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Epidemiology, presentation, and diagnosis of type 1 diabetes mellitus in children and adolescents

Lynne L Levitsky, MD
Madhusmita Misra, MD, MPH
Section Editor
Joseph I Wolfsdorf, MB, BCh
Deputy Editor
Alison G Hoppin, MD


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 [10]. 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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Literature review current through: Sep 2016. | This topic last updated: Mar 15, 2016.
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  1. Lipton RB, Drum M, Burnet D, et al. Obesity at the onset of diabetes in an ethnically diverse population of children: what does it mean for epidemiologists and clinicians? Pediatrics 2005; 115:e553.
  2. Fagot-Campagna A, Pettitt DJ, Engelgau MM, et al. Type 2 diabetes among North American children and adolescents: an epidemiologic review and a public health perspective. J Pediatr 2000; 136:664.
  3. Duncan GE. Prevalence of diabetes and impaired fasting glucose levels among US adolescents: National Health and Nutrition Examination Survey, 1999-2002. Arch Pediatr Adolesc Med 2006; 160:523.
  4. SEARCH for Diabetes in Youth Study Group, Liese AD, D'Agostino RB Jr, et al. The burden of diabetes mellitus among US youth: prevalence estimates from the SEARCH for Diabetes in Youth Study. Pediatrics 2006; 118:1510.
  5. Silink M. Childhood diabetes: a global perspective. Horm Res 2002; 57 Suppl 1:1.
  6. Karvonen M, Viik-Kajander M, Moltchanova E, et al. Incidence of childhood type 1 diabetes worldwide. Diabetes Mondiale (DiaMond) Project Group. Diabetes Care 2000; 23:1516.
  7. Rosenbauer J, Herzig P, von Kries R, et al. Temporal, seasonal, and geographical incidence patterns of type I diabetes mellitus in children under 5 years of age in Germany. Diabetologia 1999; 42:1055.
  8. Yang Z, Wang K, Li T, et al. Childhood diabetes in China. Enormous variation by place and ethnic group. Diabetes Care 1998; 21:525.
  9. Waldhör T, Schober E, Karimian-Teherani D, et al. Regional differences and temporal incidence trend of Type I diabetes mellitus in Austria from 1989 to 1999: a nationwide study. Diabetologia 2000; 43:1449.
  10. Liese AD, Lawson A, Song HR, et al. Evaluating geographic variation in type 1 and type 2 diabetes mellitus incidence in youth in four US regions. Health Place 2010; 16:547.
  11. Harjutsalo V, Sund R, Knip M, Groop PH. Incidence of type 1 diabetes in Finland. JAMA 2013; 310:427.
  12. Plotnick LP, Klingensmith GJ, Silverstein JH, et al. Diabetes mellitus. In: Principles and Practice of Pediatric Endocrinology, Kappy MS, Allen DB, Geffner ME (Eds), Charles C Thomas, Springfield 2005. p.635.
  13. Bell RA, Mayer-Davis EJ, Beyer JW, et al. Diabetes in non-Hispanic white youth: prevalence, incidence, and clinical characteristics: the SEARCH for Diabetes in Youth Study. Diabetes Care 2009; 32 Suppl 2:S102.
  14. Newhook LA, Curtis J, Hagerty D, et al. High incidence of childhood type 1 diabetes in the Avalon Peninsula, Newfoundland, Canada. Diabetes Care 2004; 27:885.
  15. Legault L, Polychronakos C. Annual incidence of type 1 diabetes in Québec between 1989-2000 in children. Clin Invest Med 2006; 29:10.
  16. Felner EI, Klitz W, Ham M, et al. Genetic interaction among three genomic regions creates distinct contributions to early- and late-onset type 1 diabetes mellitus. Pediatr Diabetes 2005; 6:213.
  17. Durruty P, Ruiz F, García de los Ríos M. Age at diagnosis and seasonal variation in the onset of insulin-dependent diabetes in Chile (Southern hemisphere). Diabetologia 1979; 17:357.
  18. Elamin A, Omer MI, Zein K, Tuvemo T. Epidemiology of childhood type I diabetes in Sudan, 1987-1990. Diabetes Care 1992; 15:1556.
  19. Writing Group for the SEARCH for Diabetes in Youth Study Group, Dabelea D, Bell RA, et al. Incidence of diabetes in youth in the United States. JAMA 2007; 297:2716.
  20. Dabelea D, Mayer-Davis EJ, Saydah S, et al. Prevalence of type 1 and type 2 diabetes among children and adolescents from 2001 to 2009. JAMA 2014; 311:1778.
  21. Gale EA, Gillespie KM. Diabetes and gender. Diabetologia 2001; 44:3.
  22. Harjutsalo V, Sjöberg L, Tuomilehto J. Time trends in the incidence of type 1 diabetes in Finnish children: a cohort study. Lancet 2008; 371:1777.
  23. Quinn M, Fleischman A, Rosner B, et al. Characteristics at diagnosis of type 1 diabetes in children younger than 6 years. J Pediatr 2006; 148:366.
  24. Mamoulakis D, Galanakis E, Bicouvarakis S, et al. Epidemiology of childhood type I diabetes in Crete, 1990-2001. Acta Paediatr 2003; 92:737.
  25. Karvonen M, Pitkäniemi J, Tuomilehto J. The onset age of type 1 diabetes in Finnish children has become younger. The Finnish Childhood Diabetes Registry Group. Diabetes Care 1999; 22:1066.
  26. Patterson CC, Dahlquist GG, Gyürüs E, et al. Incidence trends for childhood type 1 diabetes in Europe during 1989-2003 and predicted new cases 2005-20: a multicentre prospective registration study. Lancet 2009; 373:2027.
  27. Tuomilehto J. The emerging global epidemic of type 1 diabetes. Curr Diab Rep 2013; 13:795.
  28. Vehik K, Hamman RF, Lezotte D, et al. Increasing incidence of type 1 diabetes in 0- to 17-year-old Colorado youth. Diabetes Care 2007; 30:503.
  29. Lipman TH, Levitt Katz LE, Ratcliffe SJ, et al. Increasing incidence of type 1 diabetes in youth: twenty years of the Philadelphia Pediatric Diabetes Registry. Diabetes Care 2013; 36:1597.
  30. Berhan Y, Waernbaum I, Lind T, et al. Thirty years of prospective nationwide incidence of childhood type 1 diabetes: the accelerating increase by time tends to level off in Sweden. Diabetes 2011; 60:577.
  31. Derraik JG, Reed PW, Jefferies C, et al. Increasing incidence and age at diagnosis among children with type 1 diabetes mellitus over a 20-year period in Auckland (New Zealand). PLoS One 2012; 7:e32640.
  32. Tillil H, Köbberling J. Age-corrected empirical genetic risk estimates for first-degree relatives of IDDM patients. Diabetes 1987; 36:93.
  33. Steck AK, Barriga KJ, Emery LM, et al. Secondary attack rate of type 1 diabetes in Colorado families. Diabetes Care 2005; 28:296.
  34. Guo SW, Tuomilehto J. Preferential transmission of type 1 diabetes from parents to offspring: fact or artifact? Genet Epidemiol 2002; 23:323.
  35. Tuomilehto J, Podar T, Tuomilehto-Wolf E, Virtala E. Evidence for importance of gender and birth cohort for risk of IDDM in offspring of IDDM parents. Diabetologia 1995; 38:975.
  36. Olmos P, A'Hern R, Heaton DA, et al. The significance of the concordance rate for type 1 (insulin-dependent) diabetes in identical twins. Diabetologia 1988; 31:747.
  37. Redondo MJ, Jeffrey J, Fain PR, et al. Concordance for islet autoimmunity among monozygotic twins. N Engl J Med 2008; 359:2849.
  38. Lipman TH, Chang Y, Murphy KM. The epidemiology of type 1 diabetes in children in Philadelphia 1990-1994: evidence of an epidemic. Diabetes Care 2002; 25:1969.
  39. Kibirige M, Metcalf B, Renuka R, Wilkin TJ. Testing the accelerator hypothesis: the relationship between body mass and age at diagnosis of type 1 diabetes. Diabetes Care 2003; 26:2865.
  40. Wilkin TJ. The accelerator hypothesis: weight gain as the missing link between Type I and Type II diabetes. Diabetologia 2001; 44:914.
  41. O'Connell MA, Donath S, Cameron FJ. Major increase in Type 1 diabetes: no support for the Accelerator Hypothesis. Diabet Med 2007; 24:920.
  42. Zalloua PA, Terwedow H, Shbaklo H, et al. Host and environmental factors defining the epidemiology of type 1 diabetes mellitus in a group of Lebanese children and young adults. J Pediatr Endocrinol Metab 2003; 16:759.
  43. Imkampe AK, Gulliford MC. Trends in Type 1 diabetes incidence in the UK in 0- to 14-year-olds and in 15- to 34-year-olds, 1991-2008. Diabet Med 2011; 28:811.
  44. Moltchanova EV, Schreier N, Lammi N, Karvonen M. Seasonal variation of diagnosis of Type 1 diabetes mellitus in children worldwide. Diabet Med 2009; 26:673.
  45. Roche EF, Lewy H, Hoey HM, Laron Z. Differences between males and females in the seasonality of birth and month of clinical onset of disease in children with type 1 diabetes mellitus in Ireland. J Pediatr Endocrinol Metab 2003; 16:779.
  46. Haller MJ, Atkinson MA, Schatz D. Type 1 diabetes mellitus: etiology, presentation, and management. Pediatr Clin North Am 2005; 52:1553.
  47. Roche EF, Menon A, Gill D, Hoey H. Clinical presentation of type 1 diabetes. Pediatr Diabetes 2005; 6:75.
  48. Sonmez B, Bozkurt B, Atmaca A, et al. Effect of glycemic control on refractive changes in diabetic patients with hyperglycemia. Cornea 2005; 24:531.
  49. Falck A, Laatikainen L. Diabetic cataract in children. Acta Ophthalmol Scand 1998; 76:238.
  50. Datta V, Swift PG, Woodruff GH, Harris RF. Metabolic cataracts in newly diagnosed diabetes. Arch Dis Child 1997; 76:118.
  51. Wolfsdorf J, Glaser N, Sperling MA, American Diabetes Association. Diabetic ketoacidosis in infants, children, and adolescents: A consensus statement from the American Diabetes Association. Diabetes Care 2006; 29:1150.
  52. Klingensmith GJ, Tamborlane WV, Wood J, et al. Diabetic ketoacidosis at diabetes onset: still an all too common threat in youth. J Pediatr 2013; 162:330.
  53. Dabelea D, Rewers A, Stafford JM, et al. Trends in the prevalence of ketoacidosis at diabetes diagnosis: the SEARCH for diabetes in youth study. Pediatrics 2014; 133:e938.
  54. Barker JM, Goehrig SH, Barriga K, et al. Clinical characteristics of children diagnosed with type 1 diabetes through intensive screening and follow-up. Diabetes Care 2004; 27:1399.
  55. Mallare JT, Cordice CC, Ryan BA, et al. Identifying risk factors for the development of diabetic ketoacidosis in new onset type 1 diabetes mellitus. Clin Pediatr (Phila) 2003; 42:591.
  56. Neu A, Willasch A, Ehehalt S, et al. Ketoacidosis at onset of type 1 diabetes mellitus in children--frequency and clinical presentation. Pediatr Diabetes 2003; 4:77.
  57. Silverstein J, Klingensmith G, Copeland K, et al. Care of children and adolescents with type 1 diabetes: a statement of the American Diabetes Association. Diabetes Care 2005; 28:186.
  58. American Diabetes Association. Standards of medical care in diabetes--2011. Diabetes Care 2011; 34 Suppl 1:S11.
  59. Ehehalt S, Gauger N, Blumenstock G, et al. Hemoglobin A1c is a reliable criterion for diagnosing type 1 diabetes in childhood and adolescence. Pediatr Diabetes 2010; 11:446.
  60. Bry L, Chen PC, Sacks DB. Effects of hemoglobin variants and chemically modified derivatives on assays for glycohemoglobin. Clin Chem 2001; 47:153.
  61. Liu LL, Lawrence JM, Davis C, et al. Prevalence of overweight and obesity in youth with diabetes in USA: the SEARCH for Diabetes in Youth study. Pediatr Diabetes 2010; 11:4.
  62. Dabelea D, Pihoker C, Talton JW, et al. Etiological approach to characterization of diabetes type: the SEARCH for Diabetes in Youth Study. Diabetes Care 2011; 34:1628.
  63. Copeland KC, Zeitler P, Geffner M, et al. Characteristics of adolescents and youth with recent-onset type 2 diabetes: the TODAY cohort at baseline. J Clin Endocrinol Metab 2011; 96:159.
  64. Klingensmith GJ, Pyle L, Arslanian S, et al. The presence of GAD and IA-2 antibodies in youth with a type 2 diabetes phenotype: results from the TODAY study. Diabetes Care 2010; 33:1970.