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The epidemiology of type 1 diabetes mellitus in older adults

Nature Reviews Endocrinology volume 21, pages 92–104 (2025)Cite this article

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Abstract

Although type 1 diabetes mellitus (T1DM) is traditionally viewed as a youth-onset disorder, the number of older adults being diagnosed with this disease is growing. Improvements in the average life expectancy of people with T1DM have also contributed to the growing number of older people living with this disease. We summarize the evidence regarding the epidemiology (incidence, prevalence and excess mortality) of T1DM in older adults (ages ≥60 years) as well as the genetics, immunology and diagnostic challenges. Several studies report an incidence peak of T1DM in older adults of a similar size to or exceeding that in children, and population prevalence generally increases with increasing age. Glutamic acid decarboxylase antibody positivity is frequently observed in adult-onset T1DM. Guidelines for differentiating T1DM from type 2 diabetes mellitus in older adults recommend measuring levels of C-peptide and autoantibodies, including glutamic acid decarboxylase antibodies. However, there is no gold standard for differentiating T1DM from type 2 diabetes mellitus in people aged 60 years and over. As such, the global variation observed in T1DM epidemiology might be in part explained by misclassification, which increases with increasing age of diabetes mellitus onset. With a growing global population of older adults with T1DM, improved genetic and immunological evidence is needed to differentiate diabetes mellitus type at older ages so that a clear epidemiological picture can emerge.

Key points

  • The increasing population of older adults with type 1 diabetes mellitus (T1DM), including those with late-onset T1DM together with those with early-onset T1DM reaching older ages, necessitates a stronger research focus in this age group.

  • Incidence and prevalence of T1DM at older ages vary across the world, partly due to different definitions as well as population characteristics.

  • Given the considerably greater incidence of type 2 diabetes mellitus (T2DM) than of T1DM at older ages, even low levels of misclassification of T2DM as T1DM can lead to major uncertainty in the epidemiology of T1DM.

  • Although survival among older adults with T1DM has improved, older adults with T1DM still have substantially reduced life expectancy compared with those of the same age in the general population.

  • Although glutamic acid decarboxylase positivity and low C-peptide are indicative of T1DM among older adults presenting with new-onset diabetes mellitus, there is no gold standard in differentiating T1DM from T2DM at older ages.

  • A more accurate definition of T1DM in older adults should be developed and applied to epidemiological studies globally to understand the true burden of T1DM among older adults compared with that in other age groups.

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Fig. 1: Proportion of prevalent T1DM by age group in Australia in 2024.

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Authors and Affiliations

  1. School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia

    Dunya Tomic, Jonathan E. Shaw & Dianna J. Magliano

  2. Department of Surgery, Emory University School of Medicine, Atlanta, GA, USA

    Jessica L. Harding

  3. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA

    Jessica L. Harding

  4. Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia

    Alicia J. Jenkins, Jonathan E. Shaw & Dianna J. Magliano

  5. Faculty of Medicine, Monash University, Melbourne, Victoria, Australia

    Alicia J. Jenkins

  6. Baker Department of Cardiometabolic Health, Melbourne Medical School, University of Melbourne, Melbourne, Victoria, Australia

    Alicia J. Jenkins

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D.T. and D.J.M. researched data for the article and wrote the article. J.L.H., A.J.J. and J.E.S. contributed substantially to discussion of the content. All authors reviewed and/or edited the manuscript before submission.

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Correspondence to Dunya Tomic.

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Nature Reviews Endocrinology thanks Mikael Knip, Xia Li and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Review criteria

We conducted a Medline search to find articles published in English between 2000 and 2023 using the terms “type 1 diabetes mellitus” AND “incidence” OR “prevalence” OR “mortality”, which were mapped to subject headings. We included all articles that contained age-specific data on any of incidence, prevalence or mortality of type 1 diabetes among adults aged ≥60 years. The 25 identified studies were summarized in a narrative manner. Regarding genetics, immunology and diagnostic challenges of those with type 1 diabetes mellitus, we sourced information from the most recent reviews of the evidence in these areas.

Related links

Human Mortality Database: https://www.mortality.org/

International Diabetes Federation Diabetes Atlas: https://diabetesatlas.org/

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Tomic, D., Harding, J.L., Jenkins, A.J. et al. The epidemiology of type 1 diabetes mellitus in older adults. Nat Rev Endocrinol 21, 92–104 (2025). https://doi.org/10.1038/s41574-024-01046-z

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