Rising incidence of insulin dependent diabetes in children aged under 5 years in the Oxford region: time trend analysis

BMJ 1997;315:713-717 (20 September)

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Rising incidence of insulin dependent diabetes in children aged under 5 years in the Oxford region: time trend analysis

Stephen G Gardner, research fellow,^a Polly J Bingley, senior lecturer,^a Pamela A Sawtell, study administrator,^a Suzanne Weeks, field worker,^a Edwin AM Gale, professor of diabetic medicine ^a

^a Diabetes and Metabolism, Department of Medicine, University of Bristol, Southmead Hospital, Bristol BS10 5NB

Members of the study group are listed at end of article.Correspondence to: Professor Gale

Objectives: To monitor incidence of insulin dependent diabetesin children in Oxford health region since 1985, and to lookfor any evidence of disproportionate increase in children agedunder 5.
Design: Primary ascertainment of cases of childhood diabeteswas by prospective registration of all patients with insulindependent diabetes diagnosed before age 15 years between 1985and 1996 and resident in Oxford region at time of diagnosis.This was supplemented by examination of centralised hospitaldischarge records and death certificates. Secondary case ascertainmentwas by postal surveys of general practitioners in 1987 and 1996.
Setting: Area formerly administered by Oxford Regional HealthAuthority.
Subjects: 1037 children presenting with insulin dependent diabetesunder age of 15 years.
Main outcome measures: Incidence of insulin dependent diabetesin children aged 0-4, 5-9, and 10-14 years during 1985-95.
Results: Overall incidence of diabetes in children aged 0-15was 18.6 cases/100 000/year and showed an annual increase of 4%from 1985 to 1996. This was mainly due to a rapid increase inchildren aged 0-4 years, in whom there was an annual increaseof 11% (95% confidence interval 6% to 15%, P<0.0001), whilethe annual increase in those aged 5-9 was 4% (0 to 7%, P=0.05)and in those aged 10-14 was 1% (-2% to 4%, P=0.55).
Conclusions: Incidence of insulin dependent diabetes in childrenaged under 5 years has risen markedly in the Oxford region overthe past decade. The cause of the increase is unknown, but environmentalinfluences encountered before birth or in early postnatal lifeare likely to be responsible.

Key messages

The incidence of childhood diabetes has increased in Europe and many other parts of the world over the past 20-30 years
In the Oxford region we found that the incidence of childhood insulin dependent diabetes increased by 4% per year during 1985-95
Most of this increase was due to an increase of 11% a year in children aged under 5 years, in whom incidence doubled over the study period
Environmental factors encountered very early in life are likely to have been responsible for this increase, but the nature of such factors is unknown
Attempts at preventing disease should be directed towards intrauterine or early postnatal life

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