Epidemiological and clinical insights from Type 1 Diabetes Global Registries: A systematic review and meta-analysis

Type 1 diabetes (T1D) incidence is rising globally, especially among children, with Systematic evaluation of these registries can highlight disparities in diagnosis, access, and management while supporting cross-regional learning to improve care delivery.

To assess the global burden of T1D by synthesizing key epidemiological indicators, including incidence, complications, and management approaches in children aged 0-14 years, and to characterize registry populations by sociodemographic and clinical features to identify care disparities.

A systematic review and meta-analysis of five databases identified 51 eligible studies (1969-2023). Data on incidence, diabetic ketoacidosis (DKA), and continuous glucose monitoring (CGM) use were pooled from 39 studies.

51 studies comprising 433,727 participants from 38 countries were analysed. Registries included 20 national, 11 regional, and 7 hospital-based datasets. The pooled global incidence of T1D was 20.16 per 100,000 population (95% CI: 16.49-23.84; I² = 89%). Incidence varied geographically, with higher estimates reported in Europe (22.2/100,000) compared with Asia (8.90/100,000). Registries applying ISPAD criteria reported higher incidence estimates (26.45/100,000) compared with EURODIAB criteria (19.15/100,000), although diagnostic criteria subgroup differences were not statistically significant. No significant gender differences were observed. DKA at diagnosis occurred in 38% of children, with substantial variability across settings. CGM use was reported in only four registries, with a pooled prevalence of 12.5%, highlighting gaps in access and adoption of diabetes technologies.

Global T1D registries demonstrate substantial heterogeneity in incidence and persistent disparities in diagnosis and diabetes care. Harmonized registry standards and equitable access to diabetes technologies are needed to strengthen surveillance and improve outcomes.