{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T02:36:25Z","timestamp":1789094185787,"version":"build-2803163510"},"reference-count":96,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2024,4,25]],"date-time":"2024-04-25T00:00:00Z","timestamp":1714003200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Diabetes"],"published-print":{"date-parts":[[2024,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Global variations in epidemiology of type 1 diabetes mellitus (T1DM) exist. This study is designed to examine demographic and clinical features of T1DM over the past 3 decades as well as evolving trends in epidemiology over last 50\u2009years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Clinical characteristics of 925 patients with T1DM over last 30\u2009years (1990\u20132019) were evaluated and compared to previously published data of 477 patients diagnosed between 1969 and 1990 from one of the major referral centers for diabetes in Turkey.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Mean age at diagnosis decreased from 9.5\u2009\u00b1\u20094.0 to 7.1\u2009\u00b1\u20093.6\u2009years within the past 50\u2009years (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.001). Age at diagnosis peaked at 12\u201314\u2009years between 1969 and 1990, then fell to 10\u201311.9\u2009years between 1990 and 1999, and to 4\u20135.9\u2009years between 2000\u20132009 and 2010\u20132019 (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.005). Although the percentage of patients diagnosed &lt;6\u2009years of age is gradually increasing, the percentage between the ages of 6 and 11.9\u2009years is decreasing, and the percentage diagnosed \u226512\u2009years remained stable. A total of 47.5% of patients had ketoacidosis, 38.2% had ketosis, and 14.3% had only hyperglycemia. 23% of patients had severe diabetic ketoacidosis (DKA), whereas 42% had moderate. Over last 3 decades, there has been no change in frequency of ketoacidosis at presentation, but there has been significant decline in severity (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.865, and\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.001, respectively). Although the frequency of patients with mild DKA increased over time, frequency of patients with moderate DKA decreased; however, no significant difference was observed among patients with severe ketoacidosis. DKA was more frequent and severe in patients &lt;6\u2009years of age (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.005, and\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.001, respectively).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Age at diagnosis shifted to younger ages in T1DM in the past 50\u2009years. Half of patients had ketoacidosis at diagnosis and frequency of presentation with DKA did not decrease, but severity decreased slightly. Increase in prevalence of T1DM in the younger age group and the fact that half of patients present with DKA indicate that awareness should be increased in terms of early diagnosis and treatment.<\/jats:p>\n                    <jats:p>\n                      <jats:boxed-text content-type=\"graphic\" position=\"anchor\">\n                        <jats:graphic xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" mimetype=\"image\/png\" position=\"anchor\" specific-use=\"enlarged-web-image\" xlink:href=\"graphic\/jdb13562-gra-0001-m.png\">\n                          <jats:alt-text>image<\/jats:alt-text>\n                        <\/jats:graphic>\n                      <\/jats:boxed-text>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/1753-0407.13562","type":"journal-article","created":{"date-parts":[[2024,4,26]],"date-time":"2024-04-26T00:04:40Z","timestamp":1714089880000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":52,"title":["Epidemiology of type 1 diabetes mellitus in children and adolescents: A 50\u2010year, single\u2010center experience"],"prefix":"10.1111","volume":"16","author":[{"given":"Nurgun","family":"Kandemir","sequence":"first","affiliation":[{"name":"Hacettepe University Faculty of Medicine Department of Pediatric Endocrinology  Ankara Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4011-2299","authenticated-orcid":false,"given":"Dogus","family":"Vuralli","sequence":"additional","affiliation":[{"name":"Hacettepe University Faculty of Medicine Department of Pediatric Endocrinology  Ankara Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alev","family":"Ozon","sequence":"additional","affiliation":[{"name":"Hacettepe University Faculty of Medicine Department of Pediatric Endocrinology  Ankara Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nazl\u0131","family":"Gonc","sequence":"additional","affiliation":[{"name":"Hacettepe University Faculty of Medicine Department of Pediatric Endocrinology  Ankara Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Didem","family":"Ardicli","sequence":"additional","affiliation":[{"name":"Hacettepe University Faculty of Medicine Department of Pediatrics  Ankara Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lala","family":"Jalilova","sequence":"additional","affiliation":[{"name":"Hacettepe University Faculty of Medicine Department of Pediatrics  Ankara Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omer Nazim","family":"Gulcek","sequence":"additional","affiliation":[{"name":"Hacettepe University Faculty of Medicine Department of Pediatrics  Ankara Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayfer","family":"Alikasifoglu","sequence":"additional","affiliation":[{"name":"Hacettepe University Faculty of Medicine Department of Pediatric Endocrinology  Ankara Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,4,25]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ecl.2010.05.011"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2006\u20100690"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2004\u20101448"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pcl.2005.07.006"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(09)60568\u20107"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.22.7.1066"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1515\/jpem\u20102013\u20100320"},{"issue":"3","key":"e_1_2_10_9_1","first-page":"191","article-title":"The epidemiology of juvenile\u2010onset insulin\u2010dependent diabetes mellitus in Turkish children. A retrospective analysis of 477 cases","volume":"36","author":"Kandemir N","year":"1994","journal-title":"Turk J Pediatr"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2019.107842"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464\u20105491.2006.01925.x"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(99)07125-1"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.d4092"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.8399"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1080\/08035250310002588"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.297.24.2716"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc06\u20101837"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1610187"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1111\/pedi.13305"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.2337\/diabetes.51.12.3353"},{"key":"e_1_2_10_21_1","volume-title":"Textbook of diabetes","author":"Pickup JC","year":"2003"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.23.10.1516"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125\u2010003\u20101045\u20104"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc12\u20100767"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464\u20105491.2010.03174.x"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(08)60765\u20105"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399\u20105448.2008.00419.x"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00431\u2010007\u20100480\u20105"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1203\/00006450\u2010200212000\u201000008"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc21\u20100342"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.2337\/db10\u20100813"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0032640"},{"key":"e_1_2_10_33_1","doi-asserted-by":"publisher","DOI":"10.1111\/pedi.12659"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1111\/pedi.12636"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc12\u20101959"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.2174\/1573399817666210503133747"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc21\u20101251"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.1002\/dmrr.1141"},{"key":"e_1_2_10_39_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.18.7.923"},{"key":"e_1_2_10_40_1","doi-asserted-by":"publisher","DOI":"10.1080\/07853890410018952"},{"key":"e_1_2_10_41_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaut.2011.02.004"},{"key":"e_1_2_10_42_1","doi-asserted-by":"publisher","DOI":"10.1007\/s001250100548"},{"key":"e_1_2_10_43_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464\u20105491.2004.01368.x"},{"key":"e_1_2_10_44_1","doi-asserted-by":"publisher","DOI":"10.1111\/dom.12599"},{"key":"e_1_2_10_45_1","doi-asserted-by":"publisher","DOI":"10.7417\/CT.2019.2137"},{"key":"e_1_2_10_46_1","unstructured":"FryarCD CarrollM AffulJ.Prevalence of Overweight Obesity and Severe Obesity among Children and Adolescents Aged 2\u201319\u2009Years: United States 1963\u20131965 through 2017\u20132018.2020."},{"key":"e_1_2_10_47_1","doi-asserted-by":"publisher","DOI":"10.1111\/pedi.12730"},{"key":"e_1_2_10_48_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399\u20105448.2009.00519.x"},{"key":"e_1_2_10_49_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00431\u2010010\u20101372\u20107"},{"key":"e_1_2_10_50_1","doi-asserted-by":"publisher","DOI":"10.1111\/pedi.12166"},{"key":"e_1_2_10_51_1","doi-asserted-by":"publisher","DOI":"10.1136\/archdischild\u20102013\u2010304237"},{"key":"e_1_2_10_52_1","doi-asserted-by":"publisher","DOI":"10.2337\/dci18\u20100052"},{"key":"e_1_2_10_53_1","doi-asserted-by":"publisher","DOI":"10.4274\/jcrpe.galenos.2018.2018.0108"},{"key":"e_1_2_10_54_1","doi-asserted-by":"publisher","DOI":"10.4103\/njcp.njcp_173_19"},{"key":"e_1_2_10_55_1","doi-asserted-by":"publisher","DOI":"10.4274\/jcrpe.5043"},{"key":"e_1_2_10_56_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0021932022000025"},{"key":"e_1_2_10_57_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0006873"},{"key":"e_1_2_10_58_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125\u2010005\u20100033\u20102"},{"key":"e_1_2_10_59_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.29.02.06.dc05\u20101339"},{"key":"e_1_2_10_60_1","doi-asserted-by":"publisher","DOI":"10.1111\/dme.12402"},{"key":"e_1_2_10_61_1","doi-asserted-by":"publisher","DOI":"10.1210\/js.2017\u201000044"},{"key":"e_1_2_10_62_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125\u2010002\u20100801\u20101"},{"key":"e_1_2_10_63_1","doi-asserted-by":"publisher","DOI":"10.1007\/s001250051112"},{"key":"e_1_2_10_64_1","doi-asserted-by":"publisher","DOI":"10.2337\/diabetes.48.7.1389"},{"key":"e_1_2_10_65_1","doi-asserted-by":"publisher","DOI":"10.1111\/dme.13063"},{"key":"e_1_2_10_66_1","first-page":"15","article-title":"\u00c7ocukluk \u00e7a\u011f\u0131nda diyabet","volume":"1","author":"Hatun S","year":"2003","journal-title":"\u00c7ocuk Endokrinoloji Dergisi"},{"key":"e_1_2_10_67_1","doi-asserted-by":"publisher","DOI":"10.3906\/sag-1206-8"},{"key":"e_1_2_10_68_1","doi-asserted-by":"publisher","DOI":"10.4274\/jcrpe.0025"},{"key":"e_1_2_10_69_1","doi-asserted-by":"publisher","DOI":"10.4274\/Jcrpe.954"},{"key":"e_1_2_10_70_1","doi-asserted-by":"publisher","DOI":"10.5152\/TurkArchPediatr.2023.23036"},{"key":"e_1_2_10_71_1","doi-asserted-by":"publisher","DOI":"10.4274\/jcrpe.galenos.2021.2021\u201010\u20107"},{"key":"e_1_2_10_72_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399\u20105448.2007.00280.x"},{"key":"e_1_2_10_73_1","doi-asserted-by":"publisher","DOI":"10.1016\/0140\u20106736(92)90938\u2010y"},{"key":"e_1_2_10_74_1","doi-asserted-by":"publisher","DOI":"10.1002\/(sici)1099\u20100895(199712)13:4<275::aid\u2010dmr197>3.0.co;2\u2010v"},{"key":"e_1_2_10_75_1","doi-asserted-by":"publisher","DOI":"10.1007\/s001250051573"},{"key":"e_1_2_10_76_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2005.10.029"},{"key":"e_1_2_10_77_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1464\u20105491.2009.02743.x"},{"key":"e_1_2_10_78_1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/23.6.1234"},{"key":"e_1_2_10_79_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365\u20102796.2007.01896.x"},{"key":"e_1_2_10_80_1","doi-asserted-by":"publisher","DOI":"10.14310\/horm.2002.1294"},{"key":"e_1_2_10_81_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399\u20105448.2007.00310.x"},{"key":"e_1_2_10_82_1","doi-asserted-by":"publisher","DOI":"10.1177\/003693309904400205"},{"key":"e_1_2_10_83_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399\u2010543X.2005.00110.x"},{"key":"e_1_2_10_84_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399\u20105448.2006.00225.x"},{"key":"e_1_2_10_85_1","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.2951150"},{"key":"e_1_2_10_86_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125\u2010003\u20101101\u20100"},{"key":"e_1_2_10_87_1","doi-asserted-by":"publisher","DOI":"10.1007\/pl00002958"},{"issue":"12","key":"e_1_2_10_88_1","first-page":"1936","article-title":"Frequency and clinical characteristics of ketoacidosis at onset of childhood type 1 diabetes mellitus in Northwest Saudi Arabia","volume":"26","author":"Habib HS","year":"2005","journal-title":"Saudi Med J"},{"key":"e_1_2_10_89_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125\u2010010\u20101704\u20101"},{"key":"e_1_2_10_90_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc06\u20102281"},{"issue":"2","key":"e_1_2_10_91_1","first-page":"75","article-title":"\u0130ns\u00fcline Ba\u011f\u0131ml\u0131 Diyabetes Mellitusun Epidemiyolojik \u00d6zellikleri","volume":"21","author":"Taskin E","year":"2007","journal-title":"F\u0131rat \u00dcniversitesi Sa\u011fl\u0131k Bilimleri T\u0131p Dergisi"},{"key":"e_1_2_10_92_1","first-page":"216","article-title":"Bat\u0131 Karadeniz b\u00f6lgesinde ya\u015fayan \u00e7ocukluklarda ins\u00fcline ba\u011f\u0131ml\u0131 diyabetes mellitusun epidemiyolojik \u00f6zellikleri","volume":"38","author":"\u015eim\u015fek E","year":"2003","journal-title":"T\u00fcrk Pediatri Ar\u015fivi"},{"key":"e_1_2_10_93_1","first-page":"94","article-title":"Diyabetik ketoasidoz ile ba\u015fvuran \u00e7ocuklar\u0131n klinik ve labaratuvar \u00f6zellikleri","volume":"6","author":"Saglam H","year":"2008","journal-title":"J Curr Pediatr"},{"key":"e_1_2_10_94_1","doi-asserted-by":"publisher","DOI":"10.4274\/jpr.galenos.2020.83584"},{"key":"e_1_2_10_95_1","doi-asserted-by":"publisher","DOI":"10.1034\/j.1399\u20105448.2003.00007.x"},{"key":"e_1_2_10_96_1","doi-asserted-by":"publisher","DOI":"10.1136\/adc.85.1.60"},{"key":"e_1_2_10_97_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00125\u2010023\u201005953\u20100"}],"container-title":["Journal of Diabetes"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1753-0407.13562","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,15]],"date-time":"2024-05-15T04:33:25Z","timestamp":1715747605000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/1753-0407.13562"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,4,25]]},"references-count":96,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2024,5]]}},"alternative-id":["10.1111\/1753-0407.13562"],"URL":"https:\/\/doi.org\/10.1111\/1753-0407.13562","archive":["Portico"],"relation":{},"ISSN":["1753-0393","1753-0407"],"issn-type":[{"value":"1753-0393","type":"print"},{"value":"1753-0407","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,4,25]]},"assertion":[{"value":"2023-07-08","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-03-10","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-04-25","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e13562"}}