Abstract
There is very limited data on the time trend of diabetes incidence in Asia. Using population-level data, we report the secular trend of the incidence of type 1 and type 2 diabetes in Hong Kong between 2002 and 2015. The Hong Kong Diabetes Surveillance Database hosts clinical information on people with diabetes receiving care under the Hong Kong Hospital Authority, a statutory body that governs all public hospitals and clinics. Sex-specific incidence rates were standardised to the age structure of the World Health Organization population. Joinpoint regression analysis was used to describe incidence trends. A total of 562,022 cases of incident diabetes (type 1 diabetes [n = 2,426]: mean age at diagnosis is 32.5 years, 48.4% men; type 2 diabetes [n = 559,596]: mean age at diagnosis is 61.8 years, 51.9% men) were included. Among people aged <20 years, incidence of both type 1 and type 2 diabetes increased. For type 1 diabetes, the incidence increased from 3.5 (95% CI 2.2-4.9) to 5.3 (95% CI 3.4-7.1) per 100,000 person-years (average annual percentage change [AAPC] 3.6% [95% CI 0.2-7.1], p < 0.05) in boys and from 4.3 (95% CI 2.7-5.8) to 6.4 (95% CI 4.3-8.4) per 100,000 person-years (AAPC 4.7% [95% CI 1.7-7.7], p < 0.05] in girls; for type 2 diabetes, the incidence increased from 4.6 (95% CI 3.2-6.0) to 7.5 (95% CI 5.5-9.6) per 100,000 person-years (AAPC 5.9% [95% CI 3.4-8.5], p < 0.05) in boys and from 5.9 (95% CI 4.3-7.6) to 8.5 (95% CI 6.2-10.8) per 100,000 person-years (AAPC 4.8% [95% CI 2.7-7.0], p < 0.05) in girls. In people aged 20 to <40 years, incidence of type 1 diabetes remained stable, but incidence of type 2 diabetes increased over time from 75.4 (95% CI 70.1-80.7) to 110.8 (95% CI 104.1-117.5) per 100,000 person-years (AAPC 4.2% [95% CI 3.1-5.3], p < 0.05) in men and from 45.0 (95% CI 41.4-48.6) to 62.1 (95% CI 57.8-66.3) per 100,000 person-years (AAPC 3.3% [95% CI 2.3-4.2], p < 0.05) in women. In people aged 40 to <60 years, incidence of type 2 diabetes increased until 2011/2012 and then flattened. In people aged ≥60 years, incidence was stable in men and declined in women after 2011. No trend was identified in the incidence of type 1 diabetes in people aged ≥20 years. The present study is limited by its reliance on electronic medical records for identification of people with diabetes, which may result in incomplete capture of diabetes cases. The differentiation of type 1 and type 2 diabetes was based on an algorithm subject to potential misclassification. There was an increase in incidence of type 2 diabetes in people aged <40 years and stabilisation in people aged ≥40 years. Incidence of type 1 diabetes continued to climb in people aged <20 years but remained constant in other age groups.
Highlights
Type 2 diabetes mellitus is a complex progressive disease of rapidly growing prevalence
Incidence of type 1 diabetes continued to climb in people aged
Diabetes was ascertained based on one or more of the following qualifying criteria: (1) glycated haemoglobin (HbA1c) 6.5% (48 mmol/mol) in any one available HbA1c measurement [6]; (2) fasting plasma glucose (FPG) 7.0 mmol/L in any one available FPG measurement [7]; (3) prescription of noninsulin antihyperglycaemic drugs and/or (4) prescription of insulin for at least 28 days continuously, with or without (5) recording of the diagnostic code of diabetes based on the International Classification of Diseases, Ninth Revision (ICD-9) code 250; and/or (6) recording of the diagnostic code of diabetes according to the revised edition of the International Classification of Primary Care, World Organization of National Colleges, Academics, and Academic Associations of General Practitioners/Family Physicians code T89 or code T90
Summary
Type 2 diabetes mellitus is a complex progressive disease of rapidly growing prevalence. The global prevalence of type 2 diabetes is currently estimated at 415 million and is projected to escalate to 642 million over the 25 years [1]. The majority of published population-based studies on the epidemiology of type 1 and type 2 diabetes in Asia, including China, reported prevalence data, but few examined the incidence of diabetes [2,3]. We accessed the territory-wide database hosted by the Hong Kong Hospital Authority (HA) and described the secular trends in incidence of type 1 and type 2 diabetes from 2002 to 2015. There is very limited data on the time trend of diabetes incidence in Asia. We report the secular trend of the incidence of type 1 and type 2 diabetes in Hong Kong between 2002 and 2015
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