‫‪Epidemiology‬‬

‫‪of Type 1 Diabetes Mellitus in Pediatric Age‬‬

‫‪Group‬‬
‫‪in Al-Diwaniyah City‬‬
‫‪Prepared By:‬‬
‫إيثار حسن شبل‬
‫محمد مالك هادي جابر‬
‫فاطمة حسام محسن‬
‫تبارك أحمد محسن‬
‫هدير عادل عبد األمير‬
‫محمد ماهر محمد رضا‬
‫محمد حامد كاظم‬
‫فاطمة ضياء الدين ميراوي‬
‫‪Supervised By:‬‬
‫‪Prof. Hadi J. Suhail‬‬
 Introduction:
• Type 1 diabetes, once known as juvenile diabetes or insulin-
dependent diabetes, is a chronic condition in which the pancreas
produces little or no insulin.
• Insulin is a hormone needed to allow sugar (glucose) to enter cells to
produce energy.
• Type 1 diabetes mellitus (T1DM) is one of the most common
endocrine and metabolic conditions in childhood.
• Different factors, including genetics and some viruses, may
contribute to type 1 diabetes.
• Although type 1 diabetes usually appears during childhood or
adolescence, it can develop in adults.
• Its incidence is rising worldwide, with reported increases of 2–5
percent per year in the Middle East.
• Its incidence is rising worldwide, with reported increases of 2–5
percent per year in the Middle East.
• In Iraq, the incidence of T1DM in Basra City is 5–9.99/100,000 per year
and was increasing between 2012 and 2016.
• Similarly, in Al-Nassiryah City the incidence was also increasing in the
last 5 years,5 and with the existence of only a few national/regional
diabetes registries available to support diabetes research, provide
reliable data, and help cope with the widespread threat of this
disease, there is a need for establishing a population-based Arab
diabetes registry.
• Most children with T1DM grow normally, however, poor glycemic
control can result in poor linear growth, poor weight gain, and/ or
delayed skeletal development.
• Conversely, treatment with excessive insulin and/or excessive caloric
intake can lead to excessive weight gain.
• And if obesity develops, this can lead to insulin resistance, which
complicates diabetes management.
Objectives of the Study:

(1) The study aims to estimate the incidence of type 1 diabetes

mellitus in children, from 1 year until 18 years old, in Al-Diwaniyah
City from 2018-2020.
(2) To estimate the prevalence of type 1 diabetes mellitus in Al-
Diwaniyah City.
Methods of the Study:
• The type of the study is Cohort retrospective study.

• The study includes 467 of type 1 diabetes mellitus aged 1-18

years who live in Al-Diwaniyah City and who were either diagnosed
at or referred to Al Diwaniya specialized diabetes centers and
health care centers between 2018-2020.

• The diabetes centers profiles were revised.

• The duration of the study was 2 weeks.

• The methods depended on:

- Age group.

- Gender.
Results of the Study:

• A total of 467 cases were identified over the three year

period (160 cases in 2018, 167 cases in 2019, 140 cases in
2020).
• Of these, 263 (56.3%) were female and 204(43.6%) were
male.
• The mean age at diagnosis was 9 ± 4 years and showed
no sex difference (9.0±4.1 years in the girls and 9.4±4.4
years in the boys).
• Table 1 shows mean ages and distribution of the patients
by age groups over the three years period.
• The proportion of newly diagnosed T1DM cases was
highest among children aged 10-14 years (32.11%),
followed by the age group 5-9 years (23.98%),15-18
(23.95%), and 1-4years (20.1%).
• The crude mean annual incidence in children aged 1-18
years over this period was 8.99 per 100,000.
• The standardized mean incidence was 9.02 per 100,000.
Proportion of male and female

male 44%
female 56%
 2018 2019 2020 2018-2020

Total number of cases 160 167 140 467

Male 70 79 55 204
Female 90 88 85 263

Mean age at diagnosis (years)

Total group 1 ± 10 8±4 9±4 2±4
Male 9±1 9±4 9±4 4±4
Female 8±4 8±4 9±3 9±4

Proportion by age group (%)

1-4 years 18.25 10.56 35.7 20.1
5-9 years 29.5 27.54 49.7 23.98
10-14 years 42.87 44.96 22.8 32.11
15-18 years 25.62 31.17 20.7 23.95

Table (1): Mean ages at diagnosis and distribution by age groups of newly
diagnosed type 1 diabetes mellitus over the three years period.
• There was no significant difference between the mean annual
incidence figures for males and females.
• The mean annual incidence for the 1-4 year age group was
6.13/100.000.
• Incidence increased significantly with age, reaching a peak in the
age groups 5-9 and 10-14 years.
• It was 11.68/100.000 for the 5-9 year age group and 11.7/100.000
for the 10-14 year age group and subsequently the incidence
declined at age 15-18 years 5.04.
• The lowest incidence was seen in the age group 1-4
years (5.04/100,000) (Table 2).
• The incidence of the age group 1-14 years was 9.82/100,000 ).
• Female predominance was seen in all groups (Table 2).
• The incidence of T1DM was similar over the course of the three years
(Table 2).
Incidence 2018-2020 2018 2019 2020 Prevalence

Total group 8.99 9.01 8.99 8.98 0.95

Males 8.98 8.31 9.11 9.51 0.07
Female 9.01 9.76 8.85 8.43 0.1
By age groups (total group) 6.13 6.6 6.74 5.09 0.92
1-4 years 11.68 10.56 12.37 12.10 0.85
5-9 years 11.7 12.78 10.42 11.9 0.48
10-14 years 5.04 4.37 4.93 5.82 0.60
15-18 years
Males 6.39 6.26 6.98 5.94 0.78
1-4 years 10.26 8.43 11.08 11.25 0.06
5-9 years 12.73 12.29 12.39 13.51 0.41
10-14 years 5.19 5.01 4.26 6.31 0.32
15-18 years
Females 5.86 6.96 6.48 4.18 0.07
1-4 years 13.18 12.8 13.74 13.01 0.91
5-9 years 10.6 13.31 8.32 10.18 0.06
10-14 years 4.88 3.69 5.65 5.28 0.23
15-18 years

Table (2): Incidence of type 1 diabetes mellitus over the three years period.
Discussion of the Study:
• The prevalence of T1DM has been reported to vary greatly among different
countries, and among different ethnic populations.
• Recently, a study reported that the prevalence and incidence of T1DM were
found to be variable among the population.
• This study showed that prevalence of diabetes in children in Al-Diwaniyah
City was 60 per 100,000, which was lower than Al Najaf City where
prevalence rate was 87 per 100,000.
• The proportion of female was slightly more than male, which agreed with two
studies as prevalence for T1DM slightly favors females in Australia, and
Japan, but disagree with another study which slightly favors males in the USA,
and it was near parity in North-West England.
• In this study, around 30.1% of diabetics had family history of T1DM (aunts and
uncles were included), as they found that 10%–20% of newly diagnosed
childhood cases of T1DM have an affected first degree relative.
Conclusion of the Study:

• The results showed an intermediate incidence of T1DM and a similar

mean annual incidence between males and females.
• Considering the increasing incidence of T1DM worldwide, we
suggest that it would be important to follow trends in incidence in the
next few years in this same region to determine the possible
triggering factors and also to develop preventive strategies.
Recommendations of the Study:

• The study recommends to use the diabetic care plan.

• A diabetes care plan is a set of instructions for patients.
• The goal of the plan is to help keep the child’s blood sugars in a
healthy range.
• There are four parts to a diabetes care plan:
1. Checking blood sugar levels.
2. Taking insulin.
3. Eating a healthy, balanced diet while counting carbohydrates.
4. Getting regular physical activity.
1. Checking Blood Sugar Levels:
- Treating type 1 diabetes also includes checking blood sugar levels every day.
- There are two ways to do this:
A- With a blood glucose meter.
B- With continuous glucose monitoring (CGM)
2. Taking Insulin:
- All kids and teens with type 1 diabetes need to take insulin so that glucose
can get from their blood into their cells for energy.
- The care team will make an insulin schedule specifically for the patients.
- the patient can get insulin:
A- By injection.
B- With an insulin pump.
3. Eating Healthy:
- the patient with type 1 diabetes need to find the right balance of food, insulin,
and exercise to keep their blood sugars in the healthy range.
- It helps to understand how different foods affect your child’s blood sugar.
- The care team will teach you about healthy eating and how to:
A- Follow a meal plan.
B- Count carbs in meals and snacks.

4. Getting Regular Physical Activity:

- Keeping active every day is a key part of diabetes treatment.
- Exercise strengthens the patient’s body and bones, helps the patient feel
good, and controls blood sugar levels.
- In fact, exercise makes insulin work better. The patient with type 1 diabetes
can and should exercise.
- Encourage the patient to stay active, and set a goal of 60 minutes each day.
- Let the patient choose what they enjoy, whether that’s walking, riding a bike,
or playing team sports.
Limitations of the Study:

• Lack of time: limitation of time due to that end of the official college
hours coincides with the end of the official working time in the health
centers.
• Difficulty in obtaining information due to poor organization of the patient
database and anamnesis, which led to an increase in the difficulties faced,
such as:
 The lack of obtaining more information about the patient’s diet, lifestyle.
 Delay in obtaining official approvals and facilities for research members to
visit health centers.
References of the Study:

(1) Al-Diwaniyah specialized diabetes center.

(2) Al-Talia health care center.
(3) Al-Hakeem health care center.
(4) Davidson.