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Incidence of type 1 diabetes in China, 2010-13: population based study

BMJ 2018; 360 doi: (Published 04 January 2018) Cite this as: BMJ 2018;360:j5295
  1. Jianping Weng,
  2. Zhiguang Zhou,
  3. Lixin Guo,
  4. Dalong Zhu,
  5. Linong Ji,
  6. Xiaoping Luo,
  7. Yiming Mu,
  8. Weiping Jia
  9. on behalf of the T1D China Study Group
  1. Correspondence to: J Weng, Department of Endocrinology and Metabolic Disease, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China wjianp{at}
  • Accepted 31 October 2017


Objective To estimate the incidence of type 1 diabetes in all age groups in China during 2010-13.

Design Population based, registry study using data from multiple independent sources.

Setting National registration system in all 505 hospitals providing diabetes care, and communities of patients with diabetes in 13 areas across China, covering more than 133 million person years at risk, approximately 10% of the whole population.

Participants 5018 people of all ages with newly diagnosed type 1 diabetes and resident in the study areas from 1 January 2010 to 31 December 2013.

Main outcome measures Incidence of type 1 diabetes per 100 000 person years by age, sex, and study area. Type 1 diabetes was doctor diagnosed and further validated by onsite follow-up. Completeness of case ascertainment was assessed using the capture mark recapture method.

Results 5018 cases of newly diagnosed type 1 diabetes were ascertained: 1239 participants were aged <15 years, 1799 were aged 15-29 years, and 1980 were aged ≥30 years. The proportion of new onset cases in participants aged ≥20 years was 65.3%. The estimated incidence of type 1 diabetes per 100 000 persons years for all ages in China was 1.01 (95% confidence interval 0.18 to 1.84). Incidence per 100 000 persons years by age group was 1.93 (0.83 to 3.03) for 0-14 years, 1.28 (0.45 to 2.11) for 15-29 years, and 0.69 (0.00 to 1.51) for ≥30 years, with a peak in age group 10-14 years. The incidence in under 15s was positively correlated with latitude (r=0.88, P<0.001), although this association was not observed in age groups 15-29 years or ≥30 years.

Conclusion Most cases of new onset type 1 diabetes in China occurred among adults. The incidence of type 1 diabetes in Chinese children was among the lowest reported in the study.


  • Contributors: JW, ZZ, and LG are joint first authors. JW designed and organised the study and cowrote the first draft of the manuscript. JY assisted JW to run the study, collect data in the study site, interpret the data, and cowrite the first draft. ZZ and LG assisted in the design and organisation of the study, and contributed in manuscript discussion. DZ, LJ, XL, YM, WJ, WY, HK, QL, YL, LY, XY, ZS, QJ, XR, JL, JZ, LC, LH, CG, LL, FL, and YX organised the study in their study regions and contributed to the data collection. LJ, DZ, ZS, and XL also contributed in data interpretation. HK, XJ, XR, and JL also contributed to data analysis. XZ, DY, and SL contributed to the data analysis, data interpretation, and manuscript discussion. EM advised on study design and contributed to the manuscript discussion. The corresponding author (JW) had full access to all the data in the study and had final responsibility for the decision on content and publication submission. All authors have seen and approved the final text. The funder of the study had no role in the study design; data collection, analysis, or interpretation; or writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. JW, ZZ, and LG are the guarantors.

  • Funding: This study was funded by the China International Medical Foundation, national key R&D programme of China (2017YFC1309603, 1309602), and National Natural Science Foundation of China (key programme 81530025).

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at (available on request from the corresponding author). No financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: The protocol was reviewed and approved by the institutional review boards of the Third Affiliated Hospital of Sun Yat-sen University.

  • Data sharing: No additional data available.

  • Transparency: The lead author (JPW) affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

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