Pediatric Diabetes 2012: 13: 484 – 488 doi: 10.1111/j.1399-5448.2011.00839.x All rights reserved  2011 John Wiley & Sons A/S Pediatric Diabetes Original Article Incidence and modes of presentation of childhood type 1 diabetes mellitus in Malta between 2006 and 2010 Formosa N, Calleja N, Torpiano J. Incidence and modes of presentation of childhood type 1 diabetes mellitus in Malta between 2006 and 2010. Pediatric Diabetes 2012: 13: 484 – 488. Aim: To assess the incidence and mode of presentation of type 1 diabetes mellitus (T1DM) in children and adolescents younger than 14 yr of age between January 2006 and December 2010 in Malta. Methods: A nationwide prospective study which collected data from newly diagnosed T1DM children who presented to the only paediatric diabetes team available in Malta. The degree of ascertainment was estimated to be 100%. Incidence rates by age group and year were estimated using real values of diagnosed patients and population statistics. Trend analysis was carried out using Poisson’s regression analysis. Results: From 2006 to 2010, 81 children below the age of 14 yr were diagnosed with T1DM for the first time. The age- and sex-standardised incidence rate was 21.86/100,000 children/yr. The estimated annual increase in incidence was 21.8%. Compared to data collected retrospectively between 1996 – 2001, the incidence has increased threefold between 2006 and 2010. Generally, the incidence rate was highest in the 5 – 9 yr age group, followed by the 0 – 4 yr age group and finally the10 – 14 yr age group. However, the highest annual increase occurred in the 0 – 4 yr age group at 39% per year, closely followed by 5 – 9 yr age group at 31% per year. In the 10 – 14 yr age group, the trend appeared to show a reduction in incidence. The proportion of patients presenting in diabetic ketoacidosis (DKA) was high at 41%. Conclusion: In Malta, the number of children/adolescents with T1DM has been rising at a faster rate than expected, and a distinct shift to younger age at onset has been observed. DKA rate at presentation is still high in Maltese children. Nancy Formosa a , Neville Calleja b and John Torpiano a a Department of Paediatrics, Mater Dei Hospital, Msida, MSD 2090, Malta; and b Department of Health Information and Research, Ministry of Health, the Elderly and Community Care, 95 Gwardamangia Hill, Gwardamangia, PTA 1313, Malta Key words: incidence – Malta – paediatric – presentation – type 1 diabetes mellitus Corresponding author: Dr Nancy Formosa, Department of Paediatrics, Mater Dei Hospital, Msida MSD 2090, Malta. Tel: +356 25454927; fax: +356 21240176; e-mail: nancy.formosa@gov.mt Submitted 27 August 2011. Accepted for publication 31 October 2011 Diabetes is one of the most frequent chronic diseases affecting children and adolescents. Prospective large international registries and studies (EURODIAB and DIAMOND) have shown an increasing trend in the incidence of T1DM in most regions of the world over the last two decades (1, 2). In Europe, where the number of cases are large enough to enable useful comparisons of rises in incidence in different age groups, evidence shows that increases in incidence were highest in the younger age group (3). Diabetic ketoacidosis (DKA) is the initial presentation in 15–67% of children and adolescents with T1DM in Europe and North America, and this has a mortality rate of 0.15–0.30% (4). As DKA is associated with significant morbidity and mortality, and the cost of intensive care treatment in hospital is relatively expensive, increasing awareness among pri- mary health care physicians and the general public about the early symptoms of diabetes should reduce the rate of DKA and this would be expected to have a significant positive impact on health care costs and resource planning. The Republic of Malta consists of an archipelago of three islands located in the Mediterranean Sea about 93 km south of Sicily; however, only two islands (Malta 484