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Confidential: for Review Only BMJ Confidential: For Review Only Incidence of type 1 diabetes mellitus in China: population based study, 2010 – 2013 Journal: BMJ Manuscript ID BMJ.2017.040488 Article Type: Research BMJ Journal: BMJ Date Submitted by the Author: 21-Jul-2017 Complete List of Authors: Weng, Jianping; Sun Yat-sen University Third Hospital; Guangdong Provincial Key Laboratory of Diabetology Zhou, Zhiguang; the Second Xiangya Hospital, Central South University, Institue of Endocrinology and Metabolism Guo, Lixin; Beijing Hospital Zhu, Dalong; Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital Ji, Linong; Peking University People’s Hospital, Department of Endocrinology and Metabolism Luo, Xiaoping; Tongji Hospital of Tongji Medical College, Huazhong University of Science & Technology Mu, Yiming; People’s Liberation Army General Hospital, China, Jia, Wei-Ping; The Sixth Affiliated People’s Hospital, Shanghai Jiao Tong University, YANG, WEN YING; CHINA JAPAN FRIENDSHIP HOSPITAL, ENDOCRINOLOGY Kuang, Hongyu; The First Affiliated Hospital of Harbin Medical University Li, Qiang; The Second Affiliated Hospital of Harbin Medical University, Li, Yanbing; The First Affiliated Hospital of Sun Yat-sen University Yuan, Li; Union Hospital, Tongji Medical College, Huazhong University of Science & Technology Yu, Xuefeng; Wuhan Tongji Hospital, China, Shan, Zhongyan; First Affiliated Hospital, Chinese Medical University, Ji, Qiuhe; Xijing Hospital, Fourth Military Medical University, Ran, Xing-wu; West China Hospital of Sichuan University, Diabetic Foot Care Center, Department of Endocrinology and Metabolism; Liu, Jing; Gansu Provincial Hospital Zhao, Jiajun; Shandong Provincial Hospital Chen, Li; Qilu Hospital of Shandong University, He, Lanjie; General Hospital of Ningxia Medical University Gong, Chunxiu; Beijing Children’s Hospital, Capital Medical University, Endocrinology, genetics and metabolism Liu, Li; Guangzhou Women and Children's Medical Center Luo, Feihong; Children's Hospital of Shanghai Xin, Ying; Shengjing Hospital of China Medical University Zheng, Xueying; Third Affiliated Hospital of Sun Yat-Sen University; https://mc.manuscriptcentral.com/bmj Page 1 of 73 BMJ 1 2 3 4 Guangdong Provincial Key Laboratory of Diabetology Yang, Daizhi; the Third Affiliated Hospital of Sun Yat-Sen University, 5 Department of Endocrinology and Metabolic Disease; Guangdong Provincial 6 Key Laboratory of Diabetology 7 Luo, Sihui; the Third Affiliated Hospital of Sun Yat-Sen University, 8 Department of Endocrinology and Metabolic Disease 9 Yan, Jinhua; the Third Affiliated Hospital of Sun Yat-Sen University, 10 Department of Endocrinology and Metabolic Disease; Guangdong Provincial Confidential:Key Laboratory For of Diabetology Review Only 11 Mayer-Davis, Elizabeth; University of North Carolina at Chapel Hill 12 13 Keywords: type 1 diabetes, incidence 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 https://mc.manuscriptcentral.com/bmj BMJ Page 2 of 73 1 2 3 4 Incidence of type 1 diabetes mellitus in China: population based 5 6 study, 2010 – 2013 7 8 9 10 11 Confidential:Jianping Weng, M.D. 1,2*, Zhiguang Zhou, M.D.For3*, Lixin ReviewGuo, M.D.4*, Dalong Zhu Only M.D.5, Linong Ji, 12 13 M.D.6, Xiaoping Luo, M.D.7, Yiming Mu, M.D.8, Weiping Jia, M.D.9, Wenying Yang, M.D.10, Hongyu 14 15 11 12 13 14 7 16 Kuang, M.D. , Qiang Li, M.D. , Yanbing Li, M.D. , Li Yuan, M.D. , Xuefeng Yu, M.D. , 17 18 Zhongyan Shan, M.D.15, Qiuhe Ji, M.D.16, Xingwu Ran, M.D.17, Jing Liu, M.D.18, Jiajun Zhao, M.D.19, 19 20 20 21 22 23 24 21 Li Chen, M.D. , Lanjie He, M.D. , Chunxiu Gong, M.D. , Li Liu, M.D. , Feihong Luo, M.D. , Ying 22 23 Xin, M.D.25, Xueying Zheng, M.D. 1,2, Daizhi Yang, M.D. 1,2, Sihui Luo, M.D. 1,2, Jinhua Yan, M.D. 24 25 1,2and Elizabeth J. Mayer-Davis, Ph.D.26 26 27 28 29 30 1 From the Departments of Endocrinology and Metabolic Disease, The Third Affiliated Hospital of Sun 31 32 33 Yat-sen University and 2Guangdong Provincial Key Laboratory of Diabetology, Guangzhou, 510630, 34 35 China; 3The Second Xiangya Hospital of Central South University, Changsha, 410011, China; 4Beijing 36 37 5 6 38 Hospital, Beijing, 100730, China; Nanjing Drum Tower Hospital, Nanjing, 210008, China; Peking 39 40 University People's Hospital; 7 Tongji Hospital of Tongji Medical College, Huazhong University of 41 42 8 43 Science & Technology, Wuhan, 430030, China; Chinese PLA General Hospital, Beijing, 100853, 44 45 China; 9 Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, 200233, China; 10 46 47 China-Japan Friendship Hospital, Beijing, 100029, China; 11The First Affiliated Hospital of Harbin 48 49 50 Medical University, Harbin, 150001, China; 12 The Second Affiliated Hospital of Harbin Medical 51 52 13 University, Harbin, 150001, China; The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 53 54 55 510080, China; 14Union Hospital, Tongji Medical College, Huazhong University of Science & 56 57 58 59 60 https://mc.manuscriptcentral.com/bmj Page 3 of 73 BMJ 1 2 3 Technology, Wuhan, 430022, China; 15The First Hospital of China Medical University, Shenyang, 4 5 6 110001, China; 16Xijing Hospital of The Fourth Military Medical University, Xi’an, 710032, China; 7 8 17 18 West China Hospital, Sichuan University, Chengdu, 610041, China; Gansu Provincial Hospital, 9 10 11 Confidential:Lanzhou, 730000, China; 19Shandong Provincial For Hospital, Review Jinan, 250021, China; 20OnlyQilu Hospital of 12 13 Shandong University, Jinan, 250012, China; 21General Hospital of Ningxia Medical University, 14 15 22 23 16 Yinchuan, 750004, China; Beijing Children's Hospital, Beijing, 100045, China; Guangzhou 17 18 Women and Children’s Medical Center, Guangzhou, 510623, China; 24Children’s Hospital of Shanghai, 19 20 25 21 Shanghai, 200040, China; Shengjing Hospital of China Medical University, Shenyang, 110004, China 22 23 and 26University of North Carolina, Chapel Hill, NC, 27599, United States. 24 25 26 27 28 *These authors contributed equally to this study. 29 30 Correspondence to: Jianping Weng, M.D., Ph.D. 31 32 33 Department of Endocrinology and Metabolic Disease, The Third Affiliated Hospital of Sun Yat-sen 34 35 University, Guangzhou 510630, China. 36 37 38 E-mail: [email protected] 39 40 Telephone: 8620-85253162 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 https://mc.manuscriptcentral.com/bmj BMJ Page 4 of 73 1 2 3 4 Abstract 5 6 Objective: To estimate all-age group type 1 diabetes mellitus (T1D) incidence in China during 7 8 2010-2013. 9 10 11 Confidential:Design: Population-based, registry study usingFor data fromReview multiple independent Only sources. 12 13 Setting: National temporary registration system in all 505 hospitals capable of providing diabetes 14 15 16 care, and diabetes communities in 13 investigated areas across China, covering over133 million 17 18 person-years at risk, approximately 10% of the whole population. 19 20 21 Participants: T1D individuals in all age groups and genders newly diagnosed in the resident 22 23 population during Jan 1, 2010 to Dec 31, 2013 from the investigated areas. 24 25 Main Outcome Measures: Incidence rates by age, gender, and areas were calculated per 100,000 26 27 28 person-years. Diagnosis of T1D was based on physician assignment, further validated by on site 29 30 follow-up. Completeness of case ascertainment was assessed using the capture mark recapture 31 32 33 method. 34 35 Results: A total of 5,018 new T1D cases were ascertained, among them 1,239 aged <15 years, 36 37 38 1,799 aged 15-29 years, and 1,980 aged ≥30 years. The proportion of new-onset cases ≥20 years 39 40 was 65.3%. The estimated incidence of T1D (per 100,000 persons-years) for all ages in China was 41 42 43 1.01 (95% confidence interval 0.18 to 1.84). Incidence rates were 1.93 (0.83 to 3.03), 1.28 (0.45 to 44 45 2.11) and 0.69 (0.00 to 1.51) per 100,000 persons-years for age groups 0-14 years, 15-29 years, 46 47 and ≥30 years, respectively; with peak in age group 10-14 years. The incidence rate in children 48 49 50 under 15 years was positively correlated with latitude (r = 0.88, P < 0.0001), though this 51 52 association was not observed in age groups 15-29 years or ≥30 years. 53 54 55 Conclusion: For the first time, we reported the nationwide incidence in adult population and 56 57 58 59 60 https://mc.manuscriptcentral.com/bmj Page 5 of 73 BMJ 1 2 3 confirmed that the majority of new-onset T1D cases occurred among adults. Childhood T1D 4 5 6 incidence in China was among the lowest reported. 7 8 9 10 11 Confidential: For Review Only 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 https://mc.manuscriptcentral.com/bmj BMJ Page 6 of 73 1 2 3 4 What this paper adds 5 6 What is already known on this subject 7 8 The only available nationwide data of type 1 diabetes (T1D) incidence for China was provided 9 10 11 Confidential:as a part of the World Health Organization For DIAMOND Review Project, reporting thatOnly T1D incidence 12 13 among children <15 years in China were 0.51 and 0.59 per 100,000 person-years during 14 15 16 1985-1994 and 1988-1996, respectively.
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