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Ogle GD, Gregory GA, Wang F, Robinson TIG, Maniam J, Magliano DJ, Orchard TJ. The T1D Index: Implications of Initial Results, Data Limitations, and Future Development. Curr Diab Rep 2023; 23:277-291. [PMID: 37610700 PMCID: PMC10520097 DOI: 10.1007/s11892-023-01520-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/24/2023] [Indexed: 08/24/2023]
Abstract
PURPOSE OF THE REVIEW Current global information on incidence, prevalence, and mortality of type 1 diabetes (T1D) is limited, particularly in low- and middle-income countries. To address this gap in evidence, JDRF, Life for a Child, International Society for Pediatric and Adolescent Diabetes, and International Diabetes Federation have developed the T1D Index, which uses a Markov mathematical model, and machine learning and all available data to provide global estimates of the burden on T1D. This review assesses the methodology, limitations, current findings, and future directions of the Index. RECENT FINDINGS Global prevalence was estimated at 8.4 million in 2021, with 1.5 million <20 years (y). T1D prevalence varied from 1.5 to 534 per 100,000, with T1D accounting for <0.1-17.8% of all diabetes in different countries. A total of 35,000 young people <25 y are estimated to have died at clinical onset of T1D from non-diagnosis. An estimated 435,000 people <25 y were receiving "minimal care." Health-adjusted life years (HALYs) lost for individuals diagnosed with T1D at age 10 y in 2021 ranged from 14 to 55 y. These results show that interventions to reduce deaths from non-diagnosis, and improve access to at least an intermediate care level, are needed to reduce projected life years lost. The results have significant uncertainties due to incomplete data across the required inputs. Obtaining recent incidence, prevalence, and mortality data, as well as addressing data quality issues, misdiagnoses, and the lack of adult data, is essential for maintaining and improving accuracy. The index will be updated regularly as new data become available.
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Affiliation(s)
- Graham D. Ogle
- Life for a Child Program, Diabetes NSW, 26 Arundel St., Glebe, Sydney, New South Wales 2037 Australia
- Sydney Medical School, University of Sydney, City Rd, Camperdown, Sydney, New South Wales 2066 Australia
| | - Gabriel A Gregory
- Life for a Child Program, Diabetes NSW, 26 Arundel St., Glebe, Sydney, New South Wales 2037 Australia
- JDRF Australia, 4/80-84 Chandos St., St Leonards, Sydney, New South Wales 2065 Australia
- St Vincent’s Hospital Sydney, 390 Victoria Street, Darlinghurst, Sydney, New South Wales 2010 Australia
| | - Fei Wang
- JDRF Australia, 4/80-84 Chandos St., St Leonards, Sydney, New South Wales 2065 Australia
| | - Thomas IG Robinson
- JDRF Australia, 4/80-84 Chandos St., St Leonards, Sydney, New South Wales 2065 Australia
| | - Jayanthi Maniam
- Life for a Child Program, Diabetes NSW, 26 Arundel St., Glebe, Sydney, New South Wales 2037 Australia
- School of Medical Sciences, UNSW Sydney, Kensington, Sydney, New South Wales 2052 Australia
| | - Dianna J Magliano
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, Victoria 3004 Australia
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, Melbourne, Victoria 3004 Australia
| | - Trevor John Orchard
- Department of Epidemiology, University of Pittsburgh, School of Public Health, Pittsburgh, PA USA
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Abstract
AIMS/HYPOTHESIS Our study aimed to examine the trends in diabetes-related mortality in urban and rural areas in the USA over the past two decades. METHODS We examined the trends in diabetes-related mortality (as the underlying or a contributing cause of death) in urban and rural areas in the USA between 1999 and 2019, using the CDC WONDER Multiple Cause of Death database. We estimated the 20 year trends of the age-adjusted mortality rate (AAMR) per 100,000 population in urban vs rural counties. RESULTS The AAMR of diabetes was higher in rural than urban areas across all subgroups. In urban areas, there was a significant decrease in the AAMR of diabetes as the underlying (-16.7%) and contributing (-13.5%) cause of death (ptrend<0.001), which was not observed in rural areas (+2.6%, +8.9%, respectively). AAMRs of diabetes decreased more significantly in female compared with male individuals, both in rural and urban areas. Among people younger than 55 years old, there was a temporal increase in diabetes-related AAMR (+13.8% to +65.2%). While the diabetes-related AAMRs of American Indian patients decreased in all areas (-19.8% to -40.5%, all ptrend<0.001), diabetes-related AAMRs of Black and White patients decreased significantly in urban (-26.6% to -28.3% and -10.7% to -15.4%, respectively, all ptrend<0.001) but not rural areas (-6.5% to +1.8%, +2.4% to +10.6%, respectively, ptrend NS, NS, NS and <0.001). CONCLUSIONS/INTERPRETATION The temporal decrease in diabetes-related mortality in the USA has been observed only in urban areas, and mainly among female and older patients. A synchronised effort is needed to improve cardiovascular health indices and healthcare access in rural areas and to decrease diabetes-related mortality.
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Affiliation(s)
- Ofer Kobo
- Department of Cardiology, Hillel Yaffe Medical Centre, Hadera, Israel
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Harriette G C Van Spall
- Department of Medicine, McMaster University, Hamilton, ON, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada
- Research Institute of St Joseph's, Hamilton, ON, Canada
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Keele, UK.
- Department of Cardiology, Thomas Jefferson University, Philadelphia, PA, USA.
- Institute of Population Health, University of Manchester, Manchester, UK.
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Kim KN, Lim YH, Bae S, Kim JH, Hwang SS, Kim MJ, Oh J, Lim H, Choi J, Kwon HJ. Associations between cold spells and hospital admission and mortality due to diabetes: A nationwide multi-region time-series study in Korea. Sci Total Environ 2022; 838:156464. [PMID: 35660607 DOI: 10.1016/j.scitotenv.2022.156464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 05/31/2022] [Accepted: 05/31/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Climate change is predicted to increase the frequency, intensity, and duration of extreme cold events in the mid-latitudes. However, although diabetes is one of the most critical metabolic diseases due to its high and increasing prevalence worldwide, few studies have investigated the short-term association between cold exposure and diabetes-related outcomes. OBJECTIVE The aim of this study was to investigate the associations between cold spells and their characteristics (intensity, duration, and seasonal timing) and hospital admission and mortality due to diabetes. METHODS This study used claims data from the National Health Insurance Service and cause-specific mortality data from Statistics Korea (2010-2019). Cold spells were defined as ≥2 consecutive days with a daily mean temperature lower than the region-specific 5th percentile during the cold season (November-March). Quasi-Poisson regressions combined with distributed lag models were used to assess the associations between exposures and outcomes in 16 regions across the Republic of Korea. Meta-analyses were conducted to pool the region-specific estimates. RESULTS Exposure to cold spells was associated with an increased risk of hospital admission [relative risk (RR) = 1.45, 95% confidence interval (CI): 1.26, 1.66] and mortality (RR = 2.02, 95% CI: 1.37, 2.99) due to diabetes. The association between cold spells and hospital admission due to diabetes was stronger for cold spells that were more intense, longer, and occurred later during the cold season. The association between cold spells and diabetes-related mortality was stronger for more intense and longer cold spells. CONCLUSION This study emphasizes the importance of developing effective interventions against cold spells, including education on the dangers of cold spells and early alarm systems. Further studies are needed to create real-world interventions and evaluate their effectiveness in improving diabetes-related outcomes.
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Affiliation(s)
- Kyoung-Nam Kim
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Republic of Korea.
| | - Youn-Hee Lim
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Sanghyuk Bae
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong-Hun Kim
- Department of Social and Preventive Medicine, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
| | - Seung-Sik Hwang
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Mi-Ji Kim
- Department of Preventive Medicine, Institute of Health Sciences, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Jongmin Oh
- Department of Environmental Medicine, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Hyungryul Lim
- Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Jonghyuk Choi
- Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Republic of Korea
| | - Ho-Jang Kwon
- Department of Preventive Medicine, Dankook University College of Medicine, Cheonan, Republic of Korea
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