Abstract
IntroductionStudies of prevalence and the demographic profile of type 1 diabetes are challenging because of the relative rarity of the condition, however, these outcomes can be determined using routine healthcare data repositories. Understanding the epidemiology of type 1 diabetes allows for targeted interventions and care of this life-affecting condition.ObjectivesTo describe the prevalence, incidence and demographics of persons with type 1 diabetes diagnosed in Wales, UK, using the Secure Anonymised Information Linkage (SAIL) Databank.MethodsData derived from primary and secondary care throughout Wales available in the SAIL Databank were used to identify people with type 1 diabetes to determine the prevalence and incidence of type 1 diabetes over a 10 year period (2008–18) and describe the demographic and clinical characteristics of this population by age, socioeconomic deprivation and settlement type. The seasonal variation in incidence rates was also examined.ResultsThe prevalence of type 1 diabetes in 2018 was 0.32% in the whole population, being greater in men compared to women (0.35% vs 0.28% respectively); highest in those aged 15-29 years (0.52%) and living in the most socioeconomically deprived areas (0.38%). The incidence of type 1 diabetes over 10 years was 14.0 cases/100,000 people/year for the whole population of Wales. It was highest in children aged 0-14 years (33.6 cases/100,000 people/year) and areas of high socioeconomic deprivation (16.8 cases/100,000 people/year) and least in those aged 45-60 years (6.5 cases/100,000 people/year) and in areas of low socioeconomic deprivation (11.63 cases/100,000 people/year). A seasonal trend in the diagnoses of type 1 diabetes was observed with higher incidence in winter months.ConclusionThis nation-wide retrospective epidemiological study using routine data revealed that the incidence of type 1 diabetes in Wales was greatest in those aged 0-14 years with a higher incidence and prevalence in the most deprived areas. These findings illustrate the need for health-related policies targeted at high deprivation areas to include type 1 diabetes in their remit.
Highlights
Studies of prevalence and the demographic profile of type 1 diabetes are challenging because of the relative rarity of the condition, these outcomes can be determined using routine healthcare data repositories
In the UK the Quality and Outcomes Framework (QoF) combined with the National Paediatric Diabetes Audit [8] provided a dataset which allowed for the estimation of diabetes prevalence and incidence in the entire population [9, 10] with the National Diabetes Audit (NDA) providing an estimate of prevalence in adults [11]
Routine electronic health record data held in the Secure Anonymised Information Linkage (SAIL) Databank [20,21,22] from multiple sources including both primary and secondary care were used for this study
Summary
Studies of prevalence and the demographic profile of type 1 diabetes are challenging because of the relative rarity of the condition, these outcomes can be determined using routine healthcare data repositories. This study builds upon previous work to develop algorithms to identify incident cases of diabetes in the Clinical Practice Research Datalink [13], the UK IMS disease analyser [14], The Health Improvement Network [15], administrative data from Ontario, Canada [16] and Luxembourg [17] and in the Scottish Care Information-Diabetes Collaboration [18] These methods typically use coded diagnoses and/or medication prescriptions and laboratory tests to identify cases of diabetes, due to the anonymised nature of these data sources and the inherent issues related to routinely collected data, robust data cleaning methods are required to ensure the accuracy of the cohort being studied [19]
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