Published online Mar 9, 2022. doi: 10.5409/wjcp.v11.i2.173
Peer-review started: April 30, 2021
First decision: July 27, 2021
Revised: August 9, 2021
Accepted: January 5, 2022
Article in press: January 5, 2022
Published online: March 9, 2022
Type 1 diabetes (T1D) incidence varies substantially between countries/ territories, with most studies indicating increasing incidence. In Western Pacific region (WPR), reported rates are much lower than European-origin populations. In contrast, there are reports of substantial numbers of young people with type 2 diabetes (T2D). A deeper understanding of T1D and T2D in the WPR may illuminate factors important in pathogenesis of these conditions. Furthermore, with varying resources and funding for diabetes treatment in this region, there is a need to more clearly determine the current burden of disease and also any gaps in knowledge.
To compile and summarise published epidemiologic and phenotypic data on childhood diabetes in non-European populations in and from WPR.
Research articles were systematically searched from PubMed (MEDLINE), Embase, Cochrane library, and gray literature. Primary outcome measures were incidence and prevalence, with secondary measures including phenotypic descriptions of diabetes, including diabetes type categorization, presence of diabetic ketoacidosis (DKA) at onset, autoantibody positivity, C-peptide levels, and human leucocyte antigen phenotype. Extracted data were collected using a customized template. Three hundred and thirty relevant records were identified from 16 countries/territories, with analysis conducted on 265 (80.3%) records published from the year 2000.
T1D incidence ranged from < 1-7.3/100000 individuals/year, rates were highest in emigrant/ mixed populations and lowest in South-East Asia, with most countries/territories (71.4%) having no data since 1999. Incidence was increasing in all six countries/territories with data (annual increases 0.5%-14.2%, highest in China). Peak age-of-onset was 10-14 years, with a female case excess. Rate of DKA at onset varied from 19.3%-70%. Pancreatic autoantibodies at diagnosis were similar to European-origin populations, with glutamic acid decarboxylase-65 autoantibody frequency of 44.1%-64.5%, insulinoma-associated 2 autoantibody 43.5%-70.7%, and zinc transporter-8 autoantibody frequency 54.3% (one study). Fulminant T1D also occurs. T2D was not uncommon, with incidence in Japan and one Chinese study exceeding T1D rates. Monogenic forms also occurred in a number of countries.
T1D is less common, but generally has a classic phenotype. Some countries/ territories have rapidly increasing incidence. T2D is relatively common. Registries and studies are needed to fill many information gaps.
Core Tip: This systematic review found type 1 diabetes (T1D) incidence was generally low in countries/ territories in the Western Pacific region. However, incidence is rising in most countries where this has been studied. Many countries do not have data or data are quite old. Peak age-of-onset was in later childhood. Rates of diabetic ketoacidosis vary but can be quite high (up to 70%). Autoantibody status is generally like European-origin populations. Fulminant and slowly progressive forms of T1D also occur in the region. Of note, type 2 diabetes was sometimes more common in countries than T1D. Establishment of registers will facilitate incidence studies and also define prevalence and mortality, and assist in outcome assessment. Such data will inform quality of care improvements, health professional training, and assist advocacy.