PREVALENCE AND GEOGRAPHICAL DISTRIBUTION OF TYPE 1 DIABETES MELLITUS IN CHILDREN AND YOUNG ADULTS IN GREECE.

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1 PREVALENCE AND GEOGRAPHICAL DISTRIBUTION OF TYPE 1 DIABETES MELLITUS IN CHILDREN AND YOUNG ADULTS IN GREECE. Maria Mylona¹, Konstantinos Makrilakis¹, G. Dafoulas¹, Ch. Kani², P. Sfikakis¹, Stavros Liatis¹ 11st Department of Propaedeutic Internal Medicine, Diabetes Center, National and Kapodistrian University of Athens Medical School, Laiko General Hospital, Athens, Greece 2 Medicines Department, National Organization for Health Care Services Provision, Athens, Greece.

2 INTRODUCTION (1) Type 1 Diabetes Mellitus (T1DM) is a heterogeneous disorder characterized by autoimmune destruction of pancreatic beta cells, leading to absolute insulin deficiency Not linked to modifiable lifestyle factors. Over people suffer from T1DM worldwide (1/4 in Europe, 1/5 in N. America and Caribbean). 3% per year increase, new cases of diabetes in children / year.

3 INTRODUCTION (2) T1DM prevalence has wide geographical distribution. In Europe, the highest rate with ~ children per year (increase of new cases/ year).

4 T1DM prevalence in children < 15 years old Higher in Europeans with concrete south ( ) to north ( ) difference Countries T1DM prevalence ( ) in children <15 years old Finland 4.5 USA 2.4 Holland 1.75 Italy 1.26 Sardinia 3.8 Turkey 0.75

5 INTRODUCTION (3) The International Diabetes Federation (IDF) has reported an estimated prevalence of 0.13% in Greek children <15 years old, based on incidence rates from certain parts of the country, derived from the EURODIAB study.

6 AIM Aim of the present study was: to identify all children and young adults with T1DM in Greece and to further explore the geographical distribution of the disease.

7 METHODS (1) The electronic prescription database of the National Organization for Health Care Services Provision was used. Individuals < 35 years old, who received at least two fullyreimbursable insulin prescriptions with an ICD-10 code of E10 (insulin-dependent diabetes), between June 1st, 2014 and May 31st 2015 were identified.

8 METHODS (2) The size of the total Greek population was defined according to the 2011 census of the Greek population by the National Statistics Agency. The present is a part of the following study published in Diabetes Research and Clinical Practice: S. Liatis et al. The prevalence and treatment patterns of diabetes in the Greek population based on real-world data from the nation-wide prescription database. Diabetes Res. Clin. Pract Aug;118: doi: /j.diabres Epub 2016 Jun 17

9 RESULTS (1) The study population consisted of 4,081,093 individuals, accounting for 95% of the Greek population equal or younger than 35 years old. There were 6,183 cases with type 1 diabetes, corresponding to a prevalence of A slight male predominance was observed (53.9%).

10 T1DM PREVALENCE IN GREEK POPULATION ( AGE/GENDER) Age group (years) Patients with diabetes (n) Prevalence ( ) Males Females Males Females ,192 1, ,496 1,

11 T1DM PREVALENCE IN GREEK POPULATION (GEOGRAPHICAL DISTRIBUTION PER REGION ) REGION T1DM PREVALENCE ( ) EASTERN MACEDONIA-THRACE 1.45 CENTRAL MACEDONIA 1.38 WESTERN MACEDONIA 1.60 IPIRUS 1.66 THESSALY 1.45 IONIAN ISLANDS 1.49 WESTERN GREECE 1.35 CENTRAL GREECE 1.09 ATTICA 1.57 PELOPONNESE 1.22 NORTHERN AEGEAN 1.62 SOUTHERN AEGEAN 1.86 CRETE 1.30

12 T1DM PREVALENCE/PERFECTURE PERFECTURE T1DM PREVALENCE ( ) KASTORIA 2.1 IOANNINA 2.01 KOZANI 1.86 DODECANESE 1.90 CHIOS 1.98 ATTICA 1.57 THESSALONIKI 1.46 CHALKIDICE 1.01 CORINTH 1 FOKIDA 0.79 GREVENA 0.69 EVRITANIA 0.52

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14 ADVANTAGES AND LIMITATIONS ADVANTAGES LIMITATIONS Sample: almost total Greek population (95%) fully-reimbursable insulin prescriptions 0% patient cost-sharing Uninsured patients included (ΦΕΚ 1753Β/ ) Similar findings worldwide Many doctors not familiar with electronic prescriptions ~1200 patients with an ICD-10 E10 and 10% cost-sharing demanded

15 CONCLUSIONS This is the first study to investigate the prevalence of T1DM in the total population of Greek children and young adults. A low prevalence of 1.51 was observed, without northto-south differences. However, a moderately higher prevalence was revealed in the islands of the Aegean sea, but not in Crete.

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