Review Article :
Diabetes is one of the
most intensively researched disorders presenting several metabolic alterations,
but the basic biochemical aberrations or defects have not been clearly
elucidated because the disorder is characteristically of autoimmune
disposition. In addition, it is an intricately complex disease that exhibits
disparate and distinct outlook and magnitude of pathology with grim
susceptibility to gene-environment interactions. Hyperglycemia, glucosuria,
polyuria, hunger, thirst, emaciation, ketonuria, acidosis and defect in insulin
functionality, and accompanied in several instances with debilitating sequelae
involving blood vessel wall degeneration, ophthalmologic problems. Early or
invariable developments of these deteriorating changes culminate in expansive
socioeconomic costs. Adequate data regarding type 1 diabetes incidence have
been from regions with a high or intermediate incidence, particularly in Europe
and North America where numerous registries have been established earlier or
since the mid-1980s. There is a paucity of data from Africa Asia, the
Caribbean, Central America and South America. The setting up and maintenance of
population-based registries in very low-incidence areas such as the Caribbean,
Central America, South America, Asia and Africa are expansively cumbersome. If
the incidence is lower, then the surveillance population tends to be larger in
order to collate stable estimates for rates. The availability of veritable standardized type 1 diabetes
incidence data from these low incidence regions is extremely crucial to
establish that the presumed broad variation in incidence pertains, and that a
low incidence in those regions is exact and not the resultant impact of underestimated incident cases. Type
1 diabetes mellitus is a disease that has erstwhile been designated as
insulin-dependent, childhood-onset, young adult-onset or juvenile-onset
diabetes with essential insulin deficiency that requires daily insulin
administration. Type 1 diabetes is an insulin-requiring chronic disorder due to
the abrogation of pancreatic islet cells insulin generation culminating in
elevated concentrations of blood sugar and gradual functional excoriation and
degeneration of various organs and tissues. Elevated blood glucose
concentrations activate oxidative stress with concomitant degeneration of DNA,
lipid and protein macromolecules by free radicals with accelerated
diabetes-linked nonenzymatic glycosylation or glycation of proteins and tissues
damage in non-healthy persons, but not so in healthy persons. The aetiology of
type 1 diabetes is unknown; and it presents symptoms such as excessive urine
excretion or polyuria, incessant hunger and thirst, visual alterations, fatigue
and emaciation which may precipitate abruptly [1]. Even though, type 1 diabetes
permeates all age groups, numerous epidemiological investigations emphasize
disease features with clinical disease in childhood and adolescence, and
sometimes present difficulties of differentiation from certain forms of type 2
diabetes or Latent Autoimmune Diabetes in Adults, LADA [2]. Type
1 diabetes is an important and excruciating chronic disease of children
globally, with resultant 8- to 10-fold excess risk of death in developed
regions, whereas most cases die within a short period in developing countries
[3], or where not adequately followed-up or registered may elude healthcare
personnel in developed countries. A 60-fold internal gradient in the incidence
of type 1 diabetes and epidemic periods have ostensibly been identified and
reported. It is important to investigate and characterize the worldwide
incidence, morbidity,
mortality and healthcare of type 1 diabetes in order to effectively and
efficiently collate and evaluate healthcare and economics of diabetes [4],
promote and establish domestic and global training programmes in the
epidemiology of diabetes [5, 6] to prevent and curb the debilitating disorder
and its concomitant complications. Childhood
type 1 diabetes incidence reached increased heights globally towards the end of
the 20th Century, but the aetiological factors associated with the augmentation
are not properly documented [7] and elucidated. The diseases trajectory
underlying type 1 diabetes has altered spatiotemporally with continuous
evolution. Explication and elucidation of how the prevalence of type 1 diabetes
was triggered could provide the modalities for its reversal. Attempts have been
made to eradicate the anomalies inextricably-associated with diabetes via the
application of derivative compounds of 1,3,4-thiadiazine with resultant
reduction of blood glucose and HbA1c and increased insulin levels as evidenced
in rats. The substances impede the erstwhile indicated pathogenetic mechanism
and act as treatment drugs for the diabetes [8]. Type 1 diabetes has tended to
become a non-communicable disorder with the most expansive discourse globally,
with Europe and North America presenting an astronomical increase in the
disease burden, and creating it as a paradigm in the transformation of the current
worldwide trajectory regarding health and healthcare. It is not possible to
prevent type 1 diabetes with the prevailing scant and diffuse information and
knowledge or to explicate and elucidate the burden, trends and variations of
prevalence rates of the disease and its sequelae as evidenced in several
countries. At
the end of the 1970s, epidemiological information of diabetes children showed
an expansive geographical variation in type 1 diabetes incidence for the first
time. From the 1960s to the inception of
the 1980s, the data on type 1 diabetes incidence were available for merely a
few populations, particularly from regions with intermediate or high risk for
the disorder. Numerous registries were
established globally since the mid-1980s. The deficiency of standardized data
presented constraints for the determination of the veritable extent of the
global variation in incidence or temporal trends [9]. Towards the end of the
1970s and the beginning of the 1980s, The Diabetes Epidemiology Research
International Group (DERI) commenced aggregate data collation type 1 diabetes
incidence [10]. The
rigorous efforts of the DERI group resulted in the augmentation of the number
of registries on diabetic children and to the establishment of the World Health
Organization Project of Childhood Diabetes (DIAbetes MONdiale) in 1990 [11]. In
addition, at the termination of the 1980s, the collaborative research project
EURODIAB ACE was established [12] to collate data on type 1 diabetes in Europe.
Reviews on type 1 diabetes incidence within populations have indicated that
variations in the incidence are 60-fold ranging from the lowest to the highest
rates [13]. The highest incidence was found in Caucasoid populations,
particularly in northern Europe, and the lowest rates are found in Asia and
South America. To this extent merely one trend analysis of type 1 diabetes
incidence compared concurrently several, but limited number of populations was
conducted by the DERI group [14]. Convergence in standardized procedures for
collected incidence data worldwide provided the latitude for comparative
assessment of temporal trends among diverse populations. An estimation of the
temporal trends in type 1 diabetes incidence from incidence data was performed
through a systemic literature review. Data statistical analysis was conducted
to determine whether the incidence is increasing globally. Another objective
was the quantitative evaluation as to the extent the change in type 1 diabetes
incidence varied among populations. Another
study to investigate and monitor attributes in childhood type 1 diabetes
incidence globally [15] determined of type 1 diabetes incidence (per 100,000
per year) from 1990 to 1994 in children ≤14 years of age from 100 centers in 50
countries. An overall 19164 cases were diagnosed in study populations of 75.1
million children, whereby the annual incidence rates were calculated per 100,000
populations. The overall age-adjusted type 1 diabetes incidence differed from
0.1/100,000 per year in China and Venezuela to 36.8/100,000 per year in
Sardinia and 36.5/100,000 in Finland; thus representing a >350-fold
variation in the incidence among the 100 populations globally. The worldwide
pattern of incidence variation was evaluated by arbitrary grouping of the populations
with a very low (<1/100,000 per year), a low (1-4.99/100,000 per year), an intermediate
(5-9.99/100,000 per year), a high (10-19.99/100,000 per year), and a very high
(≥20/100 000 per year) incidence). Among the European populations, 18 of 39
presented an intermediate incidence, and the rest had an elevated or very elevated
incidence. Extremely high incidence (≥20/100,000 per year) was detected in
Sardinia, Finland, Sweden, Norway, Portugal, the U.K., Canada and New Zealand
[15]. The lowest incidence (<1/100, 000 per year) was realized from China
and South America populations. The incidence increased with age and was the
highest among children 10-14 years in most populations. The extent of global
disparities in the childhood type 1 diabetes incidence was greater than
previously described. The earlier reported polar-equatorial gradient in the
incidence was not ostensibly strong as previously suggested, but the variation
apparently took an ethnic and racial distribution in the global population. An
examination of the global type 1 diabetes incidence and trends from 1990-1999
[16] analysed type 1 diabetes incidence (per 100,000/year) in children aged ≤14
years from 114 populations in 112 centers in 57 countries. The incidence of
type 1 diabetes trends were analyzed by fitting Poisson regression models to
the dataset. A total of 43013 cases diagnosed in the study populations of 84
million children, with age-adjusted incidence of type 1 diabetes among 112 centers
(114 populations) varied from 0.1 per 100,000/year in China and Venezuela to
40.9 per 100,000/year in Finland. The average annual increase in incidence
calculated from 103 centers was 2.8% (95% CI 2.4-3.2%). During the years
1990-1994, this increase was 2.4% (95% CI 1.3-3.4%) and during the second
period of 1995-1999, it was slightly higher at 3.4% (95% CI 2.7-4.3%). The
trends estimated for continents depicted statistically significant increases
worldwide (4.0% in Asia, 3.2% in Europe and 5.3% in North America), excepting
Central America and the West Indies where the trend decreased by 3.6% [16]. The
trend in incidence diminished with age only among the European populations .The
increasing global type 1 diabetes incidence suggestively necessitates
continuous monitoring of incidence by the application of standardized
procedures for planning or assessment of prevention strategies. In
1988, an epidemiological study of type 1 diabetes in Europe [17], the EURODIAB
collective group established prospective geographically-defined registers of
new cases diagnosed below 15 years of age. The report utilized 16362 cases
registered from 1989-94 by 44 centers being representative of most European
countries and Israel and encompassing a population of circa 28 million
children. The results established an expansive range of incidence rates within
Europe and indicated that the rise in incidence during the period differed from
country to country. Thus, the accelerated increase of type 1 diabetes in
children aged under 5 years remains of particular concern. An identical study
[18] based on 24423 children, registered by 36 centers, with full participation
from 1989-1998 and representing most European countries with a population
coverage of circa 20 million children, also confirmed the extensively broad
range of incidence rates within Europe. Generally, the incidence rate is
increasing, but is more pronounced in certain regions than in others. There is
ostensible seasonality at disease onset even detectable in the youngest
age-group. Country-specific
characteristics of type 1 diabetes matched by regions Africa: Juvenile
diabetes mellitus is ostensibly uncommon in sub-Saharan Africa, with
environmental attributes, such as infection and resource deprivation
contributing as primary determinants [19]. Gene-environment interactions in
protective forms may play significant roles in African children in not
displaying the same elevated rates as in European countries. Concordant
observations have been made which undergird the hypothesis that transmission of
viral infection from mother to fetus during the annual epidemic of viruses
triggers the autoimmune process in pancreatic beta-cells in genetically
vulnerable subjects who consequently develop clinical diabetes in childhood
[20]. Childhood
diabetes increases in Sudan where incidence figures have been determined to
exceed other Arab countries, with identical findings tied to those from France
and Italy [21]. It is assumed that type 1 diabetes forms the prevalent African pediatric
diabetes. In recent years, achievements have included training and production
of greater than sixty endocrinologists practicing in 14 African countries, as
well as augmented training of other healthcare providers, enhanced access to
insulin, and access to testing materials combined with patient education in
native languages. There are extant lacunae in adequate provision of type 1
diabetes pediatric care in Africa in comparison to developed countries [22].
There is extant paucity of data regarding the burden, undiagnosed prevalence,
access to healthcare, acute and chronic sequelae of type 1 diabetes in Africa.
Inasmuch as there is perceived low diabetes incidence in African children,
there is projected increase in the immediate future that necessitates essential
development of government paradigms and policies to manage pertinent inducing
and debilitating factors concerning type 1 diabetes [23]. Finland
and the Baltic States: It has been determined that type 1 diabetes in Finland
of children aged 14 years or below is the highest worldwide; and the trend
continues to increase [24]. The elevated
type 1 diabetes incidence in Finnish children has not leveled off, but
maintains an increasing trajectory. A
study was conducted to determine whether type 1 diabetes incidence was
increasing globally or merely restricted to a select population, and to
estimate the extent of change in incidence [25]. From 1960 to 1996, 37 studies
in 27 countries were conducted. In compliance with the inclusion criteria the
research periods ranged from 8-32 years. It was suggested that Type 1 diabetes
incidence was increasing globally both in low and high incidence populations.
It was projected that by 2010 the incidence could approach 50 per 100 000 a
year in Finland and will be in excess of 30 per 100 000 a year in several other
populations. A
study of type 1 diabetes incidence in 4 countries, Estonia, Latvia, Lithuania
and Finland from 1983-1998 discretely on the two distinct periods of 1983-1990
and 1991-1998 [26] demonstrated that the
type 1 diabetes incidence increased since 1983 in the three Baltic
states and Finland. It was suggested that long-term monitoring is required for
better detection in metamorphosis in incidence. Scandinavia:
There is paucity of data on the future of diabetes burden in Scandinavia.
However, paradigmatic data on demographic, incidence, prevalence and mortality
factors on Sweden indicate abating incidence at 1% annually with predicted
prevalence increase in diabetes [27]. The investigation of age-period-cohort
using 0-14 year-old children in Norway
[28] showed that type 1 diabetes incidence among children increased
during the study period, with both cohort effects been identified by employing
the spatiotemporal scan statistics, but without applying age, period, and birth
cohort modelling. These effects within the relatively homogenous population of
Norway may be related non-genetic etiological attributes. The type 1 diabetes
incidence rate has been rising in children resident in Denmark; and the steep
rise has been attributed to the increased risk for cohorts who were born in the
early 1980s [29]. Europe: An overview of
age- and sex-specific type 1 diabetes incidence rates and trends in Czech
children 0-14 years of age [30] depicted a significantly increased incidence
that is at an intermediate level in comparison to other European
countries. In Croatia [31], a study
examined type 1 diabetes incidence and trends in children aged 0-14 years, and
found that the rate of incidence placed Croatia in a group of countries with
moderate risk for type 1 diabetes development. The average annual incidence
increase of 9% was higher than in most European countries, and ostensibly
indicative of changes due to the economic recovery of the country. From a
prospective population-based incidence study in Austria, it was determined that
all recently diagnosed patients with type 1 diabetes 0-<15 years of age,
presented the steepest increase in the last 5 years under study as
predominantly observed in the younger age groups [32]. Findings
have corroborated that type 1 diabetes incidence increased rate in France are
average in comparison to that obtainable in European countries during an
extended period [33]. Also, the resultant linear and regular increase in
incidence undergirds the hypothesis of causal environmental attributes
diffusing over time. The available complementary data depicted the perspicuous
functionality and implications of private medical and healthcare professionals
in public health and epidemiology. The UK presents one of the highest type 1
diabetes rates globally for reasons which remain unexplicated or
unelucidated [34]. Oceania: Childhood-onset
type 1 diabetes incidence has significantly elevated in Western Australia with
no indication of decreasing [35]. In contradistinction to other similar
studies, a greater rate of increase was not detected in the youngest children.
The remarkable increase in type 1 diabetes incidence in Victoria, Australia was
greater than those obtained in other Australian States and industrialised
countries, but the causal factors in the elevation are not pellucid, as the
elevated caseload presents marked implications for diabetes health care in
resource allocations [36]. North America: In 0-14 year-old
[37], the province of NL demonstrated one of the highest incidences of T1DM
reported worldwide. The incidence is increasing over a 19-yr study period. Type
1 diabetes incidence is increasing at an accelerated rate in the UK with circa
400, 000 persons currently being detected with the disease, of which 29, 000
were children. Although, it is axiomatically expressed that the USA harbours
the greatest number of children with type 1 diabetes, there is data scarcity
concerning adult-onset disease. The increase in incidence rate merely in youth
is suggestive of youth-onset disease precipitating factors which contrast those
of adult-onset disease [38]. Among US adults, the benchmark estimates on the
national prevalence of type 1 diabetes diagnosed was 0.5% [39]. Another reason
may be inadequate compilation of registries and follow-up whereby type 1
diabetes children die before adulthood and cause of death is listed as
complications other than diabetes. South America: The type 1
diabetes incidence increase in Santiago, Chile present data in concordance with
the increase in Latin America and globally
[40], with broad disparities among Chilean counties. Caribbean: In 1997,
diabetes prevalence rate in the Caribbean for children aged below15 years
ranged from 0.3/10, 000 in Haiti to 6.4/10, 000 in Puerto Rico, with a
consistently high incidence rate for Puerto Rico and the lowest for Barbados in
the Caribbean [41]. Genetic and
environmental factors influencing type 1 diabetes A
comparison of childhood type 1 diabetes incidence between Sweden and Lituania
depicted incidence variability between the two countries, suggesting an
intricately complex impact of environmental risk influences, certain of them
attributed to wealth and socioeconomic status
[42]. Disparities in type 1 diabetes incidence by age, sex and season at
diagnosis of children aged 0-14 years in Spain did not undergird the hypothesis
of decreased incidence of the disease in a north-to-south gradient across
Europe [43]. Data on the incidence of type 1 diabetes from the subtropical
region in southern Brazil were identical to the observation in developed
nations, but could not establish the North-South gradient, ostensibly as a
result of the European origin of residents in the area [44]. Type 1 diabetes
incidence definitely displays an expansive geographical heterogeneity and
variability as observed in 0-15 years old childrenin Spain [45] with a good number of its provinces
having similar values as evidenced in Northern Europe. A
study in China depicted that geographic and ethnic variability of type 1
diabetes incidence suggest the influence of gene and environment interactions
in the childhood diabetes development in
diverse ethnic settings [46]. The overall type 1 diabetes incidence in
Philadelphia, Pennsylvania, USA has been rising with similarity to other
registries in the country [47]. The aetiology of the significant elevation of
the disease in black subjects is not clear, and creates the importance for the
establishment of type 1 diabetes as a reportable disorder for intensive
investigation of the environmental risk factors attributable to the disease.
Type 1 diabetes aetiology and natural history remain unknown, but both genetics
and environmental effects are contributory to the disease developing [48-50].
Although, HLA genetics depict a major effect in type 1 diabetes aetiology,
other genes also contribute to the genetic impact, but the mode of inheritance
of the disease remains unclear [51]. The genetic influence contributes 70-75%
of the type 1 diabetes vulnerability [52]. Environmental factors ostensibly
initiate or trigger the process with resultant degeneration of the beta cells
and the initiation of diabetes [53, 54]. Epidemiological
study of global type 1 diabetes with regard to inter alia the biological,
cultural, demographic and geographic populace regarding the aetiology, natural
history, risks and sequelae depicted that type 1 diabetes incidence increased
2-5% globally, while the prevalence rate was circa 1 in 300 in the USA in age
18n years persons [55]. Risk factors for type 1 diabetes study areas must
include identification of gene-environment interactions [56] as trends and
targets for intervention in the clinical care and outcome, complex and
intricate aetiological factors, prevention, therapeutic regimens and cure of
and for the disease. Thus, it is vital to detect the pathognomic symptoms of
the disease, such as hunger and thirst, polydipsia, polyuria, weight loss in
new-onset type 1 diabetes, and later concomitant diabetes ketoacidosis, DKA
[31]. Also, DKA has been detected at diagnosis as a life-threatening acute
sequel of type 1 diabetes with higher frequency in developing than in developed
countries [57]. Debilitating diabetic ketoacidosis and infections contribute to
mortality of diabetes patients requiring insulin [58]. Childhood-onset
type 1 diabetes increasingly bears elevated mortality risk in comparison to the
general population, as is evident in cardiovascular diseases [59]. To abate
these mortality rates, it is pertinent to focus on defined prevention and
abatement of acute metabolic sequelae, identification of psychiatric
vulnerability, and prompt detection and treatment of cardiovascular diseases
and other inextricably-linked factors. Antecedent to late sequelae, marked
excess mortality may be extant following type 1 diabetes diagnosis in
childhood, but variations in the excess across nations cannot be explicated or
elucidated [60]. Subjects with childhood –onset type 1 diabetes in Australia
have 4-6 times mortality rate compared to Tasmanian population studied, and the
excess mortality is more debilitative amongst female than male subjects [61].
Results have also shown that the mortality experience for type 1 diabetes
subjects in Japan and the USA was more debilitative than in Finland and Israel
[62]. A
Japanese Study that compared mortality and incidence of end-stage renal disease
(ESRD) in type I diabetes individuals who attended a diabetes clinical setting
with subjects who did not, showed that the subjects who had attended the
diabetes centre had treble the chance for better prognosis for survival than
those who neglected to do so, especially when undergirded with a specialist
integrated management system and a multidisciplinary workforce [63]. It is
suggested that childhood diabetes constitutes of an array of pathogenic
mechanisms which overlap, including those usually linked to both type 1 and
type 2 diabetes [64]. These demonstrate ample therapeutic and diagnostic
considerations in the racial and heterogeneous dispositions of type 1 diabetes.
Insulin
protocol and metabolic control in non-adults having type 1 diabetes were
assessed and evaluated in a cross-sectional, non-population-based study of 22 pediatric
settings from Japan and 17 other countries in Europe and North America [65]. It
was detected that several insulin injection regimens were employed in pediatric
diabetic settings with ostensibly augmented diabetes management, especially in
young adults with achievement close to normoglycaemia in merely few subjects.
In like manner, short-term mortality and poor prognosis are substantially
manifested among blacks and Latinos than whites in the USA presenting with type
1 diabetes due to disparities and discrepancies in comprehensive diabetes
healthcare [66]. Type
1 diabetes was found to constitute the most presenting diabetes amongst young
people in Belgium with a rate of 97% [67]. Medical consultations and necessary
treatment materials are virtually free due to the Social Medicine Protocol of
Belgium with aim for the provision of good quality of life and to obviate
long-term sequelae via the maintenance of blood glucose content approaching
normoglycaemia and HbA1c level below 7%. It is suggested that diabetes
education and treatment be initiated spontaneously and pari passu in paediatric
diabetic clinical settings supported by a multidisciplinary ensemble of
specialists and essential carbohydrate twice daily allocation [67] to prevent
degenerative disorders, as well as rapid- and long-acting insulin analogues
[68] to improve quality of life without essentially decreasing HbA1c. It has also been recommended that
multidisciplinary approach be adopted in sub-Saharan Africa for effective and
efficient management of diabetes as a newfangled healthcare delivery and
educational paradigm to combat long-term sequelae. An
evaluation of the global mortality geographic variation of type 1 diabetes of
age 0-24 years depicted greater than 10-fold magnitude between developed and
Eastern European countries [69]. The regions of highest mortality were
evidenced in Eastern Europe, Japan and Russia; whereas areas presenting best
prognosis related to type 1 diabetes included Canada, Central and Northern
Europe. The data assumed an expansive type 1 diabetes mortality regional
variation as presented in developed areas. Also, this ecological research
suggests mortality disparities to be associated with an encompassing and
diabetes-linked care, of which the excess mortality rates are potentially
preventable and reducible. Previous study has strongly indicated that young
adult type 1 diabetes individuals pose increased risk of premature mortality
disparities in the mortality risk across countries, with both Japan and USA
having the main dilemma of an ostensibly excess of premature mortality rate
among young people presenting with diabetes [70]. A
study was conducted on Japanese type 1 diabetes patients not exceeding 40 years
of age when transition occurred from pediatric to adult care in combination
with the healthcare management and prognosis [71]. More than 50% of the pediatric
care patients at age 15 years sustained treatment and management until after
age 30 years, depicting that transition was not steady and that the attending
healthcare physician during the period was not a prognostic factor or
interrelated with mortality. A vast majority of new-onset type 1 diabetes cases
in China were established in adults, whereas the lowest incidence was demonstrated
in children [72]. Latent autoimmune diabetes in adults, LADA is
characteristically an aberrant pattern of type 1 diabetes in persons from the
third decade of life presenting initial response to oral hypoglycaemic agents,
cachexia and destruction of glutamic acid decarboxylase autoantibody, GAD-Ab,
with accelerated excoriation of pancreatic beta-cells secretory functionality
resulting from the debilitating activity of the autoantibodies [73]. It
was determined that socioeconomic variables had no impact on HbA1c levels,
rather diabetes duration and protein intake were significant determinants of
HbA1c status; thus preempting the importance of balanced nutrition/diet for
long-term glycaemic control in India [74]. On the investigation of the incidence,
clinical and mortality status of youth with diabetes in Bolivia, it was found
that the country had a low type 1 diabetes incidence, with reasonable
achievement of glycaemic control despite paucity of resources. Certain subjects
presented with adverse sequelae and debilitating cardiovascular risk profiles
[75]. Certain patients presented with monogenic diabetes, profound renal
degeneration, high BMI, as well as increased triglycerides and cholesterol. In
Mexico, the general risk factors encompassed ER visits and hospitalization at
older age in the start of diabetes, adverse acute complications, chronic
microvascular and macrovascular derangements including smoking, co-morbidities,
interaction between diabetes duration greater than a decade, with HbA1c levels
as risk factors for hospitalization [76]. About 1/3 of type 1 diabetes subjects
present with diabetic retinopathy and debilitating pathogeneticity frequently
observed as salient persistent proteinuria, glomerular filtration rate decline,
and elevated arterial hypertension [4]. There exist increased incidence and
prevalence of type 1 diabetes with special predilection to the USA and Northern
Europe. Elevated mortality and morbidity result in type 1 diabetes patients
having renal disorders. In type 1 diabetes subjects with incessant proteinuria,
ultimately death results within 5-10 years of diagnosis. The economic and
social effects of end stage renal disease are enormous with increasing costs at
accelerating rates. The
worldwide prevalence and concomitant impact of type 1 diabetes have increased
significantly, especially in sub-Saharan Africa. The population faces discrete
challenges and constraints in addressing the disease due to inter alia limited
healthcare funding for noncommunicable diseases, inadequate availability for,
and access to research funding and guidelines which are unique to the African
population presenting expansive disparities in knowledge and information among
rural and urban patients as well as inequities and inequalities in all the healthcare
sectors [77]. There is an extant need for proper and contextual representative
surveillance research and data of the global diabetes epidemic in the Middle
East and North Africa in order to complement the understanding of the palpable
burden of diabetes, and to motivate the design and implementation of the
prevention and control of the disease because there is paucity of information
regarding diabetes risk in the regions [78]. These pose a unique constraint in
the development of effective and efficient healthcare management system for
children in Saudi Arabia, for instance, as the largest country in the Middle
East occupying an expansive land mass with an ever-increasing population having
approximately ¼ under the age of 14 years. An excess of 35, 000 children and
adolescents in Saudi Arabia present with type 1 diabetes in comparatively
disproportionate stance to global type 1 diabetes [79]. A
report projected worldwide drugs market of type 1 diabetes to grow with a CAGR
of 7.4% from 2018-2024 [80]. The increasing incidence and prevalence of type 1
diabetes constitute the paramount factor governing the drugs market of type 1
diabetes. These are occasioned by its increasing awareness, access to
therapeutic substances, novel advanced insulin delivery pumps and pens, as well
as improved drug delivery regimens to augment type 1 diabetes drug market.
Astronomical costs of insulin delivery systems, such as insulin auto injector
and pump may inhibit market growth. Due to the elevated incidence of the disease
in the North American population and familiarization with novel innovative
insulin delivery systems and the creation of numerous opportunities within the
forecast era of 2018-2024 in the jurisdiction and also in the Asia Pacific
ambient owing to its rapidly ageing population and improved healthcare
paradigm. The
pecuniary implications of the rise in diabetes prevalence amongst middle-income
nations contribute to major constraints and challenges to equitable allocation
of health system and healthcare management as concern to the entire Society.
Diabetes constitutes a salient economic burden in the Caribbean and Latin
America [81]. The overall diabetes cost was estimated at circa USD102-123
billion in the 29 Latin American countries in 2015, with one case being
USD1088-1818, while per capita National Health Expenditures in the LAC averaged
USD1061. Discussion and
Conclusion Type 1 diabetes constitutes a
chronic, autoimmune metabolic derangement with characteristic expansive
perturbation of pancreatic beta-cells, concomitant insulin deficiency and
associated hyperglycaemia. Particular environmental factors precipitate the autoimmune
pathways in genetically susceptible children and adolescents. Type 1 diabetes
is relatively less common than type 2 diabetes, but it poses greater morbidity
and mortality than the latter. Numerous reports on type 1 diabetes incidence
have suggested that the incidence is rising. The aim of this study is inter
alia to determine whether the incidence is increasingly globally or restricted
to a selected population, and to estimate the magnitude of the metamorphosis in
incidence. The expansive variation in
childhood type 1 diabetes incidence rates within Europe may be partially
explicated by indicators of national prosperity. These indicators could reflect
disparities in environmental risk factors, such as nutrition/diet or lifestyle
which are relevant in the determination of incidence rate the expansive
variation in childhood type 1 diabetes incidence rates within Europe may be
partially explicated by indicators of national prosperity. These indicators
could reflect disparities in environmental risk factors, such as nutrition/diet
or lifestyle which are relevant in the determination of incidence rates [81]. Type 1 diabetes in childhood is
more predominant, but ¼ of cases diagnosed are in adults. There are generally
clinical characteristics of type 1 diabetes, such as classic new-onset,
hyperglycaemia in the absence of acidosis that is a common presentation at
childhood including aforementioned symptoms, diabetic ketoacidosis, and silent
or asymptomatic incidental discovery when certain children are diagnosed with
type 1 diabetes antecedent the onset of clinical symptoms [82]. Globally,
specific estimates of type 1 diabetes incidence and prevalence grouped by
association in various regions have contributed to the understanding of the
spatiotemporal trends of the disease. Both Biophysical State Index (Ibs) and
life expectancy at birth (Ibs proxy) significantly correlated to type 1
diabetes in disparate country categories via cultural background, socioeconomic
status and geographical region [83]. Natural selection abatement has
suggestively contributed to rising prevalence of type 1 diabetes globally.
Epidemiological total population study of the disease could solve the issue and
challenges in the identification of rising type 1 diabetes prevalence. An expansive
variation is extant in global type 1 diabetes incidence rates with the highest
in Finland and Sardinia by >45/100, 000 under age 15 years of age and lowest
in sections of China [84] and sub-Saharan Africa. Several countries, for
instance, in Europe and Middle East as well as Australia depicted that the
autoimmune-mediated type 1 diabetes incidence in children <15 years of age
increased by 2-5% yearly [82, 84]. Type 1 diabetes treatment is a
challenging issue in developing regions, but not so in developed countries
where those living with the disease have easier access insulin, glucometer
strips and other materials from government subvention or personal savings.
Non-industrialised countries are faced with inadequate resources, limitation in
diagnosis, insulin initiation and storage, family, marital and emotional issues
and challenges [85]. Since type 1 diabetes affects a few people compared to the
general population, it is palpably ignored by governments and policy maker. The
socio-economic status in developing regions does not provide the latitude for
the required insulin therapy and inextricably-linked monitoring of blood
glucose. It is pertinent to spread awareness regarding the metabolic disorder
and its sequelae and to undergird government health and healthcare ambient
regarding the consequences, pros and cons, in the administration of medicinal
drugs for the treatment of diabetes [6, 8]. Thus, it is imperative to focus
on expansive clinical trials which compare the appropriateness of diverse
diabetes medications to provide the guidelines for healthcare providers on
which patients to prescribe certain drugs. There tends to be decrease in
diabetes complications in certain parts of the world, and the survival and
quality of life have improved tremendously, but financial constraints and
awareness have restricted ample access to type 1 diabetes prevention, control
and treatment, as well as meeting the informed inventiveness and creativity of
gadgets, such as the closed-loop systems. The essential management and access
to medicinal drugs are more imperative than high-tech systems in developing
countries or elsewhere. There is extant optimism with opportunities for the
future in unraveling the metabolic and cellular processes in convergence for
researchers, clinicians, healthcare providers and policy makers to undertake
intensive measures regarding the issues, challenges and presenting
opportunities underlying type 1 diabetes and its sequelae which are solvable
[86].
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incidence of type 1 diabetes among c Type 1 Diabetes Mellitus, Epidemiology, Demography, Prevalence, Incidence, Impact, Costs, Global,
Population.Type 1 Diabetes Mellitus: Issues, Challenges and Opportunities
Abstract
Full-Text
Introduction
Global and
Country-Specific Estimates of Type 1 Diabetes
Clinical
characteristics and socioeconomic impact of type 1 diabetes
References
Keywords
