Epidemiology and phenotypes of diabetes in children and adolescents in non-European-origin populations in or from Western Pacific region

Table 1 Overview of the included studies (excluding publications with all data before 2000) (n = 265)

Country/territory	Total records
	n	Proportion of total
Australia	10	3.8%
China	67	25.3%
Fiji	1	0.4%
Hong Kong, China	6	2.3%
Indonesia	5	1.9%
Japan	66	24.9%
Malaysia	5	1.9%
New Zealand	6	2.3%
Papua New Guinea	1	0.4%
Philippines	2	0.8%
Singapore	5	1.9%
South Korea	35	13.2%
Taiwan, China	20	7.5%
Thailand	21	7.9%
Tonga	1	0.4%
Vietnam	11	4.2%
Multiple countries/territories	3	1.1%

Table 2 Type 1 diabetes incidence under 20 years of age in/from Western Pacific region (excluding publications with all data before 2000)

Ref.	Country/territory	Study period	Incidence/100000	n (%)	Age range (yr)
Zhang et al[26], 2008	Harbin, China	1990-2000	0.7 (average)	103	< 15
Gong et al[28], 20151	Beijing, China	1995-2010	1.72	485	< 15
Shen et al[29], 2002	Shanghai, China	1997-2000	1.6	103	< 15
Gong et al[30], 2004	Beijing, China	1997-2000	1.0 (annual): 1997 (0.76); 2000 (1.21)	71	< 15
Zhao et al[31], 2014	Shanghai, China	1997-2011	3.12 (annual): 1997-2001 (1.5); 2007-2011 (5.5)	622	< 15
Wu et al[32], 2016	Zhejiang, China	2007-2013	2.02 (annual): 2007 (1.2); 2013 (2.5)	611	< 20
Ogle et al[14], 2016	Fiji	2001-2012	0.9 (overall): 2.1 (Indo-Fijian); 0.2 (Native-Fijian)	28	< 15
Huen et al[154], 2009	Hong Kong, China	1997-2007	2.42 < 15 yr, 2.0 2 < 19 yr	335	< 19
Tung et al[22], 2018	Hong Kong, China	2008-2017	2.4 (annual)	498	< 18
Tung et al[34], 2020	Hong Kong, China	1997-2007; 2008-2017	2.12 (annual): 1997 (1.6); 2007 (2.3). 3.52 (annual): 2008 (4.0); 2017 (4.5)	498	< 18
Pulungan[15], 2013	Indonesia	2010	0.033	825	NS
Urakami et al[35], 2008	Japan	1974-2004	0.64	54	< 15
Onda et al[19], 2017	Japan	2005-2010	2.3 (annual): 2005 (2.17); 2010 (2.23)	2326	< 15
Campbell-Stokes and Taylor[138], 2005	New Zealand	1999-2000	5.6 (Māori)	22	< 15
Ogle et al[18], 2001	Papua, New Guinea	1996-2000	0.1	8	< 15
Lee[141], 2014	South Korea	1995-2000 and 2012	1995-2000 (1.4); 2012 (2.9)	217	< 15
Lee et al[33], 2015	South Korea	2001-2010	2.0 (annual): 2001 (1.3); 2010 (2.7)	239	< 15
Song et al[20], 2016	South Korea	2011-2013	3.3	2346	< 20
Kim et all[21], 2015	South Korea	1995-2000 and 2012-2014	1995-2000 (1.4); 2012-2014 (3.2)	706	< 15
Hong et al[149], 2013	South Korea	2001-2010	2.0 (annual)	239	< 15
Lin et al[23], 2014	Taiwan, China	1999-2010	4.6 (annual): 1999-2000 (3.6); 2009-2010 (5.9)	1280	< 15
Lu et al[24], 2014	Taiwan, China	2003-2008	5.3	1306	< 15
Panamonta et al[16], 2011	Thailand	1996-2005	0.6	340	< 15
Patarakijvanich et al[17], 2008	Thailand	1997-2005	0.7	116	< 15
The Writing Group for SEARCH[25]	United States-Asian and Pacific Islander immigrants	2002-2003	7.3	56	< 20

¹These data were partially published in 2013 also (Gong et al[27]).

²Standardised rate.

³Degree of ascertainment not stated.

⁴Urine glucose screening test.

NS: Not stated.

Table 3 Age of diagnosis of type 1 diabetes patients in/from the Western Pacific region (excluding publications with all data before 2000)

Ref.	Country/territory	n	Mean ± SD/median (IQR) age of diagnosis (yr)	Age range (yr)	Peak age of diagnosis (yr)
Gong et al[28], 2015	Beijing, China	485	NS	< 15	10-14
Huo et al[155], 2018	Beijing, China and Shantou, China	515	11 (7-14)	< 21	10-14
Weng et al[156], 2018	China (13 areas)1	1239	NS	< 15	10-14
Huen et al[154], 2009	Hong Kong, China	335 (< 19); 293 (< 15)	NS	< 19	10-14
Tung et al[22], 2018	Hong Kong, China	498	10.5 (± 4.2)	< 18	NS
Onda et al[19], 2017	Japan	2326	NS	< 15	13 (boys); 10 (girls)
Lee et al[157], 2006	Singapore	211	7.9 (± 4.0)	< 17	NS
Kim et al[21], 2012	South Korea	110	10.6 (± 0.9)	< 18	NS
Kim and Kim[158], 2012	South Korea	113	9.26 (± 0.99)	< 18	NS
Hong et al[149], 2013	South Korea	239	NS	< 15	10-14
Lee et al[141], 2014	South Korea	217	NS	< 15	10-14
Kim et al[159], 2016	South Korea	706	NS	< 15	10-14
Lee et al[160], 2017	South Korea	361	8.9 (± 4.0)	< 20	NS
Lo et al[46], 2004	Taiwan, China	165	7.3 (± 4.1)	< 18	NS
Ting et al[61], 2007	Taiwan, China	304	7.9 (± 3.8)	< 20	NS
Panamonta et al[161], 2000	Thailand	77	NS	< 15	10-14
Likitmaskul et al[79], 2006	Thailand	195	9.2 (± 2.5)	< 19	NS
Patarakijvanich et al[17], 2008	Thailand	116	NS	< 15	11-14
Panamonta et al[16], 2011	Thailand	340	NS	< 15	10-14
Khwanhatai et al[162], 2018	Thailand	229	7.71 (± 3.3)	< 18	NS

¹Harbin, Shenyang, Beijing, Shanghai, Nanjing, Jinan, Wuhan, Changsha, Guangzhou, Chengdu, Xi’an, Lanzhou and Yinchuan.

NS: Not stated.

Table 4 Gender ratio of type 1 diabetes patients in/from the Western Pacific region (excluding publications with all data before 2000)

Ref.	Country/territory	Ratio (M:F)	Age range (yr)
Xin et al[163], 2010	Shenyang, China	0.77	< 15
Gong et al[27], 2013	Beijing, China	0.581 (1995-2002); 0.741 (2003-2010)	< 15
Zhao et al[31], 2014	Shanghai, China	0.971	< 15
Gong et al[28], 2015	Beijing, China	0.701	< 15
Wu et al[32], 2016	Zhejiang, China	0.781	< 20
Tao et al[164], 2017	Kunming, China	1.13	< 15
Huo et al[155], 2018	Beijing, China and Shantou, China	0.77	< 21
Weng et al[156], 2018	China (13 areas)2	0.781	< 15
Huen et al[154], 2009	Hong Kong, China	0.76	< 19
Tung et al[22], 2018	Hong Kong, China	0.75	< 18
Onda et al[19], 2017	Japan	0.761	< 15
Lee et al[157], 2006	Singapore	0.77	< 17
Hong et al[149], 2012	South Korea	0.861	< 15
Lee et al[141], 2014	South Korea	0.841	< 15
Kim et al[159], 2016	South Korea	0.801	< 15
Song et al[20], 2016	South Korea	0.89	< 20
Lee et al[160], 2017	South Korea	0.86	< 20
Lo et al[46], 2004	Taiwan, China	0.70	< 18
Ting et al[61], 2007	Taiwan, China	0.94	< 20
Lu et al[24], 2014	Taiwan, China	0.781	< 15
Patarakujvanich et al[165], 2001	Thailand	1.0	< 15
Panamonta et al[16], 2011	Thailand	0.65	< 15

¹Ratio of T1D incidence.

²Harbin, Shenyang, Beijing, Shanghai, Nanjing, Jinan, Wuhan, Changsha, Guangzhou, Chengdu, Xi’an, Lanzhou and Yinchuan.

M: Male; F: Female.

Table 5 Diabetic ketoacidosis at diagnosis with type 1 diabetes in/from the Western Pacific region (excluding publications with all data before 2000)

Ref.	Country/territory	% with DKA	n	Age range (yr)
Huen et al[154], 2009	Hong Kong, China	60.0	335	< 19
Tung et al[22], 2018	Hong Kong, China	41.0	498	< 18
Jalaludin and Harun[47], 2005	Malaysia	75.3	55	< 13
Fuziah et al[166], 2008	Malaysia	57.1	166	< 20
Gunn et al[167], 2017	New Zealand	28.7 (overall); 23.71; 34.32	381; 352	< 15
Lee et al[157], 2006	Singapore	53.0	211	< 17
Park et al[168], 2011	South Korea	55.0	23	NS
Kim et al[158], 2012	South Korea	36.4	110	< 18
Kim et al[169], 2013	South Korea	32.0	100	< 18
Kim and Kim[170], 2014	South Korea	39.0	113	< 18
Kim et al[21], 2015	South Korea	39.7	706	< 15
Lee et al[160], 2017	South Korea	56.5	361	< 13
Lo et al[46], 2004	Taiwan, China	19.3	165	< 17
Ting et al[61], 2007	Taiwan, China	65.1	304	< 19
Tung et al[62], 2009	Taiwan, China	67.0	157	< 19
Chen et al[171], 2017	Taiwan, China	66.2 (overall): 87.0; 55.0	52; 94	< 6; 6-18
Likitmaskul et al[172], 2003	Thailand	55.0; 78.0	94; 28	6-18; < 15
Patjamontri and Santiprabjob[173], 2012	Thailand	40.8	49	< 15
Jaruratanasirikul et al[80], 2017	Thailand	70.0	99	< 15
Trisorus et al[48], 2018	Thailand	63.0	81	< 15

¹Māori.

²Pacific Islanders.

DKA: Diabetic ketoacidosis.

Table 6 Autoantibodies studies in children and youth with type 1 diabetes in/from the Western Pacific region (excluding publications with all data before 2000)

Ref.	Country/territory	n	Age range (yr)	% positive for GAD65	% positive for IA-2	% positive for IAA	% positive for ZnT8A	% positive for ICA
Huang[174], 2004	Guangdong, China	34	7-12	44.1	35.3			17.6
Li et al[175], 2008	Changsha, China	35; 51	0-9; 10-14	60.0; 64.7	62.8; 33.3
Baoerhan and Maimaiti[176], 2015	Urumqi, China.	94	< 15	45.0	62.0			76.0
Urakami et al[35], 2008	Japan	48	6-15	70.8				68.8
Iwabuchi et al[177], 2013	Japan	43	Children	44.0
Habu et al[134], 2013	Japan	48	< 19	59.5	68.1
Mabulac[178], 2013	Philippines	68	Paediatric	44.1
Lee et al[59], 2001	Singapore	41	< 15	41.5				41.5
Kim and Kim[170], 2014	South Korea	113	< 18	53.0		26.0		4.0
Chen et al[179], 2001	Taiwan, China	70	< 17	54.3
Tung et al[62], 2009	Taiwan, China	157	12-18	73.0	76.0	21.0
Cheng et al[146], 2018	Taiwan, China	750	< 20	66.3	65.3	35.7
Santiprabhob et al[180], 2007	Thailand	51	< 15	63.0	61.0
Patjamontri et al[173], 2012	Thailand	90	< 20	50.0	58.0
Trisorus et al[48], 2018	Thailand	81	< 15	75.3	45.7		54.3

GAD65: Glutamic acid decarboxylase 65 autoantibody; IA-2: Insulinoma-associated 2 autoantibody; IAA: Insulin autoantibody; ZnT8A: Zinc transporter 8 autoantibodies; ICA: Islet autoantibody.

Table 7 Type 2 diabetes incidence in non-European populations in/from the Western Pacific region (excluding publications with all data before 2000)

Ref.	Country/territory	Study period	n	Incidence/100000	Age range (yr)
Craig et al[181], 2007	Australia Torres Straits Islands	2001-2006	23	12.7	< 19
Tran et al[182], 2014	Australia, Torres Straits Islands	2001-2008	31	20.7	< 19
Haynes et al[183], 2016	Australia, Torres Straits Islands	1990-2012	76	12.6	< 17
Wu et al[75], 2017	Zhejiang, China	2007-2013	392	1.73 (overall): 0.62 (2007); 3.62 (2013)	< 20
Ogle et al[14], 2016	Fiji	2001-2012	13; 11; 1; 1	0.43 (overall): 1.171; 0.062; 0.703	< 15
Huen et al[154], 2009	Hong Kong, China	1997-2007	198	1.2	< 19
Tung et al[22], 2018; Tung et al[76], 2021	Hong Kong, China	2008-2017; 2008-2017	391; 391	1.9 (3.42)	< 18
Urakami et al[184], 2005	Japan	1974-2002	232	2.63 (overall): 1.73 (< 1980); 2.76 (> 1981)	< 16
Urakami et al[148], 2018	Japan	1975-2015	301	2.6	< 16
Campbell-Stokes and Taylor[138], 2005	New Zealand	1999-2000	74	1.78	< 15
Jefferies et al[185], 2012	New Zealand	1995-2007	434,5	3.4	< 15
Sjardin et al[186], 2018	New Zealand	1995-2015	344	3.3 (overall): 3.4 (1995-2007); 4.0 (2008-2015)	< 15
			475	3.6 (overall): 3.4 (1995-2007); 4.0 (2008-2015)
Hong et al[149], 2013	South Korea	2001-2010	89	0.76	< 15
Liu et al[77], 2009	United States-Asian and Pacific Islander immigrants	2002-2003	73	12.2	< 15

¹Indo-Fijian.

²Native-Fijian.

³Fijian of European descent.

⁴Māori.

⁵Pacific Islanders.

Table 8 Recommendations for further research and interventions

No.
1	Establishment registers of diabetes in young people in all countries, and, where necessary, in distinct geographic/ethnic regions within countries
2	Ongoing incidence, prevalence, and mortality studies for both T1D and T2D in all countries
3	Phenotype, endotype and genotype studies in youth with any type of diabetes
4	Education campaigns aimed at increasing awareness of the signs and symptoms of T1D and reducing rates of DKA at onset
5	Public health measures aimed at reducing incidence of T2D in young people
6	In-country/territory advocacy efforts, informed by updated and new epidemiological research, aimed at improving quality of care
7	Regional coordination and dissemination of data and research skills

DKA: Diabetic ketoacidosis; T1D: Type 1 diabetes; T2D: Type 2 diabetes.