Incidence, Genetic Risk Profiling, and Clinical Outcomes of Type 1 Diabetes Mellitus in East Mediterranean Children: A Multicenter Registry Analysis (2020–2024)

Piotr Lewandowski¹, Aleksandra Zielińska², Tomasz Krawczyk³, Anna Kowalczyk⁴, Ewa Wójcik⁵

Abstract

Type 1 Diabetes Mellitus (T1DM) in children is rising globally, with increasing incidence in the Eastern Mediterranean region. This multicenter, registry-based cohort study analyzed trends in T1DM, genetic risk profiles, and clinical outcomes among 2,316 pediatric patients (ages 1–15 years) diagnosed between 2020 and 2024 across five East Mediterranean countries.

The overall crude incidence of pediatric T1DM increased from 19.2 to 28.7 per 100,000 person-years during the study period, with the highest rise observed in children under five (up by 63%). Ketoacidosis at diagnosis occurred in 44.1% of cases, with a significant difference by age group (≤5 years: 58.2%; 6–15 years: 38.4%; p < 0.001).

HLA genotyping was performed on a subset of 784 patients. The most common risk haplotypes were DRB103:01-DQB102:01 (present in 41.3%) and DRB104:01-DQB103:02 (present in 29.6%). Patients with both haplotypes had earlier onset (mean age: 6.1 years) and higher rates of severe hypoglycemia in the first year post-diagnosis (21.4% vs. 12.3%, p = 0.004).

Clinical outcome follow-up at 12 months revealed suboptimal glycemic control in 48.7% (HbA1c > 8.5%) of patients, associated with limited access to insulin pumps and structured diabetes education programs. Children receiving multidisciplinary care (n = 608) had significantly better glycemic control (HbA1c < 7.5% in 62.9%) compared to those in standard care settings (HbA1c < 7.5% in 36.2%, p < 0.001).

This study confirms a concerning rise in T1DM incidence and highlights genetic risk stratification as a valuable tool for early identification and tailored follow-up. Expanding access to comprehensive care models may substantially improve pediatric diabetes outcomes in the region.