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Cesta CE, Cohen JM, Pazzagli L, Bateman BT, Bröms G, Einarsdóttir K, Furu K, Havard A, Heino A, Hernandez-Diaz S, Huybrechts KF, Karlstad Ø, Kieler H, Li J, Leinonen MK, Gulseth HL, Tran D, Yu Y, Zoega H, Odsbu I. Antidiabetic medication use during pregnancy: an international utilization study. BMJ Open Diabetes Res Care 2019; 7:e000759. [PMID: 31798900 PMCID: PMC6861111 DOI: 10.1136/bmjdrc-2019-000759] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 08/30/2019] [Accepted: 09/08/2019] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE Diabetes in pregnancy and consequently the need for treatment with antidiabetic medication (ADM) has become increasingly prevalent. The prevalence and patterns of use of ADM in pregnancy from 2006 onward in seven different countries was assessed. RESEARCH DESIGN AND METHODS Data sources included individually linked data from the nationwide health registers in Denmark (2006-2016), Finland (2006-2016), Iceland (2006-2012), Norway (2006-2015), Sweden (2006-2015), state-wide administrative and claims data for New South Wales, Australia (2006-2012) and two US insurance databases: Medicaid Analytic eXtract (MAX; 2006-2012, public) and IBM MarketScan (2012-2015, private). The prevalence of ADM use was calculated as the proportion of pregnancies with at least one filled prescription of an ADM in the 90 days before pregnancy or within the three trimesters of pregnancy. RESULTS Prevalence of any ADM use in 5 279 231 pregnancies was 3% (n=147 999) and varied from under 2% (Denmark, Norway, and Sweden) to above 5% (Australia and US). Insulin was the most used ADM, and metformin was the most used oral hypoglycemic agent with increasing use over time in all countries. In 11.4%-62.5% of pregnancies with prepregnancy use, ADM (primarily metformin) was discontinued. When ADM treatment was initiated in late pregnancy for treatment of gestational diabetes mellitus, insulin was most often dispensed, except in the US, where glibenclamide was most often used. CONCLUSIONS Prevalence and patterns of use of ADM classes varied between countries and over time. While insulin remained the most common ADM used in pregnancy, metformin use increased significantly over the study period.
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Affiliation(s)
- Carolyn E Cesta
- Centre for Pharmacoepidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jacqueline M Cohen
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Laura Pazzagli
- Centre for Pharmacoepidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Brian T Bateman
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
- Department of Anesthesiology, Critical Care, and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Gabriella Bröms
- Centre for Pharmacoepidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Internal Medicine, Danderyds Sjukhus AB, Stockholm, Sweden
| | - Kristjana Einarsdóttir
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Kari Furu
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Alys Havard
- Centre for Big Data Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Anna Heino
- Information Services Department, National Institute for Health and Welfare, Helsinki, Finland
| | - Sonia Hernandez-Diaz
- Department of Epidemiology, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
| | - Krista F Huybrechts
- Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| | - Øystein Karlstad
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Helle Kieler
- Centre for Pharmacoepidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
- Department for Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Jiong Li
- Department of Clinical Epidemiology, Aarhus Universitet, Aarhus, Denmark
| | - Maarit K Leinonen
- Information Services Department, National Institute for Health and Welfare, Helsinki, Finland
| | - Hanne L Gulseth
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Duong Tran
- Centre for Big Data Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Yongfu Yu
- Department of Clinical Epidemiology, Aarhus Universitet, Aarhus, Denmark
| | - Helga Zoega
- Centre of Public Health Sciences, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Centre for Big Data Research in Health, UNSW Sydney, Sydney, New South Wales, Australia
| | - Ingvild Odsbu
- Centre for Pharmacoepidemiology, Department of Medicine, Karolinska Institutet, Stockholm, Sweden
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Chen YL, Huang YC, Qiao YC, Ling W, Pan YH, Geng LJ, Xiao JL, Zhang XX, Zhao HL. Climates on incidence of childhood type 1 diabetes mellitus in 72 countries. Sci Rep 2017; 7:12810. [PMID: 28993655 PMCID: PMC5634499 DOI: 10.1038/s41598-017-12954-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 09/12/2017] [Indexed: 12/25/2022] Open
Abstract
We are aimed to systematically assess the worldwide trend in incidence of childhood type 1 diabetes mellitus (CT1DM) from 1965 to 2012 and to discuss whether climate affect incidence of CT1DM. We searched the relevant literatures in detail to judge the effect of different climates on incidence of CT1DM. The climates included Mediterranean, monsoon, oceanic, continental, savanna, and rainforest. According to different climates, we further researched relevant factor such as sunshine durations and latitudes. The overall incidence of CT1DM in 72 countries was 11.43 (95% CI 10.31–12.55) per 100,000 children/yr. The incidence of CT1DM in Oceanic climate [10.56 (8.69–12.42)] is highest compared with other climates; the incidence in 40°–66°34′N/S [14.71 (12.30–17.29)] is higher than other latitude groups; the incidence in sunshine durations with 3–4 hours per day [15.17 (11.14–19.20)] is highest compared with other two groups; the incidence of CT1DM from 2000 to 2012 [19.58 (14.55–24.60)] is higher than other periods; all p < 0.01. Incidence of CT1DM was increasing from 1965 to 2012, but incidence in Oceanic climate is higher than other climates. Furthermore, it is higher in centers with higher latitude and lower sunshine durations. The climates might play a key role in inducing CT1DM.
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Affiliation(s)
- Yin-Ling Chen
- Center of Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, 541004, China.,Department of Immunology, Faculty of basic Medicine, Guilin Medical University, Guilin, 541004, China
| | - Yong-Cheng Huang
- Center of Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, 541004, China
| | - Yong-Chao Qiao
- Department of Immunology, Xiangya School of Medicine, Central South University, Changsha, Hunan, 410078, China
| | - Wei Ling
- Center of Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, 541004, China
| | - Yan-Hong Pan
- Center of Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, 541004, China.,Department of Immunology, Faculty of basic Medicine, Guilin Medical University, Guilin, 541004, China
| | - Li-Jun Geng
- Center of Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, 541004, China.,Department of Immunology, Faculty of basic Medicine, Guilin Medical University, Guilin, 541004, China
| | - Jian-Long Xiao
- Center of Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, 541004, China.,Department of Immunology, Faculty of basic Medicine, Guilin Medical University, Guilin, 541004, China
| | - Xiao-Xi Zhang
- Center of Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, 541004, China. .,Department of Immunology, Faculty of basic Medicine, Guilin Medical University, Guilin, 541004, China.
| | - Hai-Lu Zhao
- Center of Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, 541004, China. .,Department of Immunology, Xiangya School of Medicine, Central South University, Changsha, Hunan, 410078, China. .,Department of Immunology, Faculty of basic Medicine, Guilin Medical University, Guilin, 541004, China.
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3
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Negrato CA, Lauris JRP, Saggioro IB, Corradini MCM, Borges PR, Crês MC, Junior AL, Guedes MFS, Gomes MB. Increasing incidence of type 1 diabetes between 1986 and 2015 in Bauru, Brazil. Diabetes Res Clin Pract 2017; 127:198-204. [PMID: 28391136 DOI: 10.1016/j.diabres.2017.03.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 03/16/2017] [Indexed: 12/21/2022]
Abstract
AIMS To assess temporal trends in the incidence of type 1 diabetes in Bauru, São Paulo State, Brazil from 1986 to 2015. RESEARCH DESIGN AND METHODS The yearly incidence of type 1 diabetes (per 100,000/yr) from 1986 to 2015 was determined in children ≤14yr of age, using individual case notification and the capture and recapture method. RESULTS During thirty years (1986-2015), 302 cases were diagnosed in our population. The overall incidence was of 12.8/100,000 (95% CI: 11.2-14.4), ranging from 2.8/100,000 in 1987 to 25.6/100,000 in 2013 with a 9.1-fold variation. It was non-significantly higher in girls [13.7 (95% CI: 11.4-16.1)] than in boys [12.0 (95% CI: 9.8-14.2)] (p=0.48) and significantly higher in the 5-9yr [14.6 (95% CI: 11.8-17.4)] and 10-14yr [15.8 (95% CI: 12.7-18.8)] age ranges compared to the 0-4yr [8.1 (95% CI: 6.0-10.2)] age range (p<0.001). The majority of diagnoses were made in colder months. The patterns of incidence were very high and high in 80.0% of the study-years. CONCLUSIONS The incidence of type1 diabetes in children ≤14yr has increased in Bauru, Brazil, in the last thirty years, in approximately 3.1% annually, with an absolute crude increase of 2.5-fold. These findings pose Brazil as a country with high incidence of type 1 diabetes. All Brazilian regions should be enrolled in future studies to determine the factors that contribute to the predisposition to type 1 diabetes in our population and to the steep rise in its incidence.
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Affiliation(s)
- Carlos Antonio Negrato
- Bauru's Diabetics Association, Department of Internal Medicine, Bauru, São Paulo, Brazil.
| | - José Roberto Pereira Lauris
- Department of Pediatric Dentistry, Orthodontics and Community Health, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - Ieso Braz Saggioro
- Bauru's Diabetics Association, Department of Internal Medicine, Bauru, São Paulo, Brazil
| | | | - Pricila Rubia Borges
- Bauru's Diabetics Association, Department of Internal Medicine, Bauru, São Paulo, Brazil
| | - Maria Cristina Crês
- Bauru's Diabetics Association, Department of Internal Medicine, Bauru, São Paulo, Brazil
| | - Aluysio Leal Junior
- Bauru's Diabetics Association, Department of Internal Medicine, Bauru, São Paulo, Brazil
| | | | - Marilia Brito Gomes
- Department of Internal Medicine, Diabetes Unit, State University Hospital of Rio de Janeiro, Rio de Janeiro, Brazil
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4
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Dabelea D, Mayer-Davis EJ, Saydah S, Imperatore G, Linder B, Divers J, Bell R, Badaru A, Talton JW, Crume T, Liese AD, Merchant AT, Lawrence JM, Reynolds K, Dolan L, Liu LL, Hamman RF. Prevalence of type 1 and type 2 diabetes among children and adolescents from 2001 to 2009. JAMA 2014; 311:1778-86. [PMID: 24794371 PMCID: PMC4368900 DOI: 10.1001/jama.2014.3201] [Citation(s) in RCA: 978] [Impact Index Per Article: 97.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Despite concern about an "epidemic," there are limited data on trends in prevalence of either type 1 or type 2 diabetes across US race and ethnic groups. OBJECTIVE To estimate changes in the prevalence of type 1 and type 2 diabetes in US youth, by sex, age, and race/ethnicity between 2001 and 2009. DESIGN, SETTING, AND PARTICIPANTS Case patients were ascertained in 4 geographic areas and 1 managed health care plan. The study population was determined by the 2001 and 2009 bridged-race intercensal population estimates for geographic sites and membership counts for the health plan. MAIN OUTCOMES AND MEASURES Prevalence (per 1000) of physician-diagnosed type 1 diabetes in youth aged 0 through 19 years and type 2 diabetes in youth aged 10 through 19 years. RESULTS In 2001, 4958 of 3.3 million youth were diagnosed with type 1 diabetes for a prevalence of 1.48 per 1000 (95% CI, 1.44-1.52). In 2009, 6666 of 3.4 million youth were diagnosed with type 1 diabetes for a prevalence of 1.93 per 1000 (95% CI, 1.88-1.97). In 2009, the highest prevalence of type 1 diabetes was 2.55 per 1000 among white youth (95% CI, 2.48-2.62) and the lowest was 0.35 per 1000 in American Indian youth (95% CI, 0.26-0.47) and type 1 diabetes increased between 2001 and 2009 in all sex, age, and race/ethnic subgroups except for those with the lowest prevalence (age 0-4 years and American Indians). Adjusted for completeness of ascertainment, there was a 21.1% (95% CI, 15.6%-27.0%) increase in type 1 diabetes over 8 years. In 2001, 588 of 1.7 million youth were diagnosed with type 2 diabetes for a prevalence of 0.34 per 1000 (95% CI, 0.31-0.37). In 2009, 819 of 1.8 million were diagnosed with type 2 diabetes for a prevalence of 0.46 per 1000 (95% CI, 0.43-0.49). In 2009, the prevalence of type 2 diabetes was 1.20 per 1000 among American Indian youth (95% CI, 0.96-1.51); 1.06 per 1000 among black youth (95% CI, 0.93-1.22); 0.79 per 1000 among Hispanic youth (95% CI, 0.70-0.88); and 0.17 per 1000 among white youth (95% CI, 0.15-0.20). Significant increases occurred between 2001 and 2009 in both sexes, all age-groups, and in white, Hispanic, and black youth, with no significant changes for Asian Pacific Islanders and American Indians. Adjusted for completeness of ascertainment, there was a 30.5% (95% CI, 17.3%-45.1%) overall increase in type 2 diabetes. CONCLUSIONS AND RELEVANCE Between 2001 and 2009 in 5 areas of the United States, the prevalence of both type 1 and type 2 diabetes among children and adolescents increased. Further studies are required to determine the causes of these increases.
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Affiliation(s)
- Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, Aurora
| | | | - Sharon Saydah
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Giuseppina Imperatore
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Barbara Linder
- Childhood Diabetes Research Division of Diabetes, Endocrinology and Metabolic Diseases, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland
| | - Jasmin Divers
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Ronny Bell
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Angela Badaru
- Department of Pediatric Endocrinology and Diabetes, Children's Hospital and Regional Medical Center, Seattle, Washington
| | - Jennifer W Talton
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Tessa Crume
- Department of Epidemiology, Colorado School of Public Health, Aurora
| | - Angela D Liese
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, Columbia, South Carolina
| | - Anwar T Merchant
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, Columbia, South Carolina
| | - Jean M Lawrence
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Kristi Reynolds
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Lawrence Dolan
- Department of Endocrinology, Children's Hospital Medical Center, Cincinnati, Ohio
| | - Lenna L Liu
- Department of Pediatrics, University of Washington, and Seattle Children's Hospital, Seattle
| | - Richard F Hamman
- Department of Epidemiology, Colorado School of Public Health, Aurora
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Skordis N, Efstathiou E, Kyriakides TC, Savvidou A, Savva SC, Phylactou LA, Shammas C, Neocleous V. Epidemiology of type 1 diabetes mellitus in Cyprus: rising incidence at the dawn of the 21st century. Hormones (Athens) 2012; 11:86-93. [PMID: 22450348 DOI: 10.1007/bf03401541] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVE The incidence of Type 1 diabetes mellitus (T1DM) in Greek-Cypriot children aged less than 15 years between 1990 and 2009 was examined along with gender differences concerning the age of onset and the seasonal variation at manifestation of the disease. DESIGN All newly diagnosed cases of T1DM in children less than 15 years old were registered with the capture-recapture method from 1990 until 2009. RESULTS The overall mean annual incidence during these 20 years is 12.46 per 100,000. A comparison of the incidence between the two decades (1990-1999 vs 2000-2009) indicated a rising trend, from 10.80 per 100,000 person-years during the first decade to 14.44 per 100,000 person-years during the second decade. There was an overall male predominance (M/F: 1.05), which is in agreement with the male predominance in the population less than 15 years of age, except for the group who manifested T1DM at ages 10-15 years where females prevail. The percentage of children who developed T1DM at ages 0-5 years in the total T1DM population increased in the second decade (26.4% vs 19.0%), and significantly more children were diagnosed during the cold months as opposed to the warm months (p<0.001). CONCLUSION The incidence of T1DM in Cyprus is rising. The identification of causative environmental factors will theoretically explain this phenomenon and new preventive strategies can therefore potentially be developed.
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Affiliation(s)
- Nicos Skordis
- Paediatric Endocrine Unit, Department of Paediatrics, Makarios Hospital, Nicosia, Cyprus.
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6
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Benson VS, Vanleeuwen JA, Taylor J, Somers GS, McKinney PA, Van Til L. Type 1 diabetes mellitus and components in drinking water and diet: a population-based, case-control study in Prince Edward Island, Canada. J Am Coll Nutr 2011; 29:612-24. [PMID: 21677125 DOI: 10.1080/07315724.2010.10719900] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine the relationship between the risk of type 1 diabetes (T1D) and daily intake of drinking water and dietary components, including nitrate, nitrite, and nitrosamines, during the year prior to diagnosis. METHODS Controls (n = 105) were matched by age at diagnosis and sex to T1D cases (n = 57) newly diagnosed during 2001-2004. Food consumption was assessed using a food frequency questionnaire. Locally available samples of foods were tested for nitrate, nitrite, and nitrosamine concentrations. Water consumption was determined through an additional questionnaire, and water samples were taken from homes and tested for routine chemical components, including nitrate. RESULTS After controlling for age, age, sex, and daily energy intake, nitrate intake from food sources showed a non-significant positive trend (odds ratios and 95% confidence intervals for quartiles = 1.00, 1.63 (0.58, 4.63), 1.71 (0.54, 5.40), 3.02 (0.78, 11.74); p for trend = 0.13). Nitrite and nitrosamine intake were not related to T1D risk (p for trend = 0.77 and 0.81, respectively). When food and water components were combined, zinc and calcium intakes were marginally and inversely related to T1D risk (p for trend = 0.07 and 0.06, respectively). After further model adjustment of possible confounders and significant risk factors, an increased intake of caffeine marginally increased the risk of T1D (p = 0.07). CONCLUSION Dietary components from both food and water sources may influence the risk of developing T1D in young persons.
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Affiliation(s)
- Victoria S Benson
- Department of Health Management, Atlantic Veterinary College, Canada.
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Negrato CA, Dias JPL, Teixeira MF, Dias A, Salgado MH, Lauris JR, Montenegro RM, Gomes MB, Jovanovic L. Temporal trends in incidence of Type 1 diabetes between 1986 and 2006 in Brazil. J Endocrinol Invest 2010; 33:373-7. [PMID: 19620822 DOI: 10.1007/bf03346606] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Scarce information is available about the variation in the incidence of Type 1 diabetes in the Brazilian population in the last decades. AIM The objective of this study was to assess the long-term trends (1986-2006) in the incidence of Type 1 diabetes in Bauru, São Paulo State, Brazil. SUBJECTS AND METHODS The annual incidence of Type 1 diabetes (per 100,000 per yr) from 1986 to 2006 was determined in children <or=14 yr of age, using the capture and recapture method. RESULTS A total of 176 cases were diagnosed in the study population. The overall incidence was 10.4/100,000 with a range of 2.82/100,000 in 1987 to 18.49/100,000 in 2002 representing a 6.56-fold increase within the same population. The estimated incidence, using the capture and recapture method varied from 2.82/100,000 per yr in 1987 to 27.20/100,000 per yr in 2002, representing a 9.6-fold variation. The global pattern of incidence variation was categorized as high (10-19.99/100,000 per yr), and very high (>or=20/100,000 per yr) in 71.43% of the study-years. Incidence was slightly higher among females, Caucasians, children in the 5-9 yr of age range and belonging to lower socio-economic classes. Most diagnoses were established during the colder months and/or with higher pluviometric indexes. CONCLUSIONS The incidence of Type 1 diabetes in children is increasing in Bauru, São Paulo State, Brazil, and the global pattern of incidence was classified as high or very high, mainly in the last 10 yr. All Brazilian regions should be involved in the study.
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Affiliation(s)
- C A Negrato
- Division of Diabetes, Department of Epidemiology, Bauru's Diabetics Association, Bauru, Brazil.
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Vésteinsdóttir E, Björnsdóttir S, Hreidarsson AB, Stefánsson E. Risk of retinal neovascularization in the second eye in patients with proliferative diabetic retinopathy. Acta Ophthalmol 2010; 88:449-52. [PMID: 19604165 DOI: 10.1111/j.1755-3768.2008.01440.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE This study aimed to evaluate the risk of proliferative diabetic retinopathy (DR) in the fellow eye of an eye with existing proliferative DR. METHODS Our DR screening programme database listed 1513 diabetes patients alive at the time of the study. Seventy-six had proliferative DR in one or both eyes. RESULTS In 28 of the 76 (37%) diabetes patients, proliferative DR was diagnosed in both eyes at the same examination. Another 28 patients developed proliferative DR in the second eye within 5 years of its diagnosis in the first eye, bringing the total number of diabetes patients with proliferative DR in both eyes at 5 years to 56 (74%). Almost all the diabetes patients eventually developed proliferative DR in the second eye. The median duration of diabetes before the development of proliferative retinopathy was 19 years for type 1 and 14 years for type 2 diabetes. CONCLUSIONS Proliferative DR is a bilateral disease. Diabetes patients with proliferative DR in one eye are at high risk of developing neovascularization in the second eye and close follow-up is recommended.
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Handel AE, Handunnetthi L, Ebers GC, Ramagopalan SV. Type 1 diabetes mellitus and multiple sclerosis: common etiological features. Nat Rev Endocrinol 2009; 5:655-64. [PMID: 19884899 DOI: 10.1038/nrendo.2009.216] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Type 1 diabetes mellitus and multiple sclerosis have been largely seen as different, organ-specific diseases, which are managed by different medical specialties. Research studies on these diseases have for the most part followed independent tracks. In this Review, we highlight the latest epidemiological and genetic findings, which have identified many features common to both disorders. Experts consider it increasingly likely that the environment contributes substantially to this overlap. However, although genetic elements that are distinct to each disease probably determine the ultimate form of autoimmunity that is manifested, strikingly broad parallels are seen between the components of genetic risk of type 1 diabetes mellitus and multiple sclerosis. Similarities and differences between these two diseases draw attention to shared disease pathways but insights into each disorder are providing mutual illumination of their pathogenesis.
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Affiliation(s)
- Adam E Handel
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
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Svensson J, Lyngaae-Jørgensen A, Carstensen B, Simonsen LB, Mortensen HB. Long-term trends in the incidence of type 1 diabetes in Denmark: the seasonal variation changes over time. Pediatr Diabetes 2009; 10:248-54. [PMID: 19067889 DOI: 10.1111/j.1399-5448.2008.00483.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
There is a worldwide increase of type 1 diabetes mellitus (T1DM). In 1996, the Danish population-based registry was initiated including all newly diagnosed children aged 0-15 yr. This is the report of incidence and seasonal variation for the first 10 yr of the registry. The data was analyzed using Poisson's regression analysis. A total of 2166 children with diabetes were diagnosed before the age of 15 yr between 1996 and 2005. In this period, the annual increase in childhood T1DM was 3.43% (95% confidence interval: 1.91-4.97), which was unaffected by age and gender. Seasonal variation in incidence rates varied by year but not by age and gender. In conclusion, there is a steep increase in incidence of childhood T1DM in Denmark; the increase is comparable with the increase seen in other European countries. There is a significant seasonal variation that changes on a year-to-year basis. The observed variations in cadence rates may be associated with viral epidemics, sunshine exposure, or vitamin D levels and suggest further exploration of these relations.
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Affiliation(s)
- Jannet Svensson
- Paediatric Department, Glostrup University Hospital, Glostrup, Denmark.
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12
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Benson VS, Vanleeuwen JA, Taylor J, McKinney PA, Van Til L. Food consumption and the risk of type 1 diabetes in children and youth: a population-based, case-control study in Prince Edward Island, Canada. J Am Coll Nutr 2009; 27:414-20. [PMID: 18838530 DOI: 10.1080/07315724.2008.10719719] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The objective of this study was to determine if the consumption of certain foods during the year prior to diagnosis of type 1 diabetes mellitus (T1D) was associated with the risk of developing T1D in children and youth residing in Prince Edward Island, Canada. METHODS Cases (n = 57) consisted of newly diagnosed patients with T1D during 2001 to 2004. Controls (n = 105) were randomly selected from the province's population, and matched to cases by age at diagnosis and sex. Food consumption in cases and controls was assessed using two previously validated food frequency questionnaires, and a survey was developed to collect information on potential environmental and genetic risk factors. RESULTS The median age at diagnosis was nine years, and 67% of cases were male. After controlling for the matched variables and four significant environmental and genetic risk factors (family members with T1D, the number of infections during the first two years of life, place of residence, and father's education) in the final logistic regression model, the consumption of regular soft drinks (OR = 2.78, 95% CI = 1.21, 6.36) and eggs (OR = 2.50, 95% CI = 1.09, 5.75) were significant risk factors of T1D, when consumed once per week or more often. CONCLUSION Diet may play a role in the development of T1D. However, further research is needed to confirm these observed associations.
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Affiliation(s)
- Victoria S Benson
- Cancer Epidemiology Unit, University of Oxford, Oxford, England, United Kingdom.
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13
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Zoega GM, Gunnarsdóttir T, Björnsdóttir S, Hreietharsson AB, Viggósson G, Stefánsson E. Screening compliance and visual outcome in diabetes. ACTA ACUST UNITED AC 2006; 83:687-90. [PMID: 16396645 DOI: 10.1111/j.1600-0420.2005.00541.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE To study the relationship between screening compliance and visual outcome in a screening programme for diabetic eye disease. METHODS A retrospective case control study. The screening compliance of all the diabetes patients (n = 22) listed at the Icelandic National Registry for the Blind (visual acuity <0.3) was compared to a matched group of 44 non-blind diabetes patients (visual acuity > or =0.3) who participated in the same screening programme for diabetic retinopathy. Glycaemic control (HbA1c), office blood pressure and cholesterol levels were assessed. RESULTS The study group had a significantly lower level of compliance with the screening programme (27% +/- 38% [mean +/- SD] versus 77% +/- 26% [mean +/- SD]; p < 0.0001). Macular oedema or proliferative diabetic retinopathy was found in 60% (13/22) of the study group when entering the screening programme, compared to 7% (3/44) in the control group. Blood pressure (except diastolic BP among type 1 diabetes mellitus), blood glucose and cholesterol levels were identical. The prevalence of blindness and low vision amongst diabetes patients in Iceland is about 0.5%. CONCLUSIONS There was a significant relationship between screening compliance and visual outcome in diabetes patients in our screening programme.
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Affiliation(s)
- Gunnar Már Zoega
- Department of Ophthalmology, Landspitali University Hospital, Reykjavik, Iceland
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Skordis N, Theodorou S, Apsiotou T, Stavrou S, Herakleous E, Savva SC. The incidence of type 1 diabetes mellitus in Greek-Cypriot children and adolescents in 1990-2000. Pediatr Diabetes 2002; 3:200-4. [PMID: 15016148 DOI: 10.1034/j.1399-5448.2002.30406.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES To ascertain the exact incidence of type 1 diabetes mellitus (DM1) in Greek-Cypriots under the age of 15 yr, to analyze possible gender differences in the age of onset and to observe any seasonal variation in the manifestation of the disease. RESEARCH DESIGN AND METHODS All cases of newly diagnosed DM1 patients under the age of 15 yr from 1990 to 2000 were collected and relevant information was obtained. The data were statistically processed in relation to the population data provided by the Department of Statistics and Research of the Ministry of Finance. RESULTS The mean annual incidence of DM1 in the Greek population of Cyprus under the age of 15 yr for the period 1990-2000 is 11.32/100,000. There is a trend towards increasing incidence during this period. There is a gender influence on the age of onset: more males develop DM1 before the age of 6 yr and after 13 yr. Moreover, there is a gender difference in the group who manifest DM1 in the age range 5-9 yr, with females having a mean age of onset of 8.1 yr, compared with 7.3 yr for males. There is a statistically significant seasonal variation, but not among preschool subjects who manifest DM1 before the age of 4 yr. CONCLUSIONS DM1 is a common condition in Greek-Cypriots under the age of 15 yr. The gender difference in the age of onset probably reflects the peripubertal period of each gender. The seasonal variation cannot be solely attributed to weather and temperature changes. This survey covers a 10-yr period and deals with an adequate number of reported cases; therefore, it could contribute to the international effort to determine the exact pathogenesis of DM1.
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Affiliation(s)
- Nicos Skordis
- Pediatric Endocrine Unit, Department of Pediatrics, Makarios Hospital, Nicosia, Cyprus.
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15
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Rosenbauer J, Icks A, Giani G. Incidence and prevalence of childhood type 1 diabetes mellitus in Germany--model-based national estimates. J Pediatr Endocrinol Metab 2002; 15:1497-504. [PMID: 12503857 DOI: 10.1515/jpem.2002.15.9.1497] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Fitting a Poisson model to national data on the incidence of type 1 diabetes mellitus (T1DM) under 5 years (1993-95) and to age-specific incidence data from three different German regions (age groups 0-4, 5-9, 10-14, 15-19 years, 1988-1995), national age-specific incidences of T1DM in childhood were estimated. From these the age-standardized national incidence and prevalence were derived for age groups 0-15 and 0-19 years. In 1993-95 the age-standardized national incidences (95% CIs) in the age groups 0-14 and 0-19 years were 14.2 (12.9-15.5) and 17.0 (15.2-18.8) per 100,000 person-years, respectively. The respective national prevalences were 86.7 (83.4-90.0) and 140.2 (134.3-146.1) per 100,000 persons. These estimates of the national incidence and prevalence of T1DM for the mid-1990s were about twofold higher than estimates from the former Eastern Germany in the late 1980s. This striking high frequency of T1DM in Germany has an important impact on clinical and economic aspects of diabetes care in childhood and adolescence.
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Affiliation(s)
- J Rosenbauer
- Department of Biometrics and Epidemiology, German Diabetes Research Institute, Düsseldorf University, Germany.
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17
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Abstract
Betel nut (Areca catechu) is chewed regularly by at least 10% of the world population, imported by immigrant users wherever they settle, and is the fourth most widely used addictive substance. It is thought, by users, to soothe the digestion and to be a stimulant and its use has a major role in social situations. Specific arecal alkaloids act as competitive inhibitors of GABA receptors and have widespread effects in the body, including actions on the brain, cardiovascular system, lungs, gut and pancreas. Nitrosated derivatives of arecal alkaloids, proven carcinogens inducing tumours throughout the upper gut and foregut derivatives in animals, are also associated with increased tumour risks in man. These nitrosated compounds are also diabetogenic in CD1 mice, producing a type 2 diabetes with obesity. Increased central obesity is found in association with betel usage in man as well as increases in circulating markers of inflammatory and cardiovascular damage. The effects of chronic betel usage in man are at least as diverse as those of smoking and the habit increases the risks of ill health.
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Affiliation(s)
- B J Boucher
- Department of Diabetes and Metabolic Medicine, Medical and Dental School, Queen Mary, University of London, Royal London Hospital, Whitechapel, London, UK
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18
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Thorsdottir I, Birgisdottir BE, Johannsdottir IM, Harris DP, Hill J, Steingrimsdottir L, Thorsson AV. Different beta-casein fractions in Icelandic versus Scandinavian cow's milk may influence diabetogenicity of cow's milk in infancy and explain low incidence of insulin-dependent diabetes mellitus in Iceland. Pediatrics 2000; 106:719-24. [PMID: 11015514 DOI: 10.1542/peds.106.4.719] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To compare children with insulin-dependent diabetes mellitus (IDDM) with controls in Iceland regarding their consumption of cow's milk in infancy, and to investigate the beta-casein fractions in Scandinavian and Icelandic cow's milk. The A1 variant of beta-casein has been shown to be diabetogenic in animal studies, and suggestions have been made that the B variant of beta-casein acts similarly. Differences in the relative proportions of beta-casein fractions might explain the lower incidence of IDDM in Iceland than in Scandinavia. METHODS A retrospective case-control study on IDDM patients and matching controls was performed in Iceland to compare their diets in infancy. Fifty-five children with IDDM born in Iceland over a 16-year period and randomly collected controls (n = 165) were recruited to the study. Mothers of the children answered questions on breastfeeding habits and on when cow's milk products were introduced. Samples of cow's milk from randomly selected milk batches from the largest consumption areas in Iceland and Scandinavia were collected. The milk samples were freeze-dried and their beta-casein fractions were analyzed using capillary electrophoresis. RESULTS No significant difference was found between IDDM patients and controls in the frequency and duration of breastfeeding or the first introduction of cow's milk products. The analyses of milk samples showed that the percentage of the A1 and B variants of beta-casein in Icelandic milk was significantly lower than in the milk from the Scandinavian countries. CONCLUSIONS Cow's milk consumption in infancy is not related to IDDM in Iceland. The lower fraction of A1 and B beta-caseins in Icelandic cow's milk may explain why there is a lower incidence of IDDM in Iceland than in Scandinavia.
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Affiliation(s)
- I Thorsdottir
- Unit for Nutrition Research, National University Hospital, Department of Food Science, Reykjavik, Iceland.
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19
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Serrano-Rìos M, Goday A, Martìnez Larrad T. Migrant populations and the incidence of type 1 diabetes mellitus: an overview of the literature with a focus on the Spanish-heritage countries in Latin America. Diabetes Metab Res Rev 1999; 15:113-32. [PMID: 10362459 DOI: 10.1002/(sici)1520-7560(199903/04)15:2<113::aid-dmrr25>3.0.co;2-i] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Type 1 diabetes mellitus (DM) is a 'chronic' autoimmune disorder leading to the destruction of the pancreatic beta cell. The natural history of diabetes includes a long subclinical (prediabetes) period. The pathogenesis is multifactorial and characterized by the interaction of environmental factors, with predisposing genes, most of which are associated with the HLA DR DQ loci. The relatively recent development of worldwide incidence registries for Type 1 DM has allowed us to compare the epidemiological results obtained in most parts of the world. This approach is particularly valuable in analysing the effects of migration of populations from one area of the world where the incidence of Type 1 DM is different (usually lower) to a new geographic setting. Properly designed migrant studies may be valuable in uncovering whether the genetic background remains more important than the new 'exposure' as illustrated by the Sardinian migration to Lazio and Lombardy. The presence of some putative 'protective' environmental exposures or the absence of those prevalent in the country of origin may explain the usually lower Type 1 DM incidence observed in most countries (Chile, Peru, Mexico) sharing a 'Spanish caucasoid genetic pool', and even in relatively genetically homogeneous groups such as Japanese populations migrating to Hawaii. In fact, the disease is caused by both genetic and environmental factors and to convince the scientific community of this fact is a primary responsibility for epidemiologists.
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Affiliation(s)
- M Serrano-Rìos
- Diabetes Research Laboratory, Hospital Universitario de San Carlos, Madrid, Spain
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20
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Boucher BJ. Inadequate vitamin D status: does it contribute to the disorders comprising syndrome 'X'? Br J Nutr 1998; 79:315-27. [PMID: 9624222 DOI: 10.1079/bjn19980055] [Citation(s) in RCA: 155] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Environmental factors are important in the aetiology of glucose intolerance, type II diabetes and IHD. The lack of vitamin D, which is necessary for adequate insulin secretion, relates demographically to increased risk of myocardial infarction. These disorders are connected, degenerative vascular disease increasing with glucose intolerance and diabetes and, with its risk factors, comprising syndrome 'X'. Evidence is presented suggesting that vitamin D deficiency may be an avoidable risk factor for syndrome 'X', adding another preventative measure to current recommendations which are aimed at reducing the worldwide epidemic of these disorders. Experimentally, vitamin D deficiency progressively reduces insulin secretion; glucose intolerance follows and becomes irreversible. Relationships between vitamin D status, glucose tolerance and 30 min insulin secretion during oral glucose tolerance tests are reported in British Asians; insulin secretion, but not glycaemia, improving with short-term supplementation. Studies showing reduction in blood pressure and in risk of heart attack and diabetes with exercise (usually outdoor), rarely consider the role of vitamin D status. Glycaemia and insulin secretion in elderly European men, however, relate to vitamin D status, independent of season or physical activity. Prolonged supplementation can improve glycaemia. Hypertension improves with vitamin D treatment with or without initial deficiency. Vitamin D status and climate are reviewed as risk factors for myocardial infarction; the risk reducing with altitude despite increasing cold. Glycaemia and fibrinogenaemia improve with insulin secretion increases in summer. Variation in vitamin D requirements could arise from genetic differences in vitamin D processing since bone density can vary with vitamin D-receptor genotype. Vitamin D receptors are present in islet beta cells and we report insulin secretion in healthy Asians differing profoundly with the Apa I genotype, being independent of vitamin D status. Those at risk of vitamin D deficiency include the elderly, those living indoors or having a covered-up style of dress, especially dark-skinned immigrants, and pregnant women, and these are groups recognized as being at increased risk of diabetes.
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Affiliation(s)
- B J Boucher
- Academic Medical Unit, St. Bartholomew's and the Royal London Hospital Medical & Dental School, UK
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Skordis N, Hadjiloizou S. Incidence of insulin dependent diabetes mellitus in Greek Cypriot children and adolescents, 1990-1994. J Pediatr Endocrinol Metab 1997; 10:203-7. [PMID: 9364354 DOI: 10.1515/jpem.1997.10.2.203] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Insulin dependent diabetes mellitus (IDDM) is one of the most common chronic diseases among children and adolescents worldwide. It has been well established that there are marked geographic differences in the incidence of IDDM, which may provide important clues concerning its as yet unknown etiology. The objective of this study was to estimate the incidence of IDDM in the Greek population of Cyprus based on epidemiological data collected during the period 1990-1994. The results of this survey showed that the incidence of IDDM in the Greek population of Cyprus is 10.5/100,000 population under the age of 15 years, which is in agreement with other European countries. There was a slight increase in the number of newly diagnosed patients in 1994. The mean age of onset is 8 years whereas the peak age of onset occurs at 11-12 years. There is a slight overall female predominance but not among children who manifest IDDM before the age of five years in whom males significantly predominate. Distribution by month of onset of IDDM revealed an increased number of cases during autumn and winter as expected.
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Affiliation(s)
- N Skordis
- Department of Paediatrics, Makarios Hospital, Nicosia, Cyprus
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22
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Karvonen M, Tuomilehto J, Libman I, LaPorte R. A review of the recent epidemiological data on the worldwide incidence of type 1 (insulin-dependent) diabetes mellitus. World Health Organization DIAMOND Project Group. Diabetologia 1993; 36:883-92. [PMID: 8243865 DOI: 10.1007/bf02374468] [Citation(s) in RCA: 266] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Nearly 70 registries from more than 40 countries have collected and published incidence data of childhood Type 1 (insulin-dependent) diabetes mellitus up to the end of the 1980s. The majority of incidence data comes from regions of high incidence i.e. from Europe and North America. All these published data facilitate the descriptive comparison of incidence and variation of the occurrence of Type 1 diabetes roughly throughout the northern hemisphere. The aim of this paper is to review and compare the most recent epidemiology data on the incidence of Type 1 diabetes among children under the age of 15 years. A clear difference in incidence appeared between northern and southern hemisphere with no countries below the equator having an incidence greater than 15.0 per 100,000. In contrast above the equator the disease is common. Between continents the variation in incidence showed that the lowest incidences were found in Asia, followed by Oceania (Australia and New Zealand), South and North America, and the highest rates were in Europe. The incidence varied from 0.6 per 100,000 in Korea and Mexico to 35.3 per 100,000 in Finland showing prominent worldwide variation in incidence of Type 1 diabetes. The largest intracontinental variation in incidence appeared in Europe, varying from the highest in Finland to the lowest (4.6 per 100,000) in northern Greece. The highest incidence in the world was in northern Europe, but within the continent scale there were some striking exceptions from the overall level of incidence.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- M Karvonen
- Department of Epidemiology and Health Promotion, National Public Health Institute, Helsinki, Finland
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