Society
How does type 1 diabetes affect our society and what can we do to prevent and cure it?
An increasing number of people are affected by type 1 diabetes (T1D) and in Denmark alone, the estimated societal costs of the disease amount to approximately 2 billion DKK per year
Unlike type 2 diabetes, T1D is not a lifestyle disease and cannot be prevented through lifestyle changes. It requires lifelong insulin treatment.
DiaUnion’s early detection program is a crucial step toward the ultimate goal of preventing and eventually curing T1D. This autoimmune disease often progresses over several years before symptoms appear and a diagnosis is made.
Novel drugs under development have the potential to delay the clinical onset of the disease. This requires detection of people in early stages of T1D before symptoms occur, which is what DiaUnion’s early detection program is about.
The earlier intervention occurs, the better the chances of delaying disease progression, which would significantly improve the quality of life for especially children with T1D.
The early detection program also helps identify the risk of related autoimmune diseases such as celiac disease (gluten intolerance) and autoimmune thyroid disease.
Type 1 Diabetes on the Rise
More people are developing type 1 diabetes (T1D), and for unknown reasons, the disease is appearing at an earlier age.
- In Denmark, 34,560 people live with type 1 diabetes (T1D), while the number in Sweden is around 50,000.
- Sweden has one of the highest childhood T1D rates in the world, second only to Finland. Nearly 8,000 Swedish children under 18 live with T1D, with around 1,000 new cases annually (Barndiabetesfonden)
- In Denmark, approximately 9 children under 20 are diagnosed with T1D every week – amounting to around 468 new cases annually (Diabetesforeningen)
It is of particular concern that T1D has become one of the most common chronic diseases among children in the Nordic countries and that, for unknown reasons, more children are developing the disease at an increasingly younger age.
The table below shows prevalence for selected countries. Aside from Finland, which has an unusually high prevalence, approximately 500 out of 100,000 people have T1D – equivalent to 0.5% of the population. Based on this prevalence, an estimated 2.2 million people in the EU and 3.7 million across Europe live with T1D.
The number of new T1D cases (incidence) is rising worldwide, but the rates vary significantly across different regions. The reasons for this increase remain unclear, but the rapid rise over time suggests that genetics alone cannot explain it. Other factors, including environmental influences or the decreasing prevalence of infections in Western countries (the hygiene hypothesis), may also play a role.
Treatment Goals
In Denmark and Sweden only 25-30% of those living with type 1 diabetes (T1D) meet the treatment goals and therefore it is vital that we keep focusing on research, better technology, and political support for both patients and the healthcare system.
The cornerstone of treatment outcome assessment in type 1 diabetes (T1D) is achieving optimal glycemic control. Periodic measurement of hemoglobin A1c (HbA1c) remains the gold standard for monitoring long-term blood glucose levels.
It is a complex task to manage T1D and people living with the disease must:
- Monitor blood glucose levels multiple times daily using a blood glucose meter or CGM.
- Administer daily insulin injections via pen or pump.
- Adjust diet and physical activity accordingly.
Country-Specific Observations
Data from international registries highlight ongoing challenges and across both European and U.S. datasets, adolescents experience the greatest difficulty in achieving glycemic targets.
Sweden: The treatment target is slightly lower at <52 mmol/mol and regional statistics (Nationella Diabetesregistret) show that less than 30% of patients achieve this goal.
Denmark: Regional data (Dansk Diabetes Database) indicate that fewer than 25% of patients meet this target the national treatment target (HbA1c should be ≤53 mmol/mol).
Evidence Supporting HbA1c Targets
HbA1c reflects average blood sugar levels over the preceding 2–3 months and has been the primary metric for assessing glycemic control for decades. The landmark Diabetes Control and Complications Trial (DCCT) and its follow-up studies have demonstrated that achieving the treatment goals significantly (50–76%) reduces the risk of complications such as eye disease, kidney disease, and nerve damage.
Expanding Beyond HbA1c
Current treatments aim to keep long-term blood sugar levels as close to normal as possible. If they drop too low, there is a risk of insulin shock and coma and if the levels rise too high, there is a risk of diabetic ketoacidosis (DKA).
Continuous glucose monitoring (CGM) provides additional metrics such as time in range (TIR), time above and below range, mean glucose levels, and glycemic variability. These parameters allow for a more nuanced and precise assessment of glycemic control, benefiting both patients and caregivers in managing T1D effectively.
Socio-Economic Impact
The cost of type 1 diabetes (T1D) is substantial, and it is crucial to consider all elements to gain a comprehensive understanding. Various reports indicate that the largest expenses are related to hospitalizations, including both acute and chronic complications.
The total economic burden for both pediatric and adult patients in the U.S. is approximately USD 30 billion annually. The economic burden for all patients in Europe is similar, also amounting to about USD 30 billion per year. When extrapolated globally, it is estimated that the worldwide annual costs related to T1D reach approximately USD 90 billion.
- Direct medical costs (red) include healthcare services such as medication, medical devices, treatment tools, doctor visits, hospital stays, and nursing care.
- Direct non-medical costs (yellow) cover transportation to medical appointments, hospital stays, nursing care, staff care time, and specialized daycare.
- Indirect costs (blue) result from lost productivity, including income loss, absenteeism, disability payments, and life insurance payments for patients and their relatives.
Additionally, there are significant indirect costs related to reduced quality of life. However, these are excluded due to limitations in economic literature in relation to T1D.
Screening to Prevent
In 2023 DiaUnion set a target to screen 45,000 individuals over the coming years in collaboration with Steno Diabetes Center Copenhagen and Lund University Clinical Research Center in Malmö. Lars Gaardhøj, Chairman of the Capital Region of Denmark, stated:
“This is a groundbreaking project. Not only will it allow us to delay disease progression for thousands of children and young people, but it is also remarkable that, for the first time, we have the potential to delay one of the many debilitating autoimmune diseases affecting a growing number of people.”
On a European level, DiaUnion also collaborates with other initiatives aimed at accelerating early detection of T1D, including the European Diabetes Forum and EDENT1FI.
DiaUnion offers screening to the general public in the Skåne region of Sweden. In Denmark, screening is available to immediate family members – siblings, children, and parents – of people with T1D, as the disease can be hereditary.
We work to increase awareness of early detection of T1D in order to:
- Reducing the risk of diabetic ketoacidosis (DKA) and other serious comorbidities of T1D
- Improving blood glucose control after T1D diagnosis
- Enable individuals to prepare themselves and their surroundings for a life with T1D
- Increases the opportunity for early intervention
The stages of Type 1 Diabetes Development
Type 1 diabetes (T1D) can develop at any time in life, though most often in the young years. The disease develops in stages and new preventive drugs have shown positive effects in prolonging late stage 2 / early stage 3, ie. delaying the clinical onset of the disease.
These stages are considered the most optimal window of opportunity for preventing the development of T1D, as illustrated in the figure below.
Meet DiaUnion
In recent years, DiaUnion has participated in various international conferences, including EASD, IDS, as well as public events such as Folkemødet and World Diabetes Day Skåne.
We will be attending again during 2025 and look forward to meeting even more people passionate about preventing and treating Type 1 Diabetes!
