The last decade is characterized by increased incidence of diabetes mellitus (DM) worldwide. The attention of most scholars in the late XIX-early XX century was drawn to the type two diabetes in children and adolescents, the prevalence of which increased significantly in many countries in Europe and America. However, we should not forget that the frequency of type one diabetes (SD1t), more typical for children and young adults, also continues to grow steadily. Increasingly, "popular" among doctors and patients to obtain an expression that DM - "is not a disease but a way of life." However, such "lifestyle" requires constant medical supervision and treatment. Lack of control of the disease can lead to life-threatening complications and early patient disability. In addition, the DM requires substantial material costs, due to the need for continued replacement therapy with human insulin.
All this has prompted scientists to enter the Study Group EURODIAB, an international multi center study of the European Public Conciliation Action Programme in order to predict the increase in the incidence SD1t among children younger than 15 years until 2020.
Methods and progress in the study.
Used data from 20 population-based EURODIAB registers of 17 European countries for 1989-2003 (three periods: P1 - 1989-93; P2 - P3 and 1994-98 - 1999-2004) inclusion criteria - new cases SD1t (insulin) in children under the age of 15 years. Morbidity was analyzed in six groups according to age (0-4, 5-9 and 10-14 years) and sex, and region, which were determined by geographical features, incidence, and the number of reported cases SD1t. Total allocated five regions: north, which includes the Nordic countries (Denmark, Finland, Norway, Sweden) with a very high incidence; northwest (3 UK center with a high incidence) and three regions with a lower and approximately the same incidence - Western ( Spain, Luxembourg, Belgium, Germany), central (Czech Republic, Austria, Slovenia) and Eastern (Lithuania, Poland, Slovakia, Hungary, Romania). Using various models of analysis (Poisson's regression Analysis? 2-test, etc.) and morbidity, the researchers predicted the frequency of new cases SD1t, which is expected in European countries in 2005, 2010, 2015 and 2020.
Results.
In just 15 years (1989-2003) in 17 European countries were registered 29,311 cases of new-onset SD1t children. In the 18 registers marked a significant annual increase in incidence, which ranged from 0.6% (in Spain) to 9, 3% (in Poland). For comparison, the standardized (the equivalent of the quantity, age and sex group), incidence per 100,000 in Finland for the P1-period was 39.9, for P2 - 50, 0; for P3 - 52, 5; in Oxford (UK) - 17, 1, 21.7, 22.4; in Spain - 12.4, 13.6, 13.0; in Poland - 5.2, 7.9, 13.0, respectively. On average across all countries increased morbidity for the year was 3.9% (95% confidence interval [CI]: 3,6-4,2). The maximum increase in morbidity was observed among the youngest age groups, which on average was 5.4% (95% CI: 4,8-6,1). Children 5-9 years of morbidity for the year increased by 4, 3% (95% CI: 3,8-4,8), and in the group, 10-14 years - 2, 9% (2,5-3,3 ). The most distinct increases in the incidence of young children are registered in the Central and Eastern Europe. In addition, the incidence varied according to sex. Girl 5-9 years increase in the incidence was higher in 10-14 years, by contrast, is lower than that of boys.
Estimated number of new-onset SD1t in 2005 equal to 15,000, of which 24% of children 0-4 years 35% - 5-9 years and 41% - 10-14 years. By 2020, the projected number of new cases SD1t is 24400. Estimated incidence is unevenly distributed among the sex-age groups. Thus, in the younger group, the incidence of double and boys and girls and in older is increased by 1,6 and 1,3 times, respectively. Percentage distribution of new cases SD1t depending on age in 2020 was 29% (0-4 g), 37% (5-9 years) and 34% (10-14 years). The most distinct increase in incidence is predicted for girls 5-9 years. It is expected that the prevalence of SD1t in children under 15 years will increase from 94,000 in 2005 to 160,000 in 2020.
Conclusions.
Analysis of the incidence of SD1t children showed a steady rise in incidence over the 15-year period. The highest rate of an increase in incidence observed in children during the first four years of life. The maximum increase in newly diagnosed SD1t recorded among children in Central and Eastern Europe. It is predicted that this trend will not only continue but also intensify in the coming decade. In this case, for the period 2005-2020, the incidence SD1t in children younger than five years will be doubled, while the overall prevalence of SD1t in children under 15 years will increase by 70%.
The projected increase in incidence in the younger age group means that will increase the number of cases SD1t, diagnosed at the stage of ketoacidosis. Parallel to rise and rates of hospitalization. Thus, disappointing forecasts require the necessary training of health and all doctors for the impending outbreak SD1t children.
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