associated with different genes and the involvement of multiple factors. Type 2 diabetes can be prevented and treated by removing or reducing these factors. Most of the warnings of national and international health bodies and diabetes associations are based on lifestyle changes and stress reduction that can prevent diabetes.

But in type 1 diabetes, that make up 5 to 15 percent of diabetics and often involve children, Prevention ways have not yet been defined. However, screening of type 1 diabetes in prone families in relation to autoantibodies has recently been proposed. Also, clinical studies on the prevention of type 1 diabetes have been conducted.

If one foot was amputated every 30 seconds, today it’s every 15 seconds. Need for dialysis equipment will increase. The CCU and ICU beds will be full of stroke and myocardial infarction patients. The population of the blind increases and unfortunately, new, effective, and less complicated treatments become more expensive.

The disease shows a significant increase in glucose and possibly DKA. These patients definitely need insulin due to the pathogenesis of insulin deficiency. Manufacturing and production of insulin (traditional insulins and analog insulins) and insulin pumps, despite being inexpensive in producing countries, is shipped to low- and middle-income countries for high prices which is a major problem for the managing of type 1 diabetes patients. Certainly, uncontrolled hyperglycemia in type 1 diabetic patients will make all the problems more severe.

Limitations

One of the limitations of the study was the poor quality of some articles and, despite a careful search, the lack of access to some of the full text of the published articles.

Conclusion

According to the results, the incidence and prevalence of type 1 diabetes are increasing in the world. As a result, insulin will be difficult to access and afford, especially in underdeveloped and developing countries. Thus, warnings about this can help international organizations and countries to plan for preventive measures.

Ethical approval

This research was approved by the Local Ethics Committee with No. 61701.

Competing interests

The authors declare that they have no competing interests.

Funding

This article was supported by the Research Center for Evidence-Based Medicine, and the Research Vice-Chancellor of Tabriz University of Medical Sciences.

Authors’ contributions

Concept: MM. Study design: MSH and TA. Systematic search: NV. Critical reviews: MM and TA. Data extraction: MSH and MGH. Data analysis: MGH and HHF. Writing: NV, TA and MM. All authors had primary responsibility for the final content of the manuscript and read and approved the final manuscript.

Acknowledgments

Special thanks to the Research Vice-Chancellor of Tabriz University of Medical Sciences for financial support for this study.

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    Incidence of type 1 (insulin-dependent) diabetes mellitus in Catalonia, Spain. The Catalan Epidemiology Diabetes Study Group. Diabetologia. 1992;35(3):267-71.

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    Trends in the incidence of childhood type 1 diabetes mellitus in Beijing based on hospitalization data from 1995 to 2010. Horm Res Paediatr. 2013;80(5):328-34.

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    Variations in incidence of type 1 diabetes in different municipalities of Stockholm. Ann N Y Acad Sci. 2008;1150:200-7.

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    Incidence of insulin-dependent diabetes mellitus in young adults: experience of 1,587,630 US Navy enlisted personnel. Am J Epidemiol. 1993;138(11):984-7.

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    Incidence of childhood insulin-dependent diabetes mellitus in Lithuania 1983-1988. Acta Paediatr Scand. 1991;80(6-7):718-9.

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    Trends in the incidence of childhood-onset diabetes in Europe 1989-1998. Diabetologia. 2001;44 Suppl 3:B3-8.

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    Time trends in the incidence of type 1 diabetes in Finnish children: a cohort study. Lancet. 2008;371(9626):1777-82.

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    Incidence of type 1 diabetes in Finland. JAMA. 2013;310(4):427-8.

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    Epidemiology of diabetes mellitus in children in Hong Kong: the Hong Kong childhood diabetes register. J Pediatr Endocrinol Metab. 2000;13(3):297-302.

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    Epidemiology of type 1 diabetes among Silesian children aged 0-14 years, 1989-2005. Acta Diabetol. 2010;47(1):29-33.

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    Rapid increase in the incidence of type 1 diabetes in Polish children from 1989 to 2004, and predictions for 2010 to 2025. Diabetologia. 2011;54(3):508-15.

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    Ethnic differences in incidence of type 1 diabetes among second-generation immigrants and adoptees from abroad. J Clin Endocrinol Metab. 2010;95(2):847-50.

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    Ten-year incidence (1981-90) of insulin-dependent diabetes in the 0-29-year-old age group in Benghazi, Libya. Diabetes Res Clin Pract. 1994;26(3):223-8.

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    Incidence of insulin-dependent diabetes (IDDM) and non-insulin-dependent diabetes (NIDDM) (0-34 years at onset) in Benghazi, Libya. Diabetes Res Clin Pract. 1996;32(3):165-73.

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    Seasonality in the clinical onset of insulin-dependent diabetes mellitus in Finnish children. Childhood Diabetes in Finland (DiMe) Study Group. Am J Epidemiol. 1996;143(2):167-76.

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    Incidence of childhood type 1 diabetes worldwide. Diabetes Mondiale (DiaMond) Project Group. Diabetes Care. 2000;23(10):1516-26.

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    Regional differences in the incidence of insulin-dependent diabetes mellitus among children in Finland from 1987 to 1991. Childhood Diabetes in Finland (DiMe) Study Group. Ann Med. 1997;29(4):297-304.

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    Immunogenetics of insulin-dependent diabetes mellitus. Acta Paediatr. 1999;88(s427):3-7.

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    Incidence of type 1 diabetes mellitus in the 0- to 17-yr-old Israel population, 1997-2003. Pediatr Diabetes. 2007;8(2):60-6.

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    A twelve year study of the incidence of childhood type 1 diabetes mellitus in the Eastern Province of Saudi Arabia. J Pediatr Endocrinol Metab. 2000;13(2):135-40.

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    A high incidence of type 1 diabetes and an alarming increase in the incidence of type 2 diabetes among young adults in Finland between 1992 and 1996. Diabetologia. 2007;50(7):1393-400.

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    Incidence of insulin-dependent diabetes mellitus in the IX region of Chile: ethnic differences. Diabetes Res Clin Pract. 1996;34 Suppl:S147-51.

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    Trends in incidence of type 1 diabetes among non-Hispanic white youth in the U.S., 2002-2009. Diabetes. 2014;63(11):3938-45.

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    Annual incidence of type 1 diabetes in Quebec between 1989-2000 in children. Clin Invest Med. 2006;29(1):10-3.

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    Was there an epidemic of diabetes in nonwhite adolescents in Allegheny County, Pennsylvania? Diabetes Care. 1998;21(8):1278-81.

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    Incidence of and mortality from type I diabetes in Taiwan from 1999 through 2010: a nationwide cohort study. PLoS One. 2014;9(1):e86172.

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    The epidemiology of type I diabetes in children 0-14 yr of age in Philadelphia. Diabetes Care. 1993;16(6):922-5.

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    The epidemiology of type 1 diabetes in children in Philadelphia 1990-1994: evidence of an epidemic. Diabetes Care. 2002;25(11):1969-75.

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    Incidence of type 1 diabetes in Philadelphia is higher in black than white children from 1995 to 1999: epidemic or misclassification? Diabetes Care. 2006;29(11):2391-5.

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    Increasing incidence of type 1 diabetes in youth: twenty years of the Philadelphia Pediatric Diabetes Registry. Diabetes Care. 2013;36(6):1597-603.

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    Incidence and onset features of diabetes in African-American and Latino children in Chicago, 1985-1994. Diabetes Metab Res Rev. 2002;18(2):135-42.

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    Incidence of type 1 diabetes mellitus in Passo Fundo, RS, Brazil · 1998
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    A nine-year prospective study on the incidence of childhood type 1 diabetes mellitus in China. Biomed Environ Sci. 2000;13(4):263-70.

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    Incidence of Type 1 diabetes in children in Cáceres, Spain, during 1988-1999. Diabetes Res Clin Pract. 2005;69(2):169-74.

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    Epidemiology of childhood type I diabetes in Crete, 1990-2001. Acta Paediatr. 2003;92(6):737-9.

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    Incidence of childhood type 1 diabetes mellitus in Gomel, Belarus. J Pediatr Endocrinol Metab. 2002;15(1):53-7.

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    Increasing trend of childhood type 1 diabetes in Franche-Comté (France): analysis of age and period effects from 1980 to 1998. Eur J Epidemiol. 2005;20(4):325-9.

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    Diabetes in African American youth: prevalence, incidence, and clinical characteristics: the SEARCH for Diabetes in Youth Study. Diabetes Care. 2009;32 Suppl 2:S112-22.

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    Incidence of type I diabetes in the Liguria Region, Italy. Results of a prospective study in a 0- to 14-year age-group. Diabetes Care. 1994;17(10):1193-6.

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    Incidence of insulin dependent diabetes in children aged under 15 years in the British Isles during 1988. BMJ. 1991;302(6774):443-7.

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    Trends in the incidence of childhood-onset type 1 diabetes in Slovakia 1985 - 2000. Cent Eur J Public Health. 2004;12(2):75-7.

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    Incidence of type I diabetes among children and young adults (0-29 years) in the province of Badajoz, Spain during 1992 to 1996. Acta Paediatr. 2000;89(1):101-4.

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    Epidemiological study of type 1 diabetes in children under 15 years-old in Castilla-La Mancha (Spain). An Pediatr (Barc). 2012;76(2):83-91.

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    High incidence rate of IDDM in Sardinia. Sardinian Collaborative Group for Epidemiology of IDDM. Diabetes Care. 1992;15(10):1317-22.

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    Incidence of insulin-dependent diabetes mellitus among Sardinian-heritage children born in Lazio region, Italy. Lancet. 1997;349(9046):160-2.

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    Incidence of IDDM in German children aged 0-14 years. A 6-year population-based study (1987-1993). Diabetes Care. 1997;20(4):530-3.

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    Diabetes incidence in children of different nationalities: an epidemiological approach to the pathogenesis of diabetes. Diabetologia. 2001;44 Suppl 3:B21-6.

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    High incidence of childhood type 1 diabetes in the Avalon Peninsula, Newfoundland, Canada. Diabetes Care. 2004;27(4):885-8.

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    Very high and increasing incidence of type 1 diabetes mellitus in Newfoundland and Labrador, Canada. Pediatr Diabetes. 2008;9(3 Pt 2):62-8.

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    Recent incidence of type 1 diabetes mellitus in children 0-14 years in Newfoundland and Labrador, Canada climbs to over 45/100 000: a retrospective time trend study. BMC Res Notes. 2012;5:628.

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    The incidence of type 1 diabetes mellitus among 15-34 years aged Lithuanian population: 18-year incidence study based on prospective databases. BMC Public Health. 2011;11:813.

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    Variation and trends in incidence of childhood diabetes in Europe. Lancet. 2000;355(9207):873-6.

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    Is childhood-onset type I diabetes a wealth-related disease? An ecological analysis of European incidence rates. Diabetologia. 2001;44(Suppl 3):B9-16.

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    Trends in the incidence of type I diabetes mellitus worldwide. West Indian Med J. 2007;56(3):264-9.

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    Incidence of insulin dependent diabetes mellitus in children 0-14 years old in the Veneto Region, Italy. J Pediatr Endocrinol Metab. 1998;11(3):447-50.

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    Low incidence of type 1 diabetes in Iran. Diabetes Care. 2005;28(4):927-8.

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    Insulin-dependent diabetes mellitus in native Estonians and immigrants to Estonia. Am J Epidemiol. 1992;135(11):1231-6.

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    The increase of incidence rate of diabetes mellitus type 1(T1DM) among Silesian children (Poland) still maintains the high tempo, in years 1989-2012. Pediatr Diabetes. 2014;15:49-137.

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    Incidence of IDDM in the Campania region, Italy. Diabetes Care. 1996;19(12):1454-5.

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    A 10-year (1996-2005) prospective study of the incidence of type 1 diabetes in Moscow in the age group 0-14 years. Diabet Med. 2008;25(8):956-9.

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    Incidence of type 1 diabetes in Lithuanians aged 0-39 years varies by the urban-rural setting, and the time change differs for men and women during 1991-2000. Diabetes Care. 2003;26(3):671-6.

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    The incidence of type 1 diabetes in Republic of Srpska (Bosnia and Herzegovina) and Slovenia in the period 1998-2010. Pediatr Diabetes. 2013;14(4):273-9.

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    Incidence of IDDM in children in urban population in southern India. Madras IDDM Registry Group Madras, South India. Diabetes Res Clin Pract. 1996;34(2):79-82.

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    Incidence of type I diabetes mellitus in children and young adults in the province of Upper Austria, 1994-1996. Diabetologia. 2001;44(Suppl 3):B45-7.

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    Rising incidence of type 1 diabetes in Scottish children, 1984-93. The Scottish Study Group for the Care of Young Diabetics. Arch Dis Child. 1997;77(3):210-3.

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    Incidence of type 1 (insulin-dependent) diabetes mellitus in subjects 0-14 years of age in the Comunidad of Madrid, Spain. Diabetologia. 1990;33(7):422-4.

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    National incidence of type 1 diabetes in childhood and adolescence. Ir Med J. 2002;95(4):115-6, 8.

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    Temporal, seasonal, and geographical incidence patterns of type I diabetes mellitus in children under 5 years of age in Germany. Diabetologia. 1999;42(9):1055-9.

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    Low incidence of IDDM in children of Veracruz-Boca del Rio, Veracruz. Results of the first validated IDDM registry in Mexico. Diabetes Care. 1998;21(8):1372-3.

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    The incidence of type 1 diabetes among children in Finland--rural-urban difference. Health Place. 2003;9(4):315-25.

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    Increasing incidence of childhood type 1 diabetes in Montenegro from 1997 to 2006. Pediatr Diabetes. 2010;11(6):412-6.

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    Space-time clustering in insulin-dependent diabetes mellitus (IDDM) in south-east Sweden. Int J Epidemiol. 1994;23(1):138-42.

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    Incidence rate and spatio-temporal clustering of type 1 diabetes in Santiago, Chile, from 1997 to 1998. Rev Saude Publica. 2001;35(1):96-100.

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    Epidemiology of childhood diabetes in Osaka District, Japan, using the documents from the medical benefits system specific for childhood diabetes. Diabetes Res Clin Pract. 1992;18(3):191-6.

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    Increasing incidence of IDDM in Austrian children. A nationwide study 1979-1993. Austrian Diabetes Incidence Study Group. Diabetes Care. 1995;18(9):1280-3.

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    Schober E, Waldhoer T, Rami B, Hofer S. Incidence and time trend of type 1 and type 2 diabetes in Austrian children 1999-2007. J Pediatr 2009;155(2):190-3.e1.

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    Epidemiology of type I diabetes mellitus in Switzerland: steep rise in incidence in under 5 year old children in the past decade. Diabetologia. 2001;44(3):286-9.

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    Temporal variation in incidence of IDDM in Canterbury, New Zealand. Diabetes Care. 1992;15(7):895-9.

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    A 5-year (1989-1993) prospective study of the incidence of IDDM in Rome and the Lazio region in the age-group 0-14 years. Diabetes Care. 1996;19(1):70-3.

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    A retrospective study of the incidence of diagnosed Type 1 diabetes among children and adolescents in a large health organization in Israel, 2000-2008. Diabet Med. 2011;28(1):48-53.

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    Establishment of a registry and incidence of IDDM in Avellaneda, Argentina. Diabetes Care. 1994;17(9):1022-5.

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    Further evidence for the rising incidence of childhood Type 1 diabetes in Kuwait. Diabet Med. 2002;19(6):522-5.

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    Ethnic differences in the incidence of childhood IDDM in Israel (1965-1993). Marked increase since 1985, especially in Yemenite Jews. Diabetes Care. 1997;20(4):504-8.

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    López Siguero JP, Martínez Aedo Ollero MJ, Molina JA, Lora Espinosa A, Valverde AM. Evolución de la incidencia de la diabetes mellitus tipo I en niños de 0 a 14 años en Málaga (1982-1993). An Esp Pediatr 1997;47(1):17-22. [Spanish].

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    Rising incidence of type 1 diabetes in Belgrade children aged 0-14 years in the period from 1982 to 2005. J Endocrinol Invest. 2013;36(5):307-12.

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    Incidence of insulin dependent diabetes mellitus in Greek Cypriot children and adolescents, 1990-1994. J Pediatr Endocrinol Metab. 1997;10(2):203-7.

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    The incidence of type 1 diabetes mellitus in Greek-Cypriot children and adolescents in 1990-2000. Pediatr Diabetes. 2002;3(4):200-4.

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    Epidemiology of type 1 diabetes mellitus in Cyprus: rising incidence at the dawn of the 21st century. Hormones (Athens). 2012;11(1):86-93.

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    Incidence of type 1 diabetes in Norway among children aged 0-14 years between 1989 and 2012: has the incidence stopped rising? results from the Norwegian Childhood Diabetes Registry. Diabetologia. 2014;57(1):57-62.

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    Incidence of childhood type I and non-type 1 diabetes mellitus in a diverse population: the Chicago Childhood Diabetes Registry, 1994 to 2003. J Pediatr Endocrinol Metab. 2007;20(10):1093-107.

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    The epidemiology of diabetes mellitus in the United Kingdom: the Yorkshire regional childhood diabetes register. Diabetologia. 1993;36(12):1282-7.

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    Small area variation in the incidence of childhood insulin-dependent diabetes mellitus in Yorkshire, UK: links with overcrowding and population density. Int J Epidemiol. 1997;26(6):1307-13.

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    Incidence and trends of childhood type 1 diabetes in Croatia from 1995 to 2003. Diabetes Res Clin Pract. 2008;80(1):122-7.

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    Increased risk of childhood type 1 diabetes in children born after 1985. Diabetes Care. 2002;25(12):2197-201.

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    Decreasing humoral activity in siblings of type 1 diabetes children over a ten year period with increasing incidence of the disease. Diabetologia. 2008;51(S1):232-3.

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    Prospective study of incidence of juvenile diabetes mellitus over 10 years in Dar es Salaam, Tanzania. BMJ. 1993;306(6892):1570-2.

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    Ketoacidosis at onset of type 1 diabetes mellitus in children in Bosnia and Herzegovina: frequency and clinical presentation. J Pediatr Endocrinol Metab. 2007;20(10):1137-40.

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    The rising incidence of childhood type 1 diabetes in New South Wales, 1990-2002. Med J Aust. 2005;183(5):243-6.

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    Increasing incidence of childhood-onset type 1 diabetes mellitus among Estonian children in 1999-2006. Time trend analysis 1983-2006. Pediatr Diabetes. 2010;11(2):107-10.

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    Incidence of type 1 and type 2 diabetes in adults and children in Kronoberg, Sweden. Diabetes Res Clin Pract. 2008;82(2):247-55.

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    Early changes in glomerular size selectivity in young adults with type 1 diabetes and retinopathy. Results from the Diabetes Incidence Study in Sweden. J Diabetes Complications. 2007;21(4):246-51.

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    High incidence of IDDM over 6 years in Edmonton, Alberta, Canada. Diabetes Care. 1997;20(3):311-3.

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    Rising incidence of type 1 diabetes mellitus in children and adolescents in Cyprus in 2000-2004. Pediatr Diabetes. 2007;8(6):374-6.

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    Population-based incidence of diabetes in Australian youth aged 10-18 yr: increase in type 1 diabetes but not type 2 diabetes. Pediatr Diabetes. 2014;15(8):585-90.

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    The epidemiology of type 1 diabetes in Thai children. J Med Assoc Thai. 2002;85(6):648-52.

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    Epidemiology of childhood IDDM in U.S. Virgin Islands from 1979 to 1988. Evidence of an epidemic in early 1980s and variation by degree of racial admixture. Diabetes Care. 1991;14(7):558-64.

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    Comparison of incidence of IDDM in childhood between Estonia and Finland, 1980-1988. Diabetes Care. 1991;14(11):982-8.

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    Can the difference in incidence of type 1 diabetes between Estonia and Finland be partly explained by genetic reasons. Diabetologia. 1991;34(Suppl 2):A65.

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    Epidemiology of childhood diabetes mellitus in Finland--background of a nationwide study of type 1 (insulin-dependent) diabetes mellitus. The Childhood Diabetes in Finland (DiMe) Study Group. Diabetologia. 1992;35(1):70-6.

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    Comparison of the incidence of insulin-dependent diabetes mellitus in childhood among five Baltic populations during 1983-1988. Int J Epidemiol. 1992;21(3):518-27.

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    Incidence of IDDM in Mauritian children and adolescents from 1986 to 1990. Diabetes Care. 1993;16(12):1588-91.

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    Record-high incidence of type I (insulin-dependent) diabetes mellitus in Finnish children. The Finnish Childhood Type I Diabetes Registry Group. Diabetologia. 1999;42(6):655-60.

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    Increase in IDDM incidence in Bulgarian children (1974-1995). J Pediatr Endocrinol Metab. 1998;11(6):725-32.

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    Epidemiology, clinical aspects, and biology of IDDM patients under age 40 years. Comparison of data from Antwerp with complete ascertainment with data from Belgium with 40% ascertainment. The Belgian Diabetes Registry. Diabetes Care. 1997;20(10):1556-61.

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    Increasing incidence of type 1 diabetes in 0-to 17-year-old Colorado youth. Diabetes Care. 2007;30(3):503-9.

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    The incidence of childhood IDDM in New South Wales, Australia. Diabetes Care. 1994;17(7):693-6.

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    An easy, fast, effective tool to monitor the incidence of type 1 diabetes among children aged 0-4 years in Italy: the Italian Hospital Discharge Registry (IHDR). Acta Diabetol. 2014;51(2):287-94.

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    Insulin dependent diabetes mellitus: incidence in childhood in Belgrade 1982-92. J Epidemiol Community Health. 1995;49(1):107-8.

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    Confirmation of high incidence of type 1 (insulin-dependent) diabetes mellitus in Moroccan children in The Netherlands. Diabet Med. 1997;14(5):397-400.

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    Insulin dependent diabetes in children under 5: incidence and ascertainment validation for 1992. BMJ. 1995;310(6981):700-3.

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    Not checked

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