T1D Prevalence Increased Among US Adults Aged 45 to 64

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Type 1 diabetes (T1D), which once predominantly affected children, is increasingly affecting older adults in the US, with prevalence rates peaking in those aged 45 to 64, according to recent research.

Type 1 diabetes (T1D), which once predominantly affected children, is increasingly affecting older adults in the US, with prevalence rates peaking in those aged 45 to 64, according to recent research published in JAMA.1

The life expectancy for people with T1D has increased over the last 15 years, which has led to increased prevalence among older adults.2 The CDC currently estimates that approximately 1.8 million people in the US have T1D.3

The researchers aimed to update estimates on the prevalence of T1D and examine its distribution across various demographic subgroups, including age, sex, and race/ethnicity.1

The study utilized data from the 2019 to 2022 cycles of the National Health Interview Survey (NHIS), representative of the noninstitutionalized US population. The study included over 141,000 participants (110,283 adults and 30,708 youths). The responses were self-reported and collected through in-person and telephone interviews, with response rates ranging from 50% to 60% during the study period. To reduce nonresponse bias and produce distributions similar to those of the US census, the analysis used sample weights.

Researchers aimed to update estimates on the prevalence of T1D and examine its distribution across various demographic subgroups. | image credit: Alina / stock.adobe.com

Researchers aimed to update estimates on the prevalence of T1D and examine its distribution across various demographic subgroups. | image credit: Alina / stock.adobe.com

The NHIS data did not distinguish diabetes type in youths. To determine the prevalence of T1D among US youths, researchers calculated the percentage of T1D cases in youths using published data from the SEARCH for Diabetes in Youth Study.4 This percentage was then applied to estimates of diabetes prevalence in youths from the NHIS data. In adults, T1D was defined as a self-reported diagnosis of T1D and current insulin use.

The reported prevalence of T1D in youths is 3.5 per 1000 (95% CI, 2.8-4.4), with the highest rates in those aged 10 to 17, with a prevalence of 5.0 per 1000 (95% CI, 3.9-6.4). Males showed a higher prevalence rate of 4.0 per 1000, compared with females at 3.0 per 1000.

T1D prevalence in adults was 5.3 per 1000 adults (95% CI, 4.8-5.8), with the highest rates in those aged 45 to 64 years at 6.1 per 1000 (95% CI, 5.2-7.1). Adults aged 65 and older also showed significant prevalence at 5.3 per 1000 (95% CI, 4.4-6.2).

Racial and ethnic disparities were also evident. Hispanic and non-Hispanic White populations showed higher prevalence rates among youth at 3.9 and 3.5 per 1000, respectively. Prevalence was also higher among non-Hispanic White and Black adults at 5.9 and 4.8 per 1000, respectively. Racial and ethnic minority groups often face higher barriers to accessing quality health care for diabetes.

"These patients have less access to care and state-of-the-art diabetes technology, contributing to disparities in glycemic control and complications," the authors wrote. "More data on barriers to care are needed to inform interventions that advance health equity in populations with type 1 diabetes."

The authors acknowledged the increasing prevalence among middle-aged and older adults and the higher burden of T1D in racial and ethnic minority youth and adults. “These results are consistent with the CDC’s estimates for 2021. This study adds to existing research by providing more precise up-to-date national estimates and by characterizing differences across subgroups,” they wrote.

The increasing prevalence of T1D in older adults suggests that further research is needed to develop treatment guidelines that include strategies to optimize treatment in older adults living with T1D. Current clinical practices often extrapolate from data on younger populations or those with type 2 diabetes, which may not be entirely appropriate for older adults with specific needs in terms of cardiovascular and glycemic management.

This article originally appeared on AJMC.

References
1. Fang M, Wang D, Selvin E. Prevalence of Type 1 diabetes among US children and adults by age, sex, race, and ethnicity. JAMA. 2024;331(16):1411-1413. doi:10.1001/jama.2024.2103
2. Ruiz PLD, Chen L, Morton JI, et al. Mortality trends in type 1 diabetes:
a multicountry analysis of six population-based cohorts. Diabetologia. 2022;65 (6):964-972. doi:10.1007/s00125-022-05659-9
3. Centers for Disease Control and Prevention. National diabetes statistics report. Updated November 29, 2023. Accessed April 29, 2024. https://www.cdc.gov/diabetes/data/statistics-report/index.html
4. Lawrence JM, Divers J, Isom S, et al; SEARCH for Diabetes in Youth Study Group. Trends in prevalence of type 1 and type 2 diabetes in children and adolescents in the US, 2001-2017. JAMA. 2021;326(8):717-727. doi:10.1001/ jama.2021.1116
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