The epidemiology of T1DM in children demonstrates marked geographic heterogeneity. In Finland, the incidence of pediatric T1DM has been reported to exceed 50 per 100,000 in recent years, and several Northern European countries also report high rates ranging from 20–30 per 100,000 [2]. In contrast, East Asian countries have considerably lower rates, although gradual increases have been documented. National data from Korea report an incidence of 3–5 per 100,000, with an annual increase of 3%–4% between 2007 and 2017 [3], and data from Shanghai showed an even sharper escalation, with annual increases of up to 14% during certain periods [4]. In comparison, the Vietnamese cohort demonstrated an incidence of only 0.77 per 100,000 children, representing one of the lowest rates globally [1]. Despite this low absolute incidence, the proportion of patients presenting with diabetic ketoacidosis (57.8%) was strikingly high [1]. These findings indicate that, although Vietnam remains in the early phase of the epidemiologic transition observed across Asia, the severity at presentation underscores substantial challenges in early recognition and timely management.

Age distribution is another important determinant of incidence. Previous long-term data from Turkey demonstrated a downward shift in mean age at diagnosis from 9.5 to 7.1 years, with a growing proportion of cases in children younger than 6 years [5]. Similar age-related increases have also been reported in Korea and other Asian populations [3,4]. In contrast, the Vietnamese cohort showed the highest incidence among children aged 10–14 years, whereas the number of cases in younger children remained very limited [1]. These findings suggest that Vietnam is at an earlier stage of the epidemiologic transition, where the burden is still concentrated in older pediatric groups, differing from the younger age shift observed in higher-incidence countries.

Sex differences in incidence have been inconsistently reported across regions. Several East Asian datasets, including those from Korea and the Western Pacific region, documented higher incidence in females than in males aged 0–14 years [4]. The Vietnamese study, however, did not demonstrate a clear female predominance [1]. This result diverges from previous East Asian reports and suggests that sex-related differences in T1DM incidence may vary substantially according to genetic background, environmental exposures, or healthcare access and may not yet be evident in regions where overall incidence remains very low.

Among the most concerning findings in the Vietnamese study was the very high frequency of DKA at initial diagnosis, with 57.8% of new-onset cases presenting with the affliction [1]. This proportion is comparable to reports from Ethiopia, where more than 60% of children had DKA at onset [6], and from Turkey, where nearly half of newly diagnosed patients presented with DKA despite decades of accumulated experience in pediatric diabetes care [5]. In contrast, studies from Korea have shown somewhat lower, yet still substantial, rates of DKA at diagnosis, reflecting that delayed recognition remains a challenge even in settings with relatively broad healthcare access [3]. Taken together, these data indicate that high rates of DKA at presentation are a common feature across low- and middle-income countries, and Vietnam aligns with this broader pattern. At the same time, the persistence of DKA in countries with better healthcare infrastructure underscores lack of public awareness, primary care recognition, and timely referral as universal challenges. Addressing these issues through community education and strengthened healthcare pathways will be essential to reduce preventable morbidity and mortality.

Against this broad backdrop, the recent Vietnamese single-center study offers important but limited insights. By capturing one year of new diagnoses at a tertiary hospital, the report provides valuable baseline epidemiologic information. However, its narrow scope precludes assessment of longer-term secular trends or the surge in incidence documented during and after the COVID-19 pandemic [1,7]. Therefore, while the study highlights the urgent issue of high DKA burden at diabetes diagnosis, interpretation must be tempered by recognition of its methodological constraints. Future directions should prioritize multicenter, longitudinal registries that more comprehensively can capture temporal shifts, regional variations, and post-pandemic dynamics.

In conclusion, although pediatric T1DM incidence remains lower in Asia compared with Western countries, it is rising steadily, with diagnoses occurring at younger ages and with persistently high rates of DKA at presentation. The Vietnamese data add to this growing regional evidence base but underscore the urgent need for broader surveillance and proactive public health strategies. Efforts to improve awareness, enhance primary care training, and establish nationwide registries will be pivotal in mitigating complications and ensuring timely care for children facing this lifelong condition.