Childhood diabetes has increased significantly over 30 years – Norway has one of the highest rates worldwide
Type 1 diabetes is a significant child health issue globally. The farther north you go, the higher the percentage of young people diagnosed with the disease.
“The number of children diagnosed with type 1 diabetes continues to rise globally, including in Norway. Living with this condition is a heavy burden, not only for the children and their families but also for the healthcare system,” Torild Skrivarhaug tells Norwegian News Agency NTB.
She is a senior physician and professor at Oslo University Hospital’s Department of Paediatrics, and head of the Norwegian Childhood Diabetes Registry.
“The numbers may fluctuate slightly from year to year, but overall, the trend has been upwards,” she says.
Between 1973 and 1982, there were about 150 new cases of type 1 diabetes among children under 15 each year. Last year, that number was 413. The record year was 2022, with 512 children newly diagnosed type 1 diabetes.
Even when accounting for population growth, the increase is significant.
“And we don't know why. But it’s not unique to Norway; it’s a global trend, and there’s a lot of research being done on this,” she says.
Doubling of cases and highest rates in the Nordics
Three professors from the Spanish Universidad de Castilla-La Mancha analysed the prevalence of childhood diabetes in an article in The Conversation. They gathered data from 32 European countries and analysed the development from 1994 to 2021. The researchers looked at the incidence – how many per 100,000 children under the age of 15 were diagnosed with type 1 diabetes annually. The study includes almost 220,000 children with type 1 diabetes.
On average, the incidence of type 1 diabetes has roughly doubled in Europe: from 11 new cases per 100,000 children between 1994 and 2003, to about 21 new cases per 100,000 between 2013 and 2021.
While the disease is increasing in all countries, geographical variations are significant. In countries with the lowest incidence, it rose from around 5 to 15 per 100,000. In Finland, which has the highest rate of type 1 diabetes in the world, the incidence rose from 40 to 56 new cases per 100,000 children over the three decades.
In Norway, according to the Norwegian Childhood Diabetes Registry, 22 per 100,000 children were diagnosed in 1994. Last year, the number was 39, and in the record year of 2022, it was 49.
Multiple theories, but no clear answers
Diabetes is an autoimmune disease, and its increase mirrors other autoimmune diseases like celiac disease, multiple sclerosis, and psoriasis. These diseases share a common trait: The immune system mistakenly attacks healthy cells in the body.
“We know it’s linked to an underlying genetic vulnerability. However, not everyone with this vulnerability develops the disease, so there must be a trigger, though we don't yet know what it is,” says Skrivarhaug.
While about 30 per cent of the population may have genes that predispose them to the disease, only between 0.3 and 0.5 per cent of develop type 1 diabetes.
“International research is investigating whether a viral infection could be a trigger, but there are no clear answers have been found,” she says.
If it turns out that a virus triggers type 1 diabetes, the next step would be to research potential vaccines.
What’s going on in the Nordics?
The Spanish researchers explore several theories about the peculiarities of type 1 diabetes. Why are more boys than girls diagnosed in countries with high rates? Why is the incidence increasing worldwide? Could ethnicity or social status play a role? Or is pollution and environmental toxins to blame?
The number of children diagnosed each year also increases by 3.3-3.5 per cent for every degree of latitude northwards, putting the Nordic countries at the top globally in terms of cases. Skrivarhaug is familiar with hypotheses suggesting that cold climate, UV radiation, or low vitamin D levels might trigger diabetes, but she remains unconvinced.
“Finland has always had the highest incidence, followed by Sweden and Norway. But then suddenly Kuwait surpassed Norway, and you can't blame northern latitudes for that. And if you look at smaller regions, the Italian island of Sicily is the only place that matches Finland in incidence, while mainland Italy is much lower,” she says.
A global burden
In 2019, 1.5 million people under the age of 20 worldwide were diagnosed with type 1 diabetes, according to The Lancet. That same year, the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) published data showing that over 12,000 people under the age of 25 died from the disease.
In low-income countries, diabetes was six times more likely to be listed as a cause of death than in high-income countries. The primary reason is likely a lack of access to insulin and inadequate healthcare, though exact figures are unavailable.
“While it’s unfortunate that so many children in Norway are diagnosed with type 1 diabetes, we can at least be grateful for the excellent care and follow-up that we provide, which leads to good outcomes,” says Skrivarhaug.
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Translated by Alette Bjordal Gjellesvik
Read the Norwegian version of this article on forskning.no
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