Pediatric Type 1 and 2 Diabetes Mellitus: Epidemiology, Comorbidities, and Medication Utilization

Abstract

The numbers of patients with diabetes mellitus (type 1 and type 2) are increasing globally, both in adults and children. Pediatric diabetes mellitus is an important health concern, since this disease has significant effects on health and quality of life, social function, use of medical services and reduced employability in early adulthood resulting in a huge economic burden. The Netherlands is a country with high incidence of pediatric diabetes, but little is known on current trends in pediatric diabetes, comorbidities, and medication utilization in these patients. Therefore, we aimed to study the epidemiology of diabetes mellitus in children, and to investigate screening methods, risk factors, comorbidities, and patterns of medication utilization in this population. In 2011, the age-adjusted incidence rates of pediatric type 1 diabetes (T1D) was 25.2/100,000 (95% confidence interval (CI), 23.7-26.8) person-years (PY) and the prevalence was 174.4/100,000 (95% CI, 170.2-178.5) children. During the period 1998-2011, both incidence and prevalence rates of pediatric T1D in the Netherlands increased by about 3.7% per year. We also observed a shift towards older age at the onset of T1D. From several studies in the current thesis, it appeared that a substantial number of diseases (e.g. mental disorders, anemia, and diseases of the digestive system) and drugs (e.g. ‘‘systemic hormonal preparations’’, medications for ‘‘blood and blood forming organs’’, ‘‘alimentary tract and metabolism’’, and ‘‘anti-infectives for systemic use’’) or the underlying diseases for which these drugs were prescribed were significantly more prevalent among patients who eventually developed T1D compared with diabetes-free controls. Furthermore, children with T1D are at increased risk of developing different chronic comorbidities e.g. thyroid disease, non-infectious enteritis and colitis, cardiovascular disorders, mental disorders, epilepsy, and (obstructive) pulmonary disease. These children received more antibacterials, antimycotics, antivirals, and second-line antibiotics, such as aminoglycosides, quinolones, and third-generation cephalosporins and carbapenems compared to diabetes-free children. In a systematic review of all available population-based studies on the epidemiology of pediatric type 2 diabetes (T2D), we found huge variations in the global rates of this disease which were mainly related to the differences in the study population characteristics and methodological differences. These findings highlighted the importance of continuing to follow global trends in the incidence and prevalence rates of T2D in the young population and to use a valid study design, appropriate diagnostic tools and the same diagnostic criteria as this disease can remain undiagnosed for many years. Therefore it is important to use distinctive tests and appropriate time intervals to screen children at risk for this disease. We identified that screening children at risk for T2D with fasting plasma glucose (FPG) and fasting plasma insulin (FPI) tests identifies all patients with diabetes, and more patients with precursors of diabetes. We also observed that the American Diabetes Association (ADA) recommended screening interval of 3-years for children at risk for T2D is not too long based on the fact that none of our study participants developed this disease in this time interval. From 1998 to 2011, increasing trends were observed in the incidence and prevalence rates of oral anti-diabetic (OAD) medication use among children and adolescents aged 0-19 years in the Netherlands which warrants further research to identify the indications for prescribing these medications and to find optimal treatment in children and adolescents with diabetes.