AIMS/HYPOTHESIS: Against a background of a near-universally increasing incidence of childhood type 1 diabetes, recent reports from some countries suggest a slowing in this increase. Occasional reports also describe cyclical variations in incidence, with periodicities of between 4 and 6 years. METHODS: Age/sex-standardised incidence rates for the 0- to 14-year-old age group are reported for 26 European centres (representing 22 countries) that have registered newly diagnosed individuals in geographically defined regions for up to 25 years during the period 1989-2013. Poisson regression was used to estimate rates of increase and test for cyclical patterns. Joinpoint regression software was used to fit segmented log-linear relationships to incidence trends. RESULTS: Significant increases in incidence were noted in all but two small centres, with a maximum rate of increase of 6.6% per annum in a Polish centre. Several centres in high-incidence countries showed reducing rates of increase in more recent years. Despite this, a pooled analysis across all centres revealed a 3.4% (95% CI 2.8%, 3.9%) per annum increase in incidence rate, although there was some suggestion of a reduced rate of increase in the 2004-2008 period. Rates of increase were similar in boys and girls in the 0- to 4-year-old age group (3.7% and 3.7% per annum, respectively) and in the 5- to 9-year-old age group (3.4% and 3.7% per annum, respectively), but were higher in boys than girls in the 10- to 14-year-old age group (3.3% and 2.6% per annum, respectively). Significant 4 year periodicity was detected in four centres, with three centres showing that the most recent peak in fitted rates occurred in 2012. CONCLUSIONS/INTERPRETATION: Despite reductions in the rate of increase in some high-risk countries, the pooled estimate across centres continues to show a 3.4% increase per annum in incidence rate, suggesting a doubling in incidence rate within approximately 20 years in Europe. Although four centres showed support for a cyclical pattern of incidence with a 4 year periodicity, no plausible explanation for this can be given.

Centre for Public Health and UKCRC Centre of Excellence for Public Health Northern Ireland Queen's University Belfast Grosvenor Road Belfast BT12 6BJ UK

Department of Children's Diabetology Medical University of Silesia Katowice Poland

Department of Clinical Sciences Paediatrics University of Umeå Umeå Sweden

Department of Endocrinology and Diabetology University Children's Hospital Zurich Switzerland

Department of Endocrinology and Genetics University Children's Hospital Skopje Republic of Macedonia

Department of Endocrinology Institute for Sick Children Podgorica Montenegro

Department of Health Government of Catalonia Barcelona Spain

Department of Paediatric Diabetes and Endocrinology University of Luxembourg Luxembourg Luxembourg

Department of Paediatrics and Adolescent Medicine Copenhagen University Hospital Herlev and Gentofte Denmark

Department of Paediatrics Medical School University of Pécs Pécs Hungary

Department of Paediatrics Tallaght University Hospital Trinity College Dublin The University of Dublin Dublin Ireland

Department of Pediatric and Adolescent Medicine Medical University of Vienna Vienna Austria

Department of Pediatric Endocrinology and Diabetes University Hospital Zagreb Zagreb Croatia

Department of Pediatrics 2nd Faculty of Medicine Charles University and University Hospital Motol Prague Czechia

Diabetes and Metabolic Diseases University Children's Hospital Department of Endocrinology Ljubljana Slovenia

Diabetes and Metabolism Bristol Medical School University of Bristol Bristol UK

Diabetes Research Center and Laboratory of Clinical Biology Brussels Free University Vrije Universiteit Brussel University Hospital Brussels Universitair Ziekenhuis Brussel Brussels Belgium

Division of Adolescent and Paediatric Medicine Institute of Clinical Medicine University of Oslo Oslo University Hospital Oslo Norway

Division of Paediatric Diabetes Azienda University Hospital Ancona Italy

Folkhälsan Institute of Genetics Folkhälsan Research Center Helsinki Finland

German Diabetes Center Institute of Biometrics and Epidemiology Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf Düsseldorf Germany

Health Sciences Public Health Faculty of Medicine Carl Gustav Carus Technische Universität Dresden Dresden Germany

Institute of Endocrinology Lithuanian University of Health Sciences Kaunas Lithuania

Institute of Microbiology and Virology Lithuanian University of Health Sciences Kaunas Lithuania

Leeds Institute of Cardiovascular and Metabolic Medicine University of Leeds Leeds UK

National Institute of Diabetes Nutrition and Metabolic Diseases NC Paulescu Bucharest Romania

Odense Patient data Exploratory Network Odense University Hospital Department of Clinical Research University of Southern Denmark Odense Denmark

University Children's Hospital Tübingen Germany

Diabetologia. 2019 Mar;62(3):370-372. doi: 10.1007/s00125-018-4791-z. PubMed

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