The Greek contribution to diabetes research

Incidence of childhood Type 1 diabetes mellitus in Crete

AIM

To investigate the epidemiology of childhood Type 1 diabetes mellitus in Crete over the last 25 years and to evaluate incidence trends over time.

METHODS

The study included all children aged 0-14 years who live in Crete and were diagnosed during the 25-year period from 1 January 1992 to 31 December 2016.

RESULTS

A total of 271 children were diagnosed with Type 1 diabetes during the 25-year period: 148 boys and 123 girls (boy:girl ratio 1.2). The median (interquartile range) age at diagnosis was 8.3 (5.0-12.0) years for boys and 8.0 (5.3-11.3) years for girls. The standardized annual incidence rate was 10.5 per 100 000 children (95% CI 9.2 to 11.8). Incidence rates were higher in children aged 5-9 years. During the 25-year study period an average 4.4% annual increase in incidence was documented and was most prominent in the age group 5-14 years. Incidence seemed to remain relatively stable for the age group 0-4 years in the last decade. No seasonality of the clinical onset of Type 1 diabetes was observed.

CONCLUSIONS

The recent increase in Type 1 diabetes incidence places Crete among regions with high incidence as per the World Health Organization DiaMond project classification. The rising trends in incidence confirmed by this study are in accordance with the reported global trends in Type 1 diabetes incidence.

Serologic prevalence of coxsackievirus group B in Greece

Coxsackieviruses are human enteroviruses, which have been associated with myocarditis/pericarditis and sudden death. In one investigation (Spanakis N, Manolis EN, Tsakris A, Tsiodras S, Panagiotopoulos T, Saroglou G, and Legakis NJ: J Clin Pathol 2005;58:357-360), a cluster of cases of fatal myocarditis in Greece was linked to coxsackievirus B3. The information from this investigation prompted us to study serologically the prevalence of coxsackieviruses B throughout Greece. Sera were obtained from 506 healthy blood donors from various transfusion centers, covering the entire country. All sera were tested for the presence of IgG and IgM antibodies, using ELISAs with various antigenic specificities: (1) heat-denatured coxsackievirus type B1 and B5 virions, (2) a synthetic peptide from the N terminus of the VP1 protein of coxsackievirus B3, and (3) a synthetic peptide from the N terminus of the VP1 protein of coxsackievirus B4. Sera positive for IgG antibodies against coxsackieviruses B1/B5, B3, and B4 were detected in 6.7 to 21.6% of the individuals tested in the various regions of Greece. Statistical analysis revealed that the highest prevalence of IgG antibodies against coxsackieviruses B1/B5 was found in blood donors from Crete (p = 0.025), whereas the highest prevalence against coxsackievirus B4 was detected in blood donors from Athens (p = 0.01). IgM antibodies against coxsackievirus B were detected at low percentage, less than 5%, with no significant viral preference for particular geographic regions. The preference of anti-coxsackievirus IgG antibodies for particular geographic regions could be potentially related to the previously reported clustering of cases of insulin-dependent diabetes mellitus and myocarditis in Athens and Crete, respectively.