Type 1 diabetes may occur at any age and the incidence rate varies by age (Figure 1). Type 1 diabetes is not present at birth and is rare in the first two years of life. Onset of type 1 diabetes before 12 months, and even before 6 months, may occur in rare instances, but monogenic or syndromic forms should be suspected, as these represent a sizeable proportion of cases with diabetes diagnosed in this age group [1].

Fig1. Incidence of type 1 diabetes by age and sex. (a) Incidence in Sweden by age and sex during 1983–1998. Source: Reproduced from Pundziute- Lyckå et al. 2002 [2], with permission from Springer- Verlag. (b) Incidence of type 1 diabetes by age group in China during 2010–2013. The upper age group was ≥75 years, placed at 80 years on the x- axis. Shaded area represents pointwise 95% confidence intervals. Source: Produced with data from Weng et al. 2018 [3].

The incidence rate increases from age 6 months to peak at around 9–14 years, a common finding over time and across populations with different incidence rates [4, 2, 3, 5–9]. The incidence among 15–29- year- olds is lower than among 0–14- year- olds in most studied populations. In some populations there appears to be an additional rise in incidence after the age of ~25–30 years [10–12].

There are few population- based incidence studies for older age groups above 35 years of age and especially few covering the whole age range [9]. For many years, the only two sources of the latter were Minnesota, 1945–1969 [13], and a nationwide study from Denmark, 1973–1977 [14]. More recent data have been published from China 2010–2013 in a nationally representative sample of approximately 10% of the population [15] (Figure 1b) and Olmsted county, Minnesota [16]. In the Olmsted county study between 1994 and 2010, approximately half of the 233 individuals with incident type 1 diabetes developed the condition below 15 years of age, 25% between 15 and 30 years, and 25% after 30 years of age [16]. The corresponding proportions among the over 5000 individuals with incident type 1 diabetes in the Chinese study were 25% below 15 years, 33% among 15–29- year- olds, and nearly 40% after 30 years of age [15].

It may be difficult to distinguish type 1 diabetes from type 2 diabetes in some adults, especially after ~30 years of age. In the Swedish nationwide prospective incidence study of 15–34- year- olds, 78% of the newly diagnosed individuals were classified as having type 1 diabetes and 15% as having type 2 diabetes at the time of the diagnosis [17]. The follow- up showed that 92% of the individuals diagnosed before 30 years of age were treated with insulin later [18]. These findings are consistent with incidence data from Finland among people aged 15–39 years [19, 20]. In these studies, the incidence of type 2 diabetes exceeded that of type 1 diabetes after the age of ~30 years. By contrast, in Turin, Italy, which has a much lower incidence of type 1 diabetes, the incidence of type 2 diabetes is about three times higher than that of type 1 diabetes at the age of 30 years [10]. Although beyond the scope of this chapter, it is important to consider the possible clinical heterogeneity and increasing difficulty of classification of diabetes with increasing age. Some of the apparent heterogeneity may represent extremes along a continuum [21].

References

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1. Johnson, M.B., Patel, K.A., De Franco, E. et al. (2020). Diabetologia 63: 2605–2615.

2. Pundziute- Lyckå, A., Dahlquist, G., Nyström, L. et al. (2002). Diabetologia 45: 783–791.

3. Weng, J., Zhou, Z., Guo, L. et al. (2018). BMJ 360: j5295.

4. Diamond Project Group (2006). Diabet. Med. 23: 857–866.

 5. Christau, B., Kromann, H., Andersen, O.O. et al. (1977). Diabetologia 13: 281–284.

6. Gamble, D.R. (1980). Epidemiol. Rev. 2: 49–70.

 7. Joner, G. and Søvik, O. (1991). Diabetologia 34: 271–274.

8. Kyvik, K.O., Nystrom, L., Gorus, F. et al. (2004). Diabetologia 47: 377–384.

9. Diaz- Valencia, P.A., Bougneres, P., and Valleron, A.J. (2015). BMC Public Health 15: 255.

10. Bruno, G., Runzo, C., Cavallo- Perin, P. et al. (2005). Diabetes Care 28: 2613–2619.

11. Weets, I., De Leeuw, I.H., Du Caju, M.V. et al. (2002). Diabetes Care 25: 840–846.

12. Pundziute- Lyckå, A., Urbonaite, B., Ostrauskas, R. et al. (2003). Diabetes Care 26: 671–676.

 13. Melton, L.J., Palumbo, P., and Chu- Pin, C. (1983). Diabetes Care 6: 75–86.

14. Mølbak, A.G., Christau, B., Marner, B. et al. (1994). Diabet. Med. 11: 650–655.

15. Weng, J., Zhou, Z., Guo, L. et al. (2018). BMJ 360: j5295.

16 Cartee, A.K., Owens, L.A., Lahr, B.D. et al. (2016). Mayo Clin. Proc. 91: 1066–1073.

17 Arnqvist, H.J., Littorin, B., Nyström, L. et al. (1993). Diabet. Med. 10: 606–613.

18. Littorin, B., Sundkvist, G., Hagopian, W. et al. (1999). Diabetes Care 22: 409–412.

19. Lammi, N., Taskinen, O., Moltchanova, E. et al. (2007). Diabetologia 50: 1393–1400.

20. Lammi, N., Blomstedt, P.A., Moltchanova, E. et al. (2008). Diabetologia 51: 897–899.

21. Leslie, R.D., Palmer, J., Schloot, N.C., and Lernmark, Å. (2016). Diabetologia 59: 13–20.

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