**4.2. The age-related differences of type 1 diabetes mellitus prevalence**

Regarding age dependents phenomena of type 1 diabetes incidence (see section 3.4) it be‐ comes conclusive that 1) the prevalence of type 1 diabetes shows no sex-related differences and increases with age due to accumulation of individuals suffering from the disease and 2) the age-dependent increment of prevalence is not just linear but more likely exponential due to an age-dependent increment of type 1 diabetes incidence. These assumptions have been confirmed for example by the findings of the Australian Institute of Health and Welfare (see Table 4) that were based on the Australian National Diabetes Register.

period and the preclinical period (Oresic, Simell et al. 2008), may provide clues to environ‐ mental triggers, such as infections or dietary changes, which likely cause disturbances in the intestinal microbiota and the immune system and contribute to the onset of type 1 diabetes. Thereby, children/adolescents at a high risk may be identified and possibilities for preven‐

The Epidemiology of Type 1 Diabetes Mellitus

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In part promising therapeutic approaches to type 1 diabetes as immunotherapy, stem cell-, β-cell- or islet of Langerhans-transplantation have to be assessed in future studies to find causal therapeutic strategies (Chatenoud, Warncke et al. 2012; Li, Gu et al. 2012; McCall, James Shapiro et al. 2012). Additionally, further research is needed in the field of chronic type 1 diabetes and the detection and treatment of its complications. The role of genetics in susceptibility to nephropathy, retinopathy and other diabetic complications still largely re‐

**6. What the changing epidemiology implies for future health care**

Until now, the treatment of type 1 diabetic patients has been the duty of pediatricians, internal specialists, or diabetologists. The consultation prevalence of type 1 diabetic pa‐ tients in the general practitioners' consultation hour was low (Frese, Sandholzer et al. 2008). However, if the present trends continue, a doubling of new cases of type 1 diabe‐ tes in European children younger than 5 years is predicted between 2005 and 2020, and prevalent cases younger than 15 years will rise by 70% (Patterson, Dahlquist et al. 2009). Adequate health-care resources to meet these children's needs should be made available (Patterson, Dahlquist et al. 2009). It is important to ensure appropriate planning of serv‐ ices and that resources are in place to provide high-quality care for the increased num‐ bers of children who will be diagnosed with diabetes in future years (Patterson,

In Germany, the costs of pediatric diabetes care exceeded €110 million in 2007. Com‐ pared with estimates from the year 2000, average costs per patient had increased by 20% and direct total costs for German pediatric diabetes care by 47% (Bachle, Holl et al. 2012). The treatment costs rose because of new therapeutic strategies and an increase in diabe‐ tes prevalence. This illustrates that type 1 diabetes will be an increasing challenge for fu‐

Regarding future health care, it should be kept in mind that elderly and old patients with type 1 diabetes represent a growing population that requires thorough diabetes care. Espe‐ cially type 1 diabetic patients older than 60 years will suffer from a longer diabetes duration, a doubled risk for severe hypoglycemia, and a higher percentage of cardiovascular compli‐ cations (Schutt, Fach et al. 2012). In order to provide an adequate health care service, treat‐ ment strategies for adults and elderly persons suffering from type 1 diabetes have to be implemented in practice and the knowledge of involved physicians, especially general prac‐

tion of type 1 diabetes may be detected.

mains to be explored (Borchers, Uibo et al. 2010).

Dahlquist et al. 2009).

ture health care.

titioners, has to be enhanced.


**Table 4.** The estimated prevalence (per 100,000 inhabitants of the respective age group with 95% confidence interval) of type 1 diabetes among Australian children aged 0-14 years (Australian Institute of Health and Welfare 2011).
