Epidemiology, presentation, and diagnosis of type 1 diabetes mellitus in children and adolescents
- Lynne L Levitsky, MD
Lynne L Levitsky, MD
- Associate Professor of Pediatrics
- Harvard Medical School
- Madhusmita Misra, MD, MPH
Madhusmita Misra, MD, MPH
- Pediatric Endocrine and Neuroendocrine Units
- Mass General Hospital for Children and Harvard Medical School
Type 1 diabetes mellitus (T1DM), one of the most common chronic diseases in childhood, is caused by insulin deficiency following destruction of the insulin-producing pancreatic beta cells. It most commonly presents in childhood, but one-fourth of cases are diagnosed in adults. T1DM remains the most common form of diabetes in childhood, accounting for approximately two-thirds of new diagnoses of diabetes in patients ≤19 years of age in the United States, despite the increasing rate of type 2 diabetes [1-4].
The epidemiology, presentation, and diagnosis of T1DM in children and adolescents are presented here. The pathogenesis of T1DM and the management and complications of childhood T1DM are discussed separately. (See "Pathogenesis of type 1 diabetes mellitus" and "Management of type 1 diabetes mellitus in children and adolescents" and "Complications and screening in children and adolescents with type 1 diabetes mellitus".)
The assessment and management of individuals presenting during infancy with hyperglycemia also are discussed separately. (See "Neonatal hyperglycemia".)
The incidence of childhood type 1 diabetes (T1DM) varies based upon geography, age, gender, family history, and ethnicity.
Geographical variation — The incidence of childhood T1DM varies worldwide [5,6]. In Europe and China, the risk appears to rise as the geographical latitude (distance from the equator) increases [7-9]. This North-South variation is not found in the United States, even after adjusting for racial and ethnic variation . When people relocate from a region of low to high incidence, their risk of developing T1DM also increases, suggesting a causative role for environmental factor(s). However, wide variations in incidence occur between neighboring areas of similar latitude, suggesting the presence of other contributing risk factors and demonstrating the complexity of the pathogenesis of T1DM. (See "Pathogenesis of type 1 diabetes mellitus".)
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- Geographical variation
- Age and gender
- Time trends
- RISK FACTORS
- Genetic susceptibility
- Other risk factors
- CLINICAL PRESENTATION
- Classic new onset
- Diabetic ketoacidosis
- Silent presentation
- Special populations
- - Infants
- - Young children
- Diagnostic criteria for diabetes
- Type 1 versus type 2 diabetes
- DIFFERENTIAL DIAGNOSIS
- Other causes of hyperglycemia
- Other causes of diabetes
- INFORMATION FOR PATIENTS