title: The rise of childhood type 1 diabetes in the 20th century.
abstract: The incidence of childhood type 1 diabetes increased worldwide in the closing decades of the 20th century, but the origins of this increase are poorly documented. A search through the early literature revealed a number of useful but neglected sources, particularly in Scandinavia. While these do not meet the exacting standards of more recent surveys, tentative conclusions can be drawn concerning long-term changes in the demography of the disease. Childhood type 1 diabetes was rare but well recognized before the introduction of insulin. Low incidence and prevalence rates were recorded in several countries over the period 1920-1950, and one carefully performed study showed no change in childhood incidence over the period 1925-1955. An almost simultaneous upturn was documented in several countries around the mid-century. The overall pattern since then is one of linear increase, with evidence of a plateau in some high-incidence populations and of a catch-up phenomenon in some low-incidence areas. Steep rises in the age-group under 5 years have been recorded recently. The disease process underlying type 1 diabetes has changed over time and continues to evolve. Understanding why and how this produced the pandemic of childhood diabetes would be an important step toward reversing it.
authors.affiliation: Department of Diabetes and Metabolism, Division of Medicine, University of Bristol, Medical School Unit, Southmead Hospital, Bristol BS10 5NB, U.K.
authors.forename: Edwin A M
authors.initials: EA
authors.lastname: Gale
mesh_terms: D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy / Q000453:epidemiology*; D005060:Europe / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007328:Insulin / Q000627:therapeutic use; D015995:Prevalence; D014481:United States / Q000453:epidemiology
chemical_list: D007328:Insulin