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Incidence of diabetes mellitus in Italy in year 2018. A nationwide population-based study of the ARNO Diabetes Observatory

      Highlights

      • Incidence of diabetes in Italy is ~5 per 1000 person-years.
      • Incident cases of diabetes represent approximately 10% of all detected cases in 2018.
      • Incident cases treated with noninsulin drugs are almost 10-fold more common than incident cases treated with insulin.
      • Incidence is higher in women aged 11–40 years than in men of the same age, and in men vs. women aged >40 years.

      Abstract

      Backgrounds and aims

      To assess incidence of diabetes in Italy in 2018 by the use of administrative claims from several million residents. Differences in rates in men and women across decades of age were investigated. Incident rates of insulin or noninsulin treated subjects were also examined.

      Methods and results

      We analyzed administrative healthcare claims of 11,300,750 subjects monitored by the ARNO Diabetes Observatory. Incident cases of diabetes were identified by glucose lowering drug prescriptions, disease-specific co-payment exemptions and hospital discharge codes related to diabetes occurring in 2018 but not in 2017.
      We identified 697,208 subjects with ascertained diabetes. Incident cases were 65,932, with a rate of 5.83 per 1000 person-years (p-y). Incidence of drug-treated diabetes (n = 60,271) was 5.33 per 1000 p-y. Subjects receiving only insulin prescriptions were 5652 (rate 0.50 per 1000 p-y) and those receiving only prescriptions of noninsulin medications were 51,085 (rate 4.52 per 1000 p-y). Incidence rates progressively increased across decades until age 80 and then dropped by 25–30%. Overall, incident rates were generally higher in women aged 11–40 and in men aged ≥51.

      Conclusions

      Recent cases represented ~10% of the population of diabetic subjects. Incidence of noninsulin-treated diabetes was almost 10-fold higher than incidence of insulin-treated diabetes. Substantial differences in incidence rates were observed in men and women of several decades of age: women more affected in adolescence and young adult age, men more affected in mature and advanced age. These data provide further understanding on the epidemiological burden of the disease in Italy.

      Keywords

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      References

        • World Health Organization
        Global report on diabetes.
        WHO Press, Geneva, Switzerland2016
        • Bhupathiraju S.N.
        • Hu F.B.
        Epidemiology of obesity and diabetes and their cardiovascular complications.
        Circ Res. 2016; 118: 1723-1735
        • Ley S.H.
        • Meigs J.B.
        Epidemiology and risk factors of type 2 diabetes.
        in: Diabetes epidemiology, genetics, pathogenesis, diagnosis, prevention, and treatment. Springer International Publisher, Cham, Switzerland2018: 55-80
        • International Diabetes Federation
        IDF diabetes atlas.
        9th ed. Brussels, Belgium2019
        • International Diabetes Federation
        IDF diabetes atlas.
        Brussels, Belgium2000
        • Muggeo M.
        • Verlato G.
        • Bonora E.
        • Bressan F.
        • Girotto S.
        • Corbellini M.
        • et al.
        The Verona Diabetes Study: a population-based survey on known diabetes mellitus prevalence and 5-year all-cause mortality.
        Diabetologia. 1995; 38: 318-325
        • Bonora E.
        • Cataudella S.
        • Marchesini G.
        • Miccoli R.
        • Vaccaro O.
        • Fadini G.P.
        • et al.
        Under the mandate of the Italian Diabetes Society. Clinical burden of diabetes in Italy in 2018: a look at a systemic disease from the ARNO Diabetes Observatory.
        BMJ Open Diabetes Res Care. 2020; 8e001191
        • Magliano D.J.
        • Islam R.M.
        • Barr E.L.M.
        • Gregg E.W.
        • Pavkov M.E.
        • Harding J.L.
        • et al.
        Trends in incidence of total or type 2 diabetes: systematic review.
        BMJ. 2019; 366: l5003
        • Geiss L.S.
        • Wang J.
        • Cheng Y.J.
        • Thompson T.J.
        • Barker L.
        • Li Y.
        • et al.
        Prevalence and incidence trends for diagnosed diabetes among adults aged 20–79 years, United States, 1980–2012.
        J Am Med Assoc. 2014; 312: 1218-1226
        • Abraham T.M.
        • Pencina K.M.
        • Pencina M.J.
        • Fox C.S.
        Trends in diabetes incidence. The Framingham Heart study.
        Diabetes Care. 2015; 38: 482-487
        • Hu F.B.
        • Manson J.E.
        • Stampfer M.J.
        • Colditz G.
        • Liu S.
        • Solomon C.G.
        • et al.
        Diet, lifestyle, and the risk of type 2 diabetes mellitus in women.
        N Engl J Med. 2001; 345: 790-797
        • Brancati F.L.
        • Kao W.H.
        • Folsom A.R.
        • Watson R.L.
        • Szklo M.
        Incident type 2 diabetes mellitus in African American and white adults: the Atherosclerosis risk in communities study.
        J Am Med Assoc. 2000; 283: 2253-2259
        • Weng W.
        • Liang Y.
        • Kimball E.S.
        • Hobbs T.
        • Kong S.X.
        • Sakurada B.
        • et al.
        Decreasing incidence of type 2 diabetes mellitus in the United States, 2007–2012: epidemiologic findings from a large US claims database.
        Diabetes Res Clin Pract. 2016; 117: 111-118
        • Lipscombe L.L.
        • Hux J.E.
        Trends in diabetes prevalence, incidence, and mortality in Ontario, Canada 1995–2005: a population-based study.
        Lancet. 2007; 369: 750-756
        • Andersson T.
        • Ahlbom A.
        • Carlsson S.
        Diabetes prevalence in Sweden at present and projections for year 2050.
        PLoS One. 2015; 10e0143084
        • Strøm H.
        • Selmer R.
        • Birkeland K.I.
        • Schirmer H.
        • Berg T.J.
        • Jenum A.K.
        • et al.
        No increase in new users of blood glucose-lowering drugs in Norway 2006–2011: a nationwide prescription database study.
        BMC Publ Health. 2014; 14: 520
        • Carstensen B.
        • Kristensen J.K.
        • Ottosen P.
        • Borch-Johnsen K.
        Steering group of the national diabetes register. The Danish national diabetes register: trends in incidence, prevalence and mortality.
        Diabetologia. 2008; 51: 2187-2196
        • de Sousa-Uva M.
        • Antunes L.
        • Nunes B.
        • Rodrigues A.P.
        • Simões J.A.
        • Ribeiro R.T.
        • et al.
        Trends in diabetes incidence from 1992 to 2015 and projections for 2024: a Portuguese General Practitioner's Network study.
        Prim Care Diabetes. 2016; 10: 329-333
        • Read S.H.
        • Kerssens J.J.
        • McAllister D.A.
        • Colhoun H.M.
        • Fischbacher C.M.
        • Lindsay R.S.
        • et al.
        Scottish diabetes Research network epidemiology group. Trends in type 2 diabetes incidence and mortality in scotland between 2004 and 2013.
        Diabetologia. 2016; 59: 2106-2113
        • Boehme M.W.
        • Buechele G.
        • Frankenhauser-Mannuss J.
        • Mueller J.
        • Lump D.
        • Boehm B.O.
        • et al.
        Prevalence, incidence and concomitant co-morbidities of type 2 diabetes mellitus in South Western Germany. A retrospective cohort and case control study in claims data of a large statutory health insurance.
        BMC Publ Health. 2015; 15: 855
        • Huber C.A.
        • Schwenkglenks M.
        • Rapold R.
        • Reich O.
        Epidemiology and costs of diabetes mellitus in Switzerland: an analysis of health care claims data, 2006–2011.
        BMC Endocr Disord. 2014; 14: 44
        • Zghebi S.S.
        • Steinke D.T.
        • Carr M.J.
        • Rutter M.K.
        • Emsley R.A.
        • Ashcroft D.M.
        Examining trends in type 2 diabetes incidence, prevalence and mortality in the UK between 2004 and 2014.
        Diabetes Obes Metabol. 2017; 19: 1537-1545
        • Marchesini G.
        • Forlani G.
        • Rossi E.
        • Berti A.
        • De Rosa M.
        • ARNO Working Group
        The direct economic cost of pharmacologically-treated diabetes in Italy-2006. The ARNO Observatory.
        Nutr Metabol Cardiovasc Dis. 2011; 21: 339-346
        • Bruno G.
        • Pagano E.
        • Rossi E.
        • Cataudella S.
        • De Rosa M.
        • Marchesini G.
        • et al.
        Incidence, prevalence, costs and quality of care of type 1 diabetes in Italy, age 0–29 years: the population-based CINECA-SID ARNO Observatory, 2002–2012.
        Nutr Metabol Cardiovasc Dis. 2016; 26: 1104-1111
        • Bonora E.
        • Cataudella S.
        • Marchesini G.
        • Miccoli R.
        • Vaccaro O.
        • Fadini G.P.
        • et al.
        A view on the quality of diabetes care in Italy and the role of Diabetes Clinics from the 2018 ARNO Diabetes Observatory.
        Nutr Metabol Cardiovasc Dis. 2020; 30: 1945-1953
        • Brocco S.
        • Visentin C.
        • Fedeli U.
        • Schievano E.
        • Avogaro A.
        • Andretta M.
        • et al.
        Monitoring the occurrence of diabetes mellitus and its major complications: the combined use of different administrative databases.
        Cardiovasc Diabetol. 2007; 6: 5
        • Bruno G.
        • Picariello R.
        • Petrelli A.
        • Panero F.
        • Costa G.
        • Cavallo-Perin P.
        • et al.
        Direct costs in diabetic and nondiabetic people: the population-based Turin study.
        Italy. Nutr Metab Cardiovasc Dis. 2012; 22: 684-690
        • Monesi L.
        • Baviera M.
        • Marzona I.
        • Avanzini F.
        • Monesi G.
        • Nobili A.
        • et al.
        Prevalence, incidence and mortality of diagnosed diabetes: evidence from an Italian population-based study.
        Diabet Med. 2012; 29: 385-392
        • De Marco R.
        • Locatelli F.
        • Zoppini G.
        • Verlato G.
        • Bonora E.
        • Muggeo M.
        Cause-specific mortality in type 2 diabetes. The verona diabetes study.
        Diabetes Care. 1999; 22: 756-761
        • Zoppini G.
        • Fedeli U.
        • Gennaro N.
        • Saugo M.
        • Targher G.
        • Bonora E.
        Mortality from chronic liver diseases in diabetes.
        Am J Gastroenterol. 2014; 109: 1020-1025
        • Patterson C.C.
        • Karuranga S.
        • Salpea P.
        • Saeedi P.
        • Dahlquist G.
        • Soltesz G.
        • et al.
        Worldwide estimates of incidence, prevalence and mortality of type 1 diabetes in children and adolescents: results from the International Diabetes Federation Diabetes Atlas.
        Diabetes Res Clin Pract. 2019; 157 (9th ed): 107842
        • Magliano D.J.
        • Chen L.
        • Islam R.M.
        • Carstensen B.
        • Gregg E.W.
        • Pavkov M.E.
        • et al.
        Trends in the incidence of diagnosed diabetes: a multicountry analysis of aggregate data from 22 million diagnoses in high-income and middle-income settings.
        Lancet Diabetes Endocrinol. 2021 Feb 23; (30402-2) ([Epub ahead of print]): S2213-S8587https://doi.org/10.1016/S2213-8587(20)30402-2
        • Tuomilehto J.
        The emerging global epidemic of type 1 diabetes.
        Curr Diabetes Rep. 2013; 13: 795-804
        • Patterson C.C.
        • Harjutsalo V.
        • Rosenbauer J.
        • Neu A.
        • Cinek O.
        • Skrivarhaug T.
        • et al.
        Trends and cyclical variation in the incidence of childhood type 1 diabetes in 26 European centres in the 25 year period 1989–2013: a multicentre prospective registration study.
        Diabetologia. 2019; 62: 408-417
        • Carle F.
        • Gesuita R.
        • Bruno G.
        • Coppa G.V.
        • Falorni A.
        • Lorini R.
        • et al.
        • RIDI Study Group
        Diabetes incidence in 0- to 14-year age-group in Italy: a 10-year prospective study.
        Diabetes Care. 2004; 27: 2790-2796
        • Bonora E.
        • Kiechl S.
        • Willeit J.
        • Oberhollenzer F.
        • Egger G.
        • Meigs J.B.
        • et al.
        Population-based incidence rates and risk factors for type 2 diabetes in white individuals: the Bruneck study.
        Diabetes. 2004; 53: 1782-1789
        • Sousa M.
        • Bruges-Armas J.
        Monogenic diabetes: genetics and relevance on diabetes mellitus personalized medicine.
        Curr Diabetes Rev. 2020; 16: 807-819
        • Buzzetti R.
        • Di Pietro S.
        • Giaccari A.
        • Petrone A.
        • Locatelli M.
        • Suraci C.
        • et al.
        Non Insulin Requiring Autoimmune Diabetes Study Group. High titer of autoantibodies to GAD identifies a specific phenotype of adult-onset autoimmune diabetes.
        Diabetes Care. 2007; 30: 932-938
        • Hart P.A.
        • Bellin M.D.
        • Andersen D.K.
        • Bradley D.
        • Cruz-Monserrate Z.
        • Forsmark C.E.
        • et al.
        Consortium for the Study of Chronic Pancreatitis, Diabetes, and Pancreatic Cancer (CPDPC). Type 3c (pancreatogenic) diabetes mellitus secondary to chronic pancreatitis and pancreatic cancer.
        Lancet Gastroenterol Hepatol. 2016; 1: 226-237
        • Delvecchio M.
        • Mozzillo E.
        • Salzano G.
        • Iafusco D.
        • Frontino G.
        • Patera P.I.
        • et al.
        Monogenic diabetes accounts for 6.3% of cases referred to 15 Italian pediatric diabetes centers during 2007–2012.
        J Clin Endocrinol Metab. 2017; 102: 1826-1834
        • Penno G.
        • Solini A.
        • Orsi E.
        • Bonora E.
        • Fondelli C.
        • Trevisan R.
        • et al.
        Non-albuminuric renal impairment is a strong predictor of mortality in individuals with type 2 diabetes: the Renal Insufficiency and Cardiovascular Events (RIACE) Italian multicentre study.
        Diabetologia. 2018; 61: 2277-2289