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Fernández-Ramos C, Arana-Arri E, Vela A, Urrutia I, Santos Zorrozua B, Rica I. Increased incidence of pediatric type 1 diabetes during the pandemic in Biscay, Spain. ENDOCRINOL DIAB NUTR 2024; 71:332-339. [PMID: 39374995 DOI: 10.1016/j.endien.2024.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Accepted: 05/03/2024] [Indexed: 10/09/2024]
Abstract
OBJECTIVE To update the incidence rate (IR) and trends of type 1 diabetes mellitus (T1DM) in children aged 0-14 years from 2003 to 2022, in Biscay, Spain. SUBJECTS AND METHOD We used the capture-recapture method: primary cases were prospectively extracted from the hospital registry and a secondary independent data source was obtained from diabetes associations and a public health database. The IRs standardized by age and sex were calculated using the direct method, assuming an equal distribution in each age/sex group. The IR occurring during the various COVID-19 waves was compared with the pre-pandemic IR. RESULTS A total of 378 new cases were identified. The mean age at diagnosis was 9.7 years (5.8-11.9). The completeness of ascertainment was 99.1%. The mean annual age-standardized IR was 12.92 (95%CI, 11.35-13.91). The mean IRs for the 0-4, 5-9, and 10-14 age groups were 7.67, 13.41 and 17.83 cases/100,000 children/year, respectively. The IR trend was statistically significant in the entire group and in the 5-9 year-old group with a mean annual increase of 1.9% (95%CI, 0.1-3.8) and 3.3% (95%CI, 1.002-1.065); p=0.039. The 5-year period analysis confirmed that the increase was significant only in the last 5 years (20%). When 2020-2022 (pandemic) and 2017-2019 (pre-pandemic) periods were compared this difference goes up to 44.5%; p=0.029. CONCLUSIONS After a long period of stability in the IR of T1DM in children younger than 15 years of age in Biscay, Spain, an increase in recent years has been reported, which is consistent with the SARS-CoV2 pandemic, with the largest increase being reported in the 5-to 9-year-old age group.
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Affiliation(s)
- Concepción Fernández-Ramos
- Pediatric Endocrinology Unit, Biobizkaia Health Research Institute, Basurto University Hospital, University of the Basque Country (UPV/EHU), Avenida Montevideo 18, 48013 Bilbao, Bizkaia, Spain.
| | - Eunate Arana-Arri
- Clinical Epidemiology Unit, Biobizkaia Health Research Institute, Cruces University Hospital, Plaza de Cruces s/n, 48903 Barakaldo, Bizkaia, Spain
| | - Amaia Vela
- Pediatric Endocrinology Unit, Biobizkaia Health Research Institute, Cruces University Hospital, University of the Basque Country (UPV/EHU), CIBERDEM, Plaza de Cruces s/n, 48903 Barakaldo, Bizkaia, Spain
| | - Inés Urrutia
- Biobizkaia Health Research Institute, CIBERDEM, CIBERER, University of the Basque Country (UPV/EHU), Endo-ERN, Plaza de Cruces s/n, 48903 Barakaldo, Bizkaia, Spain
| | - Borja Santos Zorrozua
- Bioinformatics, Biostatistics and Information Systems Unit, Biobizkaia Health Research Institute, Plaza de Cruces s/n, 48903 Barakaldo, Bizkaia, Spain
| | - Itxaso Rica
- Pediatric Endocrinology Unit, Biobizkaia Health Research Institute, Cruces University Hospital, CIBERDEM, CIBERER, Plaza de Cruces s/n, 48903 Barakaldo, Bizkaia, Spain
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Roche EF, McKenna AM, O'Regan M, Ryder KJ, Fitzgerald HM, Hoey HMCV. The incidence of type 1 diabetes in children under 15 years of age is rising again-a nationwide study. Eur J Pediatr 2023; 182:4615-4623. [PMID: 37550598 PMCID: PMC10587220 DOI: 10.1007/s00431-023-05125-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/08/2023] [Accepted: 07/18/2023] [Indexed: 08/09/2023]
Abstract
International incidence rates (IRs) and trends of childhood type 1 diabetes (T1D) vary. Recent data from Ireland and other high incidence countries suggested a stabilisation in IRs of T1D in children aged under 15 years. Our primary objective was to report the IR of T1D in children in Ireland from 2019 to 2021 and evaluate if age, sex and season of diagnosis had changed. Incident cases of T1D in those aged under 15 years were identified prospectively by clinicians nationally and reported to the Irish Childhood Diabetes National Register (ICDNR). Following case verification, capture-recapture methodology was applied, and IRs calculated. Numbers of children including age, sex and season of diagnosis per year were evaluated. There were 1027 cases, 542 males (53%). The direct standardised incidence rates (SIRs) increased by 21% overall and were 31.1, 32.2 and 37.6/100,000/year, respectively, with no significant sex difference. The highest IRs were in the 10-14-year category until 2021, then changed to the 5-9-year category (40% of cases). Whilst autumn and winter remain dominant diagnostic seasons, seasonality differed in 2021 with a greater number presenting in spring. CONCLUSION The incidence of childhood T1D in Ireland is increasing, observed prior to the COVID-19 pandemic, and shifting to an earlier age at diagnosis for the first time. The pattern of seasonality also appears to have changed. This may reflect an increased severity of diabetes with important implications for healthcare providers. WHAT IS KNOWN • Ireland has a very high incidence of T1D in childhood, which had stabilised following a rapid rise, similar to other high incidence countries. • The incidence rate is consistently highest in older children (10-14 years). WHAT IS NEW • Irish IR is no longer stable and has increased again, with the highest incidence occurring in the younger 5-9 age category for the first time. • The seasonality of diagnosis has changed during the COVID-19 pandemic years of 2020-2021.
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Affiliation(s)
- Edna F Roche
- The Discipline of Paediatrics, School of Medicine, Trinity College Dublin, Dublin, Ireland.
- The Department of Paediatric Growth, Diabetes, and Endocrinology, Children's Health Ireland (CHI) at, Tallaght University Hospital, Dublin, Ireland.
| | - Amanda M McKenna
- The Discipline of Paediatrics, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Myra O'Regan
- The Discipline of Paediatrics, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Kerry J Ryder
- The Research and Evidence Office, Health Service Executive, Dublin, Ireland
| | - Helen M Fitzgerald
- The Department of Paediatric Growth, Diabetes, and Endocrinology, Children's Health Ireland (CHI) at, Tallaght University Hospital, Dublin, Ireland
| | - Hilary M C V Hoey
- The Discipline of Paediatrics, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Sarfo-Kantanka O, Asamoah-Boaheng M, Arthur J, Agyei M, Barnes NA, Tenkorang EY, Midodzi W. Trends in type 1 diabetes diagnosis in Ghana. Int Health 2022; 14:442-446. [PMID: 32050027 PMCID: PMC9248061 DOI: 10.1093/inthealth/ihz096] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 08/26/2019] [Accepted: 09/13/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Despite the fact that the rate of type 1 diabetes (T1D) is increasing worldwide, there exists a dearth of information on the disease in most sub-Saharan African countries. The goal of this study was to determine the enrolment trend of T1D using data compiled over 28 y from a teaching hospital in Kumasi, Ghana. METHODS Information collected included sex, age at diagnosis and date of T1D diagnosis. We identified trends from 1992 to 2018, divided into 3 y intervals. RESULTS From 1992 to 2018, 1717 individuals with T1D were enrolled in the diabetes clinic at the Komfo Anokye Teaching Hospital. The male:female ratio was 1:1.2. The number of individuals diagnosed with T1D decreased among the 10-19 y age group during the 1992-1994 period, followed by a progressive increase within the same age group during the subsequent period (from 35.4% in 1995-1997 to 63.2% in 2016-2018). There was a decline in the proportion of children 0-9 y of age diagnosed during the study period (from 5.1% in 1992-1994 to 3.6% in 2016-2018). CONCLUSIONS In our study population, a decreasing trend of T1D enrolments was observed in general while among adolescents an increasing trend was observed.
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Affiliation(s)
- Osei Sarfo-Kantanka
- Directorate of Internal Medicine, Komfo Anokye Teaching Hospital, PO Box 1934, Kumasi, Ghana
| | - Michael Asamoah-Boaheng
- Faculty of Medicine, Clinical Epidemiology Unit, Memorial University of Newfoundland, St John’s, NL, Canada
| | - Joshua Arthur
- Public Health Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Martin Agyei
- Directorate of Internal Medicine, Komfo Anokye Teaching Hospital, PO Box 1934, Kumasi, Ghana
- Department of Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Nana Ama Barnes
- Department of Internal Medicine, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Eric Y Tenkorang
- Department of Sociology, Memorial University of Newfoundland, St Johns, NL, Canada
| | - William Midodzi
- Faculty of Medicine, Clinical Epidemiology Unit, Memorial University of Newfoundland, St John’s, NL, Canada
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Bacus IP, Mahomed H, Murphy AM, Connolly M, Neylon O, O'Gorman C. Play, art, music and exercise therapy impact on children with diabetes. Ir J Med Sci 2022; 191:2663-2668. [PMID: 35037160 DOI: 10.1007/s11845-021-02889-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 12/07/2021] [Indexed: 11/30/2022]
Abstract
Diabetes mellitus (DM) is a global public health issue. Type 1 diabetes (T1D) is the predominant diabetes type in children and always requires insulin therapy. The incidence rate of newly diagnosed T1D in children continues to increase in Ireland Roche et al. (Eur J Pediatr 175(12):1913-1919, 2016) and worldwide Patterson et al. (Diabetologia 62(3):408-417, 2019). The objective of this study was to conduct a literature review of the effects of various non-pharmacological therapeutic modalities on the control of diabetes in children. A literature review was performed using PubMed, Medline, Embase and Cochrane library to evaluate play, art, music and exercise therapy in the treatment of DM using the keywords: "paediatric", "diabetes", "play therapy", "art therapy", "music therapy" and "exercise therapy". These search terms initially returned 270 cases, which resulted in a total of 11 papers being reviewed after eliminating duplicate or irrelevant papers. Literature review showed that all therapies have a positive impact on the child, but there is limited research looking at the impact of therapy on quantitative measures such as HbA1c or 'time in range'.
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Affiliation(s)
- Ioana Patricia Bacus
- Department of Paediatrics, School of Medicine, University of Limerick, Limerick, Ireland.
| | - Husnain Mahomed
- Department of Paediatrics, University of Limerick, Limerick, Ireland
| | - Anne-Marie Murphy
- Department of Paediatrics, School of Medicine, University of Limerick, Limerick, Ireland
- Department of Paediatrics, University of Limerick, Limerick, Ireland
| | - Muiriosa Connolly
- Department of Paediatrics, School of Medicine, University of Limerick, Limerick, Ireland
- Department of Paediatrics, University of Limerick, Limerick, Ireland
| | - Orla Neylon
- Department of Paediatrics, School of Medicine, University of Limerick, Limerick, Ireland
- Department of Paediatrics, University of Limerick, Limerick, Ireland
| | - Clodagh O'Gorman
- Department of Paediatrics, School of Medicine, University of Limerick, Limerick, Ireland
- Department of Paediatrics, University of Limerick, Limerick, Ireland
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5
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Increasing incidence of type 1 and 2 diabetes among Canadian children. Can J Diabetes 2021; 46:189-195. [DOI: 10.1016/j.jcjd.2021.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/13/2021] [Accepted: 08/14/2021] [Indexed: 11/20/2022]
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McKenna A, O'Regan M, Ryder K, Fitzgerald H, Hoey H, Roche E. Incidence of childhood type 1 diabetes mellitus in Ireland remains high but no longer rising. Acta Paediatr 2021; 110:2142-2148. [PMID: 33690888 DOI: 10.1111/apa.15836] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/05/2021] [Accepted: 03/09/2021] [Indexed: 11/30/2022]
Abstract
AIM The global incidence of type 1 diabetes mellitus (T1DM) varies considerably geographically. Ireland has a high incidence of T1DM. Incidence accelerated between 1997 and 2008, although more recent data (2008-2013) suggested stabilisation in the incidence rate (IR). This study sought to determine IRs for 2014 to 2018. METHODS Incident cases were prospectively recorded through the established Irish Childhood Diabetes National Register (ICDNR). Cases were verified, and IRs were calculated. Capture-recapture methodology was identical to previous studies. Age and seasonality data were compared. RESULTS A total of 1429 cases were reported (age range 0.45-14.98 years), with significantly more males (772, 54%) and male-to-female ratio of 1.17 (95% CI 1.05, 1.29). Standardised IRs for T1DM in the period were 28.0; 29.6; 30.9; 27.0; and 27.1/100,000/year, respectively. There was a slight reduction in standardised IR, more marked in females than males (9.9% v 1.6%). The highest IR remains in the 10- to 14-year-old age group (44% of total cases). Seasonality of diagnosis is persistently higher in autumn and winter. CONCLUSION Ireland remains a high incidence country, despite a minor reduction in incidence rates. Ongoing incidence monitoring through national registers is vital to inform healthcare services, research relating to aetiology and paediatric diabetes management.
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Affiliation(s)
- Amanda McKenna
- The Department of Paediatrics Trinity College Dublin The University of Dublin Dublin Ireland
| | - Myra O'Regan
- The Department of Statistics Trinity College Dublin The University of Dublin Dublin Ireland
| | - Kerry Ryder
- The National Immunisation Office Dublin Ireland
| | - Helen Fitzgerald
- The Department of Paediatric Growth, Diabetes and Endocrinology Children’s Health Ireland (CHI) at Tallaght University Hospital Dublin Ireland
| | - Hilary Hoey
- The Department of Paediatrics Trinity College Dublin The University of Dublin Dublin Ireland
| | - Edna Roche
- The Department of Paediatrics Trinity College Dublin The University of Dublin Dublin Ireland
- The Department of Paediatric Growth, Diabetes and Endocrinology Children’s Health Ireland (CHI) at Tallaght University Hospital Dublin Ireland
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7
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Harvey JN, Hibbs R, Maguire MJ, O'Connell H, Gregory JW. The changing incidence of childhood-onset type 1 diabetes in Wales: Effect of gender and season at diagnosis and birth. Diabetes Res Clin Pract 2021; 175:108739. [PMID: 33711398 DOI: 10.1016/j.diabres.2021.108739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/15/2021] [Accepted: 02/22/2021] [Indexed: 10/22/2022]
Abstract
AIMS Determinants of the changing incidence of childhood-onset type 1 diabetes remain uncertain. We determined the recent time-trend of type 1 diabetes incidence in Wales and explored the role of vitamin D by evaluating the influence of season both at diagnosis and at birth. METHODS Data from all Welsh paediatric units 1990-2019, and from primary care to determine ascertainment. RESULTS Log-linear modelling indicated a non-linear secular trend in incidence with peak and subsequent decline. The peak occurred around June 2010: 31∙3 cases/year/100,000 children aged < 15y. It occurred earlier in children younger at diagnosis and earlier in boys. There were more cases in males aged <2y and >12y but more in females aged 9-10 y. More were diagnosed in winter. Also, children born in winter had less risk of future diabetes. CONCLUSIONS The risk of developing type 1 diabetes before age 15y in Wales is no longer increasing. The data on season are consistent with a preventative role for vitamin D both during pregnancy and later childhood. Metereological Office data shows increasing hours of sunlight since 1980 likely to increase vitamin D levels with less diabetes. Additional dietary supplementation with vitamin D might further reduce the incidence of type 1 diabetes.
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Affiliation(s)
- J N Harvey
- Wrexham Academic Unit, Bangor University, United Kingdom.
| | - R Hibbs
- Wrexham Academic Unit, Bangor University, United Kingdom
| | - M J Maguire
- Department of Child Health, Prince Charles Hospital, Merthyr Tydfil, United Kingdom
| | - H O'Connell
- Division of Population Health, School of Medicine, Cardiff University, United Kingdom
| | - J W Gregory
- Division of Population Health, School of Medicine, Cardiff University, United Kingdom
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Rafferty J, Stephens JW, Atkinson MD, Luzio SD, Akbari A, Gregory JW, Bain S, Owens DR, Thomas RL. A retrospective epidemiological study of type 1 diabetes mellitus in wales, UK between 2008 and 2018. Int J Popul Data Sci 2021; 6:1387. [PMID: 34007896 PMCID: PMC8103995 DOI: 10.23889/ijpds.v6i1.1387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Introduction Studies of prevalence and the demographic profile of type 1 diabetes are challenging because of the relative rarity of the condition, however, these outcomes can be determined using routine healthcare data repositories. Understanding the epidemiology of type 1 diabetes allows for targeted interventions and care of this life-affecting condition. Objectives To describe the prevalence, incidence and demographics of persons with type 1 diabetes diagnosed in Wales, UK, using the Secure Anonymised Information Linkage (SAIL) Databank. Methods Data derived from primary and secondary care throughout Wales available in the SAIL Databank were used to identify people with type 1 diabetes to determine the prevalence and incidence of type 1 diabetes over a 10 year period (2008-18) and describe the demographic and clinical characteristics of this population by age, socioeconomic deprivation and settlement type. The seasonal variation in incidence rates was also examined. Results The prevalence of type 1 diabetes in 2018 was 0.32% in the whole population, being greater in men compared to women (0.35% vs 0.28% respectively); highest in those aged 15-29 years (0.52%) and living in the most socioeconomically deprived areas (0.38%). The incidence of type 1 diabetes over 10 years was 14.0 cases/100,000 people/year for the whole population of Wales. It was highest in children aged 0-14 years (33.6 cases/100,000 people/year) and areas of high socioeconomic deprivation (16.8 cases/100,000 people/year) and least in those aged 45-60 years (6.5 cases/100,000 people/year) and in areas of low socioeconomic deprivation (11.63 cases/100,000 people/year). A seasonal trend in the diagnoses of type 1 diabetes was observed with higher incidence in winter months. Conclusion This nation-wide retrospective epidemiological study using routine data revealed that the incidence of type 1 diabetes in Wales was greatest in those aged 0-14 years with a higher incidence and prevalence in the most deprived areas. These findings illustrate the need for health-related policies targeted at high deprivation areas to include type 1 diabetes in their remit.
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Affiliation(s)
- James Rafferty
- Health Data Research UK, Swansea University Medical School, Singleton Park, Swansea, UK
| | - Jeffery W Stephens
- Diabetes Research Unit Cymru, Swansea University Medical School, Singleton Park, Swansea, UK
| | - Mark D Atkinson
- Swansea University Medical School, Singleton Park, Swansea, UK
| | - Stephen D Luzio
- Diabetes Research Unit Cymru, Swansea University Medical School, Singleton Park, Swansea, UK
| | - Ashley Akbari
- Health Data Research UK, Swansea University Medical School, Singleton Park, Swansea, UK
| | - John W Gregory
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Stephen Bain
- Diabetes Research Unit Cymru, Swansea University Medical School, Singleton Park, Swansea, UK
| | - David R Owens
- Diabetes Research Unit Cymru, Swansea University Medical School, Singleton Park, Swansea, UK
| | - Rebecca L Thomas
- Diabetes Research Unit Cymru, Swansea University Medical School, Singleton Park, Swansea, UK
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Mavinkurve M, Jalaludin MY, Chan EWL, Noordin M, Samingan N, Leong A, Zaini AA. Is Misdiagnosis of Type 1 Diabetes Mellitus in Malaysian Children a Common Phenomenon? Front Endocrinol (Lausanne) 2021; 12:606018. [PMID: 33763028 PMCID: PMC7982891 DOI: 10.3389/fendo.2021.606018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 01/25/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Children with Type 1 diabetes (T1DM) commonly present in diabetic ketoacidosis (DKA) at initial diagnosis. This is likely due to several factors, one of which includes the propensity for T1DM to be misdiagnosed. The prevalence of misdiagnosis has been reported in non-Asian children with T1DM but not in Asian cohorts. AIM To report the rate of misdiagnosis and its associated risk factors in Malaysian children and adolescents with T1DM. METHODS A retrospective analysis of children with T1DM below 18 years of age over a 10 year period was conducted. RESULTS The cohort included 119 children (53.8% female) with a mean age 8.1 SD ± 3.9 years. 38.7% of cases were misdiagnosed, of which respiratory illnesses were the most common (37.0%) misdiagnosis. The rate of misdiagnosis remained the same over the 10 year period. Among the variables examined, younger age at presentation, DKA at presentation, healthcare professional (HCP) contact and admission to the intensive care unit were significantly different between the misdiagnosed and correctly diagnosed groups (p <0.05). CONCLUSION Misdiagnosis of T1DM occurs more frequently in Malaysian children <5 years of age. Misdiagnosed cases are at a higher risk of presenting in DKA with increased risk of ICU admission and more likely to have had prior HCP contact. Awareness of T1DM amongst healthcare professionals is crucial for early identification, prevention of DKA and reducing rates of misdiagnosis.
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Affiliation(s)
- Meenal Mavinkurve
- Department of Paediatrics, School of Medicine, International Medical University, Wilayah Persekutuan, Kuala Lumpur, Malaysia
- Department of Paediatrics, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Muhammad Yazid Jalaludin
- Department of Paediatrics, University Malaya Medical Centre, Kuala Lumpur, Malaysia
- Department of Paediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Elaine Wan Ling Chan
- Institute for Research, Development and Innovation, International Medical University, Kuala Lumpur, Malaysia
| | - Mazidah Noordin
- Department of Paediatrics, University Malaya Medical Centre, Kuala Lumpur, Malaysia
- Department of Paediatrics, School of Medicine, University Teknologi MARA, Selangor, Malaysia
| | - Nurshadia Samingan
- Department of Paediatrics, University Malaya Medical Centre, Kuala Lumpur, Malaysia
- Department of Paediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Annie Leong
- Department of Paediatrics, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Azriyanti Anuar Zaini
- Department of Paediatrics, University Malaya Medical Centre, Kuala Lumpur, Malaysia
- Department of Paediatrics, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
- *Correspondence: Azriyanti Anuar Zaini,
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Parviainen A, But A, Siljander H, Knip M. Decreased Incidence of Type 1 Diabetes in Young Finnish Children. Diabetes Care 2020; 43:2953-2958. [PMID: 32998988 DOI: 10.2337/dc20-0604] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 09/04/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The incidence of type 1 diabetes has been rising for decades, particularly among young children. Between 2006 and 2011, the incidence rate (IR) reached a plateau in Finland. In this observational, register-based cohort study, we assess recent trends in the disease rate in Finnish children. RESEARCH DESIGN AND METHODS Based on data from the Finnish Pediatric Diabetes Register, we studied the incidence of type 1 diabetes among children younger than 15 years of age between 2003 and 2018. We assessed sex-specific IRs per 100,000 person-years (PY) by 4-year time periods in three age-groups (0.50-4.99, 5.00-9.99, and 10.00-14.99 years). RESULTS Among the 7,871 children with newly diagnosed type 1 diabetes, the median age at diagnosis increased from 7.88 to 8.33 years (P = 0.001), while the overall IR decreased from 57.9/100,000 PY in 2003-2006 to 52.2/100,000 PY in 2015-2018, yielding an IR ratio (IRR) of 0.90 (95% CI 0.85-0.96, P = 0.001). This decline was mainly due to the decrease in the youngest age-group (IRR 0.77 [95% CI 0.68-0.87]; P < 0.001), being significant both among boys and girls. In the middle age-group, a significant decrease was observed only among girls. No changes were observed in the oldest children. CONCLUSIONS The incidence of type 1 diabetes decreased among young Finnish children between 2003 and 2018. Current findings imply that environmental factors driving the immune system toward islet autoimmunity are changing in young children.
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Affiliation(s)
- Anna Parviainen
- Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Anna But
- Biostatistics consulting, Department of Public Health, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Heli Siljander
- Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Mikael Knip
- Pediatric Research Center, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland .,Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland.,Center for Child Health Research, Tampere University Hospital, Tampere, Finland.,Folkhälsan Research Center, Helsinki, Finland
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Rami‐Merhar B, Hofer SE, Fröhlich‐Reiterer E, Waldhoer T, Fritsch M. Time trends in incidence of diabetes mellitus in Austrian children and adolescents <15 years (1989-2017). Pediatr Diabetes 2020; 21:720-726. [PMID: 32410357 PMCID: PMC7383999 DOI: 10.1111/pedi.13038] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 04/24/2020] [Accepted: 05/06/2020] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To analyze the time trends of nationwide diabetes incidence <15 years of age from 1989 until 2017 in Austria. METHODS The Austrian Diabetes Incidence Study Group registers all newly diagnosed patients with diabetes mellitus <15 years of age in a prospective population-based study. The diabetes type was classified on the basis of clinical and laboratory findings according to American Diabetes Association criteria. Time trends were estimated by Joinpoint analysis. RESULTS 1311 patients were diagnosed with type 1 diabetes (T1D) between 1989 and 1999 and 4624 patients with any type of diabetes (1999-2017). T1D accounted for the majority of cases (94.2%), 1.8% were classified as type 2 (T2D) and 4.0% as other specific types of diabetes (1999-2017). In the total cohort (age 0 to <15 years), a constant increase until 2012 (annual percent change [APC] 4.5, 95% confidence interval [CI]: 3.94, 5.06) was observed, followed by a leveling off with a corresponding drop (APC 0.28, 95%CI: -3.94, 4.69). This observation was mainly driven by the dynamic in the youngest age group (0-4 years) with a steep increase until 2007 (APC 7.1, 95%CI: 5.05, 9.19) and a decrease from 2007 to 2017 (APC -0.86, 95%CI: 4.41, 2.82). No significant increase of T2D <15 years was detected. Over the observed time period (APC = 3.7, 95%CI: -0.30, 7.78). CONCLUSIONS The incidence of T1D is declining in young children aged 0 to 4 years, but is still rising in children 5 to 14 years in Austria. Incidence of T2D did not increase significantly and other specific types of diabetes occur twice as often compared to T2D.
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Affiliation(s)
- Birgit Rami‐Merhar
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for PediatricsMedical University of ViennaViennaAustria
| | - Sabine E. Hofer
- Department of PediatricsMedical University of InnsbruckInnsbruckAustria
| | | | - Thomas Waldhoer
- Department of Epidemiology, Center of Public HealthMedical University of ViennaViennaAustria
| | - Maria Fritsch
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for PediatricsMedical University of ViennaViennaAustria,Department of Pediatrics and Adolescent MedicineMedical University of GrazGrazAustria
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12
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Gajewska KA, Biesma R, Sreenan S, Bennett K. Prevalence and incidence of type 1 diabetes in Ireland: a retrospective cross-sectional study using a national pharmacy claims data from 2016. BMJ Open 2020; 10:e032916. [PMID: 32312725 PMCID: PMC7245400 DOI: 10.1136/bmjopen-2019-032916] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES The aim of this study is to estimate the prevalence and incidence of type 1 diabetes in the Irish population using a national pharmacy claims database in the absence of a national diabetes register. DESIGN National, population-based, retrospective, cross-sectional study. SETTING Community care with data available through the Health Service Executive Pharmacy Claims Reimbursement Scheme from 2011 to 2016. PARTICIPANTS Individuals with type 1 diabetes were identified by coprescription of insulin and glucometer test strips without any prolonged course (>12 months) of oral hypoglycaemic agents prior to commencing insulin. Those claiming prescriptions for long-acting insulin only, without any prandial insulin, were excluded from the analysis. Incidence was estimated based on the first claim for insulin in 2016, with no insulin use in the preceding 12 months. MAIN OUTCOME MEASURES Prevalence of type 1 diabetes in children (<18 years) and adults (≥18 years); incidence of type 1 diabetes in children (≤14 years) and adolescents and adults (>14 years). RESULTS There were 20 081 prevalent cases of type 1 diabetes in 2016. The crude prevalence was 0.42% (95% CI 0.42% to 0.43%). Most prevalent cases (n=17 053, 85%) were in adults with a prevalence of 0.48% (95% CI 0.47% to 0.48%). There were 1527 new cases of type 1 diabetes in 2016, giving an incidence rate of 32 per 100 000 population/year (95% CI 30.5 to 33.7). There was a significant positive linear trend for age, for prevalence (p<0.0001) and incidence (p=0.014). The prevalence and incidence were 1.2-fold and 1.3-fold higher in men than women, respectively. Significant variations in prevalence (p<0.0001) and incidence (p<0.001) between the different geographical regions were observed. CONCLUSIONS This study provides epidemiological estimates of type 1 diabetes across age groups in Ireland, with the majority of prevalent cases in adults. Establishing a national diabetes register is essential to enable updated epidemiological estimates of diabetes and for planning of services in Ireland.
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Affiliation(s)
- Katarzyna Anna Gajewska
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Regien Biesma
- Global Health Unit, Department of Health Sciences, University Medical Centre Groningen, Groningen, The Netherlands
| | - Seamus Sreenan
- 3U Diabetes, Royal College of Surgeons in Ireland, Dublin, Ireland
- Department of Diabetes and Endocrinology, Connolly Hospital Blanchardstown, Blanchardstown, Dublin, Ireland
| | - Kathleen Bennett
- Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
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13
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Hannigan A, Villarroel N, Roura M, LeMaster J, Basogomba A, Bradley C, MacFarlane A. Ethnicity recording in health and social care data collections in Ireland: where and how is it measured and what is it used for? Int J Equity Health 2019; 19:2. [PMID: 31892328 PMCID: PMC6938635 DOI: 10.1186/s12939-019-1107-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 12/09/2019] [Indexed: 12/25/2022] Open
Abstract
Background In the European Union (EU), discrimination based on racial and ethnic origin is prohibited under the Racial Equality Directive. Ireland is one of only three EU countries where a legal duty of equality data collection is placed on public bodies. It provides an important context in which to study ethnic equality monitoring; however no systematic mapping of where it occurs in health information systems has been carried out. The aim of this study is to identify all existing national health and social care data collections with information on ethnicity and to explore how this data has been collected and used. Methods An electronic search of a national catalogue of health and social care data collections (N = 97) was carried out to identify any collections which contained information on ethnicity. Data dictionaries were searched and key informants contacted. For each of the data collections that collected information on ethnicity, data was extracted on the ethnic categories used and how this data is collected; the completeness of ethnicity recording; and other measures related to ethnicity in the data collection. Relevant outputs for these data collections, related to ethnicity, were identified through key informants and electronic searches. Results Of the 97 data collections, 14 (14%) collected information on ethnic or cultural background. Country of birth was collected by 10 of these 14 data collections. Most used the ethnic categories in the Census and recommended that ethnicity should be self-identified and not assigned. Reported rates of identification were generally high (≥90%). Data collections which recorded ethnicity tended to be focused on potentially high-risk populations with no routine recording in primary care. There were some examples of where ethnic equality monitoring had informed targeted interventions e.g. vaccination awareness initiatives or cultural training for healthcare staff. Conclusions Despite strong policy and legal imperatives, there is limited data collection of ethnicity in health and social care data collections in Ireland. While there are some examples of where differences by ethnicity have been identified and acted upon, a more coordinated and comprehensive approach to the collection, quality and utilization of ethnicity data is needed to promote health equity.
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Affiliation(s)
- Ailish Hannigan
- Public and Patient Involvement Research Unit, Graduate Entry Medical School, University of Limerick, Limerick, V94 T9PX, Ireland. .,Health Research Institute, University of Limerick, Limerick, Ireland.
| | - Nazmy Villarroel
- Public and Patient Involvement Research Unit, Graduate Entry Medical School, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Maria Roura
- Public and Patient Involvement Research Unit, Graduate Entry Medical School, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Joseph LeMaster
- Department of Family Medicine and Community Health, University of Kansas School of Medicine, Kansas City, Kansas, USA
| | - Alphonse Basogomba
- Intercultural and Diversity Education Centre - Ireland (IDEC-Ireland), Ennis, Co. Clare, Ireland
| | | | - Anne MacFarlane
- Public and Patient Involvement Research Unit, Graduate Entry Medical School, University of Limerick, Limerick, V94 T9PX, Ireland.,Health Research Institute, University of Limerick, Limerick, Ireland
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14
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Gomez-Lopera N, Pineda-Trujillo N, Diaz-Valencia PA. Correlating the global increase in type 1 diabetes incidence across age groups with national economic prosperity: A systematic review. World J Diabetes 2019; 10:560-580. [PMID: 31915518 PMCID: PMC6944530 DOI: 10.4239/wjd.v10.i12.560] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 10/17/2019] [Accepted: 10/29/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The global epidemiology of type 1 diabetes (T1D) is not yet well known, as no precise data are available from many countries. T1D is, however, characterized by an important variation in incidences among countries and a dramatic increase of these incidences during the last decades, predominantly in younger children. In the United States and Europe, the increase has been associated with the gross domestic product (GDP) per capita. In our previous systematic review, geographical variation of incidence was correlated with socio-economic factors.
AIM To investigate variation in the incidence of T1D in age categories and search to what extent these variations correlated with the GDP per capita.
METHODS A systematic review was performed to retrieve information about the global incidence of T1D among those younger than 14 years of age. The study was carried out according to the PRISMA recommendations. For the analysis, the incidence was organized in the periods: 1975-1999 and 2000-2017. We searched the incidence of T1D in the age-groups 0-4, 5-9 and 10-14. We compared the incidences in countries for which information was available for the two periods. We obtained the GDP from the World Bank. We analysed the relationship between the incidence of T1D with the GDP in countries reporting data at the national level.
RESULTS We retrieved information for 84 out of 194 countries around the world. We found a wide geographic variation in the incidence of T1D and a worldwide increase during the two periods. The largest contribution to this increase was observed in the youngest group of children with T1D, with a relative increase of almost double when comparing the two periods (P value = 2.5 × e-5). Twenty-six countries had information on the incidence of T1D at the national level for the two periods. There was a positive correlation between GDP and the incidence of T1D in both periods (Spearman correlation = 0.52 from 1975-1999 and Spearman correlation = 0.53 from 2000-2017).
CONCLUSION The incidence increase was higher in the youngest group (0-4 years of age), and the highest incidences of T1D were found in wealthier countries.
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Affiliation(s)
- Natalia Gomez-Lopera
- Grupo Mapeo Genetico, Departamento de Pediatría, Facultad de Medicina, Universidad de Antioquia, Medellín 050010470, Colombia
| | - Nicolas Pineda-Trujillo
- Grupo Mapeo Genetico, Departamento de Pediatría, Facultad de Medicina, Universidad de Antioquia, Medellín 050010470, Colombia
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15
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Walsh NA, O'Dea MI, O'Grady MJ. The apparent low incidence of paediatric Type 2 diabetes in the Republic of Ireland is multifactorial. Diabet Med 2019; 36:1715-1716. [PMID: 30552767 DOI: 10.1111/dme.13877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- N A Walsh
- Department of Paediatrics, Midland Regional Hospital, Mullingar, Co. Westmeath, Ireland
| | - M I O'Dea
- Department of Paediatrics, Midland Regional Hospital, Mullingar, Co. Westmeath, Ireland
| | - M J O'Grady
- Department of Paediatrics, Midland Regional Hospital, Mullingar, Co. Westmeath, Ireland
- Women's and Children's Health, School of Medicine, University College Dublin, Ireland
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16
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Trefz P, Obermeier J, Lehbrink R, Schubert JK, Miekisch W, Fischer DC. Exhaled volatile substances in children suffering from type 1 diabetes mellitus: results from a cross-sectional study. Sci Rep 2019; 9:15707. [PMID: 31673076 PMCID: PMC6823423 DOI: 10.1038/s41598-019-52165-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 10/10/2019] [Indexed: 02/06/2023] Open
Abstract
Monitoring metabolic adaptation to type 1 diabetes mellitus in children is challenging. Analysis of volatile organic compounds (VOCs) in exhaled breath is non-invasive and appears as a promising tool. However, data on breath VOC profiles in pediatric patients are limited. We conducted a cross-sectional study and applied quantitative analysis of exhaled VOCs in children suffering from type 1 diabetes mellitus (T1DM) (n = 53) and healthy controls (n = 60). Both groups were matched for sex and age. For breath gas analysis, a very sensitive direct mass spectrometric technique (PTR-TOF) was applied. The duration of disease, the mode of insulin application (continuous subcutaneous insulin infusion vs. multiple daily insulin injection) and long-term metabolic control were considered as classifiers in patients. The concentration of exhaled VOCs differed between T1DM patients and healthy children. In particular, T1DM patients exhaled significantly higher amounts of ethanol, isopropanol, dimethylsulfid, isoprene and pentanal compared to healthy controls (171, 1223, 19.6, 112 and 13.5 ppbV vs. 82.4, 784, 11.3, 49.6, and 5.30 ppbV). The most remarkable differences in concentrations were found in patients with poor metabolic control, i.e. those with a mean HbA1c above 8%. In conclusion, non-invasive breath testing may support the discovery of basic metabolic mechanisms and adaptation early in the progress of T1DM.
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Affiliation(s)
- Phillip Trefz
- Department of Anesthesiology and Intensive Care Medicine, Rostock Medical Breath Research Analytics and Technologies (ROMBAT), Rostock University Medical Centre, Rostock, Germany.
| | - Juliane Obermeier
- Department of Anesthesiology and Intensive Care Medicine, Rostock Medical Breath Research Analytics and Technologies (ROMBAT), Rostock University Medical Centre, Rostock, Germany
| | - Ruth Lehbrink
- Department of Pediatrics, Rostock University Medical Centre, Rostock, Germany
| | - Jochen K Schubert
- Department of Anesthesiology and Intensive Care Medicine, Rostock Medical Breath Research Analytics and Technologies (ROMBAT), Rostock University Medical Centre, Rostock, Germany
| | - Wolfram Miekisch
- Department of Anesthesiology and Intensive Care Medicine, Rostock Medical Breath Research Analytics and Technologies (ROMBAT), Rostock University Medical Centre, Rostock, Germany
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17
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Non-Invasive Assessment of Metabolic Adaptation in Paediatric Patients Suffering from Type 1 Diabetes Mellitus. J Clin Med 2019; 8:jcm8111797. [PMID: 31717811 PMCID: PMC6912469 DOI: 10.3390/jcm8111797] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 10/22/2019] [Accepted: 10/25/2019] [Indexed: 02/06/2023] Open
Abstract
An analysis of exhaled volatile organic compounds (VOC) may deliver systemic information quicker than available invasive techniques. Metabolic aberrations in pediatric type 1 diabetes (T1DM) are of high clinical importance and could be addressed via breathomics. Real-time breath analysis was combined with continuous glucose monitoring (CGM) and blood tests in children suffering from T1DM and age-matched healthy controls in a highly standardized setting. CGM and breath-resolved VOC analysis were performed every 5 minutes for 9 hours and blood was sampled at pre-defined time points. Per participant (n = 44) food intake and physical activity were identical and a total of 22 blood samples and 93 minutes of breath samples were investigated. The inter-individual variability of glucose, insulin, glucagon, leptin, and soluble leptin receptor relative to food intake differed distinctly between patients and controls. In T1DM patients, the exhaled amounts of acetone, 2-propanol, and pentanal correlated to glucose concentrations. Of note, the strength of these correlations strongly depended on the interval between food intake and breath sampling. Our data suggests that metabolic adaptation through postprandial hyperglycemia and related oxidative stress is immediately reflected in exhaled breath VOC concentrations. Clinical translations of our findings may enable point-of-care applicability of online breath analysis towards personalized medicine.
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18
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de Oliveira Rassi T, Xavier Pietra R, Melo Silva Canton J, Novato Silva I. Temporal trend of newly diagnosed type 1 diabetes children and adolescents identified over a 35-year period in a Brazilian institution. Diabetes Res Clin Pract 2019; 151:82-87. [PMID: 30935926 DOI: 10.1016/j.diabres.2019.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 01/25/2019] [Accepted: 03/28/2019] [Indexed: 11/21/2022]
Abstract
AIMS To evaluate the temporal trend of newly diagnosed Type 1 Diabetes cases over a 35-year period in a reference Pediatric Endocrinology service in the city of Belo Horizonte, Brazil. METHODS Subjects were all children and adolescents diagnosed with Type 1 Diabetes in the Federal University of Minas Gerais Hospital. Information collected included: gender, age and date of Type 1 diabetes diagnosis. Temporal trends were analyzed between 1980 and 2014 and divided in 5-year intervals. RESULTS During this period 642 children and adolescents were diagnosed with Type 1 diabetes. From 1980 to 1994 there was an increase in the proportion of children diagnosed between 0 and 4 years old, followed by progressive decrease in the subsequent decades (47% in 1990-1994 to 20% in 2010-2014; p = 0.01). There was an increase in the proportion of children diagnosed between 10 and 18 years old (13% in 1990-1994 to 54% in 2010-2014; p = 0.01). There was no statistical difference in the proportion of children diagnosed between 5 and 9 years old through the studied time. CONCLUSIONS In the studied population Type 1 Diabetes in infants and toddlers seems to be decreasing throughout the years while in the age group older than 10 years, it seems to be increasing.
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Affiliation(s)
- Tatiana de Oliveira Rassi
- Federal University of Minas Gerais, School of Medicine, Av. Prof. Alfredo Balena, 190, Belo Horizonte, Minas Gerais CEP:30130-100, Brazil.
| | - Rafaella Xavier Pietra
- Belo Horizonte University Center, School of Medicine, Av. Professor Mário Werneck, 1685, Buritis, Belo Horizonte, Minas Gerais CEP 30575-180, Brazil
| | - Juliane Melo Silva Canton
- Federal University of Minas Gerais, University Hospital, Av. Prof. Alfredo Balena, 110, Belo Horizonte, Minas Gerais CEP:30130-100, Brazil
| | - Ivani Novato Silva
- Federal University of Minas Gerais, School of Medicine, Av. Prof. Alfredo Balena, 190, Belo Horizonte, Minas Gerais CEP:30130-100, Brazil
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19
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Xia Y, Xie Z, Huang G, Zhou Z. Incidence and trend of type 1 diabetes and the underlying environmental determinants. Diabetes Metab Res Rev 2019; 35:e3075. [PMID: 30207035 DOI: 10.1002/dmrr.3075] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 08/27/2018] [Accepted: 09/09/2018] [Indexed: 12/15/2022]
Abstract
A wealth of epidemiological studies concerning the distribution of type 1 diabetes (T1D) around the world have pointed to the appreciable variation in the incidence of T1D among disparate age groups, ethnicities, and geographical locations. On the whole, the incidence of childhood T1D has been on the rise, and a plausible inverse relationship between the initial incidence rate and the following annual increase in incidence has been raised. Countries that used to exhibit lower incidences tend to have steep annual increase whereas those with already-established high incidences are more likely to show a modest increase or even stabilization in T1D incidence. Environmental agents considered responsible for the current evolving pattern of T1D incidence will be detailed, mainly including the increasing prevalence of childhood obesity, viral infections in a chronic manner, maternal-child interaction such as breastfeeding, and latitude-ultraviolet B-vitamin D pathway. Certain rationale has been put forward in an attempt to explain the potential association between environmental agents and development of T1D. For instance, accelerator hypothesis regards insulin resistance as the promoter of earlier disease onset in obese children whereas the negative correlation of microbial infections in background populations with incidence of T1D represents the basic component of the hygiene hypothesis. Further investigations are still warranted to verify these theories across multiple ethnic groups and to identify additional contributors to the variation in T1D incidence.
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Affiliation(s)
- Ying Xia
- Department of Metabolism & Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education; National Clinical Research Center for Metabolic Diseases, Changsha, Hunan, China
| | - Zhiguo Xie
- Department of Metabolism & Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education; National Clinical Research Center for Metabolic Diseases, Changsha, Hunan, China
| | - Gan Huang
- Department of Metabolism & Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education; National Clinical Research Center for Metabolic Diseases, Changsha, Hunan, China
| | - Zhiguang Zhou
- Department of Metabolism & Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education; National Clinical Research Center for Metabolic Diseases, Changsha, Hunan, China
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20
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Püttmann S, Koch J, Steinacker JP, Schmidt SA, Seufferlein T, Kratzer W, Schmidberger J, Manfras B. Ultrasound point shear wave elastography of the pancreas: comparison of patients with type 1 diabetes and healthy volunteers - results from a pilot study. BMC Med Imaging 2018; 18:52. [PMID: 30545313 PMCID: PMC6293554 DOI: 10.1186/s12880-018-0295-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 11/27/2018] [Indexed: 02/07/2023] Open
Abstract
Background The aims of this study were to establish shear wave elastography of the pancreas by comparing measurements in patients with type 1 diabetes (T1D) and healthy volunteers and to consider whether this method could contribute to the screening or prevention of T1D. Methods This pilot study included 15 patients with T1D (10 men, 5 women) and 15 healthy volunteers (10 men, 5 women) as controls. Measurements were performed with a Siemens Acuson S3000 (Siemens Healthcare, Erlangen, Germany) using a 6C1 convex transducer and the Virtual Touch™ tissue quantification (VTQ) method. Results The mean shear wave velocity of the head of the pancreas was 1.0 ± 0.2 m/s (median: 1.1 m/s) for the study group and likewise 1.0 ± 0.2 m/s (median: 0.9 m/s) for the control group. Velocities of 1.2 ± 0.2 m/s (median: 1.2 m/s) were measured in the body of the pancreas in both groups. There was a significant difference between the values obtained in the tail of the pancreas: patients 1.1 ± 0.1 m/s (median: 1.0 m/s) versus controls 0.9 ± 0.1 m/s (median: 0.8 m/s) (p = 0.0474). The mean value in the whole pancreas of the study group was not significantly above that of the control group: 1.1 ± 0.1 m/s (median: 1.0 m/s) versus 1.0 ± 0.1 m/s (median: 1.0 m/s) (p = 0.2453). Conclusions Sonoelastography of the pancreas revealed no overall difference between patients with T1D and healthy volunteers. Patients with T1D showed higher values only in the tail segment. Future studies need to determine whether specific regional differences can be found in a larger study population.
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Affiliation(s)
- Sophie Püttmann
- Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Janina Koch
- Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Jochen Paul Steinacker
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Stefan Andreas Schmidt
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Thomas Seufferlein
- Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
| | - Wolfgang Kratzer
- Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany.
| | - Julian Schmidberger
- Department of Internal Medicine I, University Hospital Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Germany
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Finn BP, Power C, McSweeney N, Breen D, Wyse G, O'Connell SM. Subarachnoid and parenchymal haemorrhages as a complication of severe diabetic ketoacidosis in a preadolescent with new onset type 1 diabetes. Pediatr Diabetes 2018; 19:1487-1491. [PMID: 30175460 DOI: 10.1111/pedi.12760] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/15/2018] [Accepted: 08/14/2018] [Indexed: 01/24/2023] Open
Abstract
Diabetic ketoacidosis (DKA) is one of the most common causes of morbidity and mortality in new onset type 1 diabetes mellitus (T1DM). Children have a higher rate of neurological complications from DKA when compared to adults. The differential for sudden focal neurological deterioration in the setting of DKA is cerebral oedema followed by ischaemic and haemorrhagic stroke. Spontaneous intracranial haemorrhages can present with non-specific features frequently, for example, impaired consciousness, even when biochemical parameters are improving in the setting of DKA. We report the case of a girl with new onset T1D who presented in severe DKA and subsequently developed intracerebral parenchymal and subarachnoid haemorrhages. Our patient is unique in that no focal neurological or neuropsychological deficits have been found at 1-year follow up, compared to the literature which suggests poor outcomes. Our case contrasts with these previous cases as none of the other case reports demonstrated subarachnoid haemorrhages with survival.
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Affiliation(s)
- Bryan P Finn
- Department of Paediatrics and Child Health, Cork University Hospital, Cork, Ireland
| | - Claire Power
- Department of Paediatrics and Child Health, Cork University Hospital, Cork, Ireland
| | - Niamh McSweeney
- Department of Paediatrics and Child Health, Cork University Hospital, Cork, Ireland
| | - Dorothy Breen
- Department of Intensive Care, Cork University Hospital, Cork, Ireland
| | - Gerald Wyse
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Susan M O'Connell
- Department of Paediatrics and Child Health, Cork University Hospital, Cork, Ireland
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22
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McCollum DC, Mason O, Codd MB, O'Grady MJ. Management of type 1 diabetes in primary schools in Ireland: a cross-sectional survey. Ir J Med Sci 2018; 188:835-841. [PMID: 30488171 DOI: 10.1007/s11845-018-1942-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 11/22/2018] [Indexed: 01/26/2023]
Abstract
BACKGROUND Parents reported experiences of support for diabetes management in schools are variable. Recent data from European countries are sparse and experiences in the Irish primary school setting have not been described previously. AIM To describe parents' experiences of support for diabetes management in primary schools in Ireland. METHODS Questionnaires were distributed through nine regional and tertiary paediatric diabetes services to parents of children aged 4-13 years with type 1 diabetes attending primary school. Data sought included patient demographics, treatment regimens, diabetes education of school staff, assistances received, and interactions between the school and family. RESULTS Responses were received from 418 parents of primary school children with type 1 diabetes. Twenty-six percent of children were not on intensive insulin therapy. Children on a multiple daily injection regime who were unable to self-administer insulin had administration facilitated by attendance of a parent in 95% of cases. Seventy-eight percent of parents were phoned by the school regarding diabetes management, particularly those of younger children (p < 0.001). More than half of parents attended the school at least once per month to assist with diabetes management, particularly those of younger children (p < 0.001). Younger children were also more likely to have a special needs assistant (p < 0.001) and have a written management plan (p = 0.001). CONCLUSIONS Our research has demonstrated deficits in care with respect to access to intensive insulin therapy, individualised care plans and a high burden on families which should be addressed through the National Clinical Programme for Paediatrics and Neonatology and relevant government departments.
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Affiliation(s)
- Danielle C McCollum
- Department of Paediatrics, Regional Hospital Mullingar, Mullingar, Co. Westmeath, Ireland
| | - Olivia Mason
- Centre for Support and Training in Analysis and Research (CSTAR), University College Dublin, Belfield, Dublin 4, Ireland
| | - Mary B Codd
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin 4, Ireland
| | - Michael J O'Grady
- Department of Paediatrics, Regional Hospital Mullingar, Mullingar, Co. Westmeath, Ireland. .,Women's and Children's Health, School of Medicine, University College Dublin, Dublin 4, Ireland.
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23
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Vukovic R, Jesic MD, Vorgucin I, Stankovic S, Folic N, Milenkovic T, Sajic S, Katanic D, Zivic S, Markovic S, Soldatovic I. First report on the nationwide incidence of type 1 diabetes and ketoacidosis at onset in children in Serbia: a multicenter study. Eur J Pediatr 2018; 177:1155-1162. [PMID: 29774417 DOI: 10.1007/s00431-018-3172-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 05/05/2018] [Accepted: 05/08/2018] [Indexed: 10/16/2022]
Abstract
UNLABELLED Data regarding incidence of type 1 diabetes (T1DM), as well as data on frequency and severity of diabetic ketoacidosis (DKA) at the time of T1DM diagnosis is of paramount importance for national and regional healthcare planning. The aim of present multicenter study was to provide the first report regarding nationwide annual incidence rates for T1DM in youth in Serbia, as well as prevalence of DKA at the time of diagnosis. Data on all pediatric patients with newly diagnosed T1DM was retrospectively collected from all 15 regional centers for pediatric diabetes in Serbia during the period 2007-2017. During the study period, average-standardized incidence of T1DM in youth < 19 years was 11.82/100,000, and 14.28/100,000 in 0-14 years age group, with an average yearly increase in incidence of 5.9%. High prevalence of DKA (35.1%) at the time of diagnosis was observed, with highest frequency in children aged < 5 years (47.2%). CONCLUSION This is the first study reporting the nationwide incidence of T1DM and alarmingly high prevalence of DKA at diagnosis in youth in Serbia. The focus of public health preventive measures should be directed towards the preschoolers, considering the highest frequency and severity of DKA observed in this age group. What is Known: • Knowing regional T1DM incidence is of paramount importance for resource allocation and healthcare services provision. • DKA is the leading cause of acute mortality in youth with T1DM, and public health preventive educational measures could improve early diagnosis and reduce the frequency and severity of DKA at presentation. What is New: • Incidence of pediatric T1DM in Serbia is on the rise, with an average yearly increase of 5.9%. • Worryingly high prevalence of DKA (35.1%) at the time of T1DM diagnosis was observed, with the highest frequency of DKA in children aged < 5 years (47.2%).
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Affiliation(s)
- Rade Vukovic
- Mother and Child Health Care Institute of Serbia "Dr Vukan Cupic", Radoja Dakica 8, Belgrade, 11070, Serbia.
| | - Maja D Jesic
- University Children's Hospital, Tirsova 10, Belgrade, 11000, Serbia.,School of Medicine, University of Belgrade, Dr Subotica 15, Belgrade, 11000, Serbia
| | - Ivana Vorgucin
- Institute for Children and Youth Health Care of Vojvodina, Hajduk Veljkova 10, Novi Sad, 21000, Serbia.,Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, Novi Sad, 21000, Serbia
| | - Sandra Stankovic
- Children Clinic, Clinical Center Nis, Dr Zorana Djindjica Blvd. 48a, Nis, 18000, Serbia
| | - Nevena Folic
- Pediatric Clinic, Clinical Centre Kragujevac, Zmaj Jovina 30, Kragujevac, 34000, Serbia.,Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovića 69, Kragujevac, 34000, Serbia
| | - Tatjana Milenkovic
- Mother and Child Health Care Institute of Serbia "Dr Vukan Cupic", Radoja Dakica 8, Belgrade, 11070, Serbia
| | - Silvija Sajic
- University Children's Hospital, Tirsova 10, Belgrade, 11000, Serbia.,School of Medicine, University of Belgrade, Dr Subotica 15, Belgrade, 11000, Serbia
| | - Dragan Katanic
- Institute for Children and Youth Health Care of Vojvodina, Hajduk Veljkova 10, Novi Sad, 21000, Serbia.,Faculty of Medicine, University of Novi Sad, Hajduk Veljkova 3, Novi Sad, 21000, Serbia
| | - Sasa Zivic
- Children Clinic, Clinical Center Nis, Dr Zorana Djindjica Blvd. 48a, Nis, 18000, Serbia.,Faculty of Medicine, University of Nis, Dr Zorana Djindjica Blvd. 81, Nis, 18000, Serbia
| | - Slavica Markovic
- Pediatric Clinic, Clinical Centre Kragujevac, Zmaj Jovina 30, Kragujevac, 34000, Serbia.,Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovića 69, Kragujevac, 34000, Serbia
| | - Ivan Soldatovic
- Institute for Medical Statistics and Informatics, School of Medicine, University of Belgrade, Dr Subotica 15, Belgrade, 11000, Serbia
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24
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Melvin A, Redahan L, Hatunic M, McQuaid SE. Microvascular diabetes complications in a specialist young adult diabetes service. Ir J Med Sci 2018; 188:129-134. [PMID: 29732503 DOI: 10.1007/s11845-018-1827-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 04/25/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS The provision of medical care to young adults with type 1 diabetes mellitus is challenging. The aim of this study was to determine the rates of microvascular complications and their progression among patients with type 1 diabetes mellitus attending a specialist young adult diabetes service in Ireland. METHODS A retrospective review of 62 (male 56.5%) patients with type 1 diabetes mellitus attending the young adult diabetes service at our institution was undertaken. Data was recorded across two time points, clinic registration and at 5 years following initial contact. RESULTS The mean ± SD age at first attendance was 17.4 ± 2.0 years. Mean ± SD duration of diabetes was 6.3 ± 3.9 years with most patients treated using multiple daily insulin injections (75.8%). diabetic retinopathy rate at first attendance was 17.7% and after 5 years was 37.1% (p = 0.003). The majority of cases were background retinopathy. The prevalence of diabetic kidney disease was 6.4% and this remained unchanged at follow-up. Mean ± SD HbA1c improved from 76.1 ± 22.4 mmol/mol (9.1 ± 4.2%) to 69.1 ± 14.9 mmol/mol (8.5 ± 3.5%), p = 0.044. Duration of diabetes was the only clinical variable associated with retinopathy risk at 5 years on multiple regression analysis (p = 0.037). CONCLUSIONS Diabetic retinopathy is prevalent in young adults with type 1 diabetes attending specialist secondary care diabetes services. Duration of diabetes was the strongest determinant of retinopathy risk.
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Affiliation(s)
- Audrey Melvin
- Department of Diabetes and Endocrinology, Mater Misericordiae University Hospital and University College Dublin, Dublin, Ireland.
| | - Lynn Redahan
- Department of Diabetes and Endocrinology, Mater Misericordiae University Hospital and University College Dublin, Dublin, Ireland
| | - Mensud Hatunic
- Department of Diabetes and Endocrinology, Mater Misericordiae University Hospital and University College Dublin, Dublin, Ireland
| | - Siobhán E McQuaid
- Department of Diabetes and Endocrinology, Mater Misericordiae University Hospital and University College Dublin, Dublin, Ireland
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25
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Fox DA, Islam N, Sutherland J, Reimer K, Amed S. Type 1 diabetes incidence and prevalence trends in a cohort of Canadian children and youth. Pediatr Diabetes 2018; 19:501-505. [PMID: 28857360 DOI: 10.1111/pedi.12566] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 07/14/2017] [Accepted: 07/17/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Incidence rates of type 1 diabetes have long been on the rise across the globe, however, there is emerging evidence that the rate of rise may be slowing. The objective of this study was to describe trends in the incidence and prevalence of type 1 diabetes in a sample of Canadian children and youth. METHODS Cases were extracted using linked administrative datasets and a validated diabetes case-finding definition. Incidence and prevalence trends were analyzed using the JoinPoint regression analysis program. RESULTS A small increase in the incidence of type 1 diabetes was observed over the 11-year period from 2002-2003 to 2012-2013. Total incident cases per year ranged from 201 (2005-2006) to 250 (2007-2008). Total prevalent cases per year ranged from 1790 (2002-2003) to 2264 (2012-2013). Incidence was highest among children aged 5 to 14 years, and lowest in the youngest (1-4 years) and oldest (15-19 years) age brackets. The most significant increase in incidence was in children aged 10 to 14 years. Age-standardized prevalence increased significantly throughout the study period. CONCLUSION These results are similar to data from the United States but differ from European data with respect to the annual percent change for incidence as well as age-specific incidence trends. In keeping with the low mortality rates associated with type 1 diabetes, the prevalence continues to rise.
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Affiliation(s)
- Danya A Fox
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Nazrul Islam
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada.,Clinical Prevention Services, British Columbia Centre for Disease Control, Vancouver, Canada.,Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Jenny Sutherland
- BC Ministry of Health, Population Health Surveillance & Epidemiology, Victoria, Canada
| | - Kim Reimer
- BC Ministry of Health, Population Health Surveillance & Epidemiology, Victoria, Canada
| | - Shazhan Amed
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
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26
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Finn BP, Fraser B, O'Connell SM. Supraventricular tachycardia as a complication of severe diabetic ketoacidosis in an adolescent with new-onset type 1 diabetes. BMJ Case Rep 2018; 2018:bcr-2017-222861. [PMID: 29545427 DOI: 10.1136/bcr-2017-222861] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Diabetic ketoacidosis (DKA) is one of the most common causes of morbidity and mortality in new-onset type 1 diabetes (T1D). Supraventricular tachycardia (SVT), however, is a very rare complication of DKA. We present the case of a patient with new-onset T1D who presented with DKA. He received intravenous fluid resuscitation, insulin and potassium supplementation and subsequently developed SVT, confirmed on a 12-lead electrocardiograph despite a structurally normal heart. Vagal manoeuvres and adenosine failed to restore sinus rhythm, but flecainide was successful. We conclude that SVT can occur as a complication of DKA, including in new-onset T1D. Our case is the first of this phenomenon occurring in new-onset childhood diabetes, as the few prior documented cases had established diabetes. Furthermore, a combination of potassium derangement, hypophosphataemia and falling magnesium levels may have precipitated the event.
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Affiliation(s)
| | - Brian Fraser
- Department of Paediatrics and Child Health, Cork University Hospital Group, Cork, Ireland
| | - Susan M O'Connell
- Department of Paediatrics and Child Health, Cork University Hospital Group, Cork, Ireland
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27
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The corneal subbasal nerve plexus and thickness of the retinal layers in pediatric type 1 diabetes and matched controls. Sci Rep 2018; 8:14. [PMID: 29311586 PMCID: PMC5758564 DOI: 10.1038/s41598-017-18284-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 12/05/2017] [Indexed: 11/08/2022] Open
Abstract
Optical coherence tomography (OCT) of the retina and corneal confocal laser scanning microscopy (CLSM) of the subbasal nerve plexus (SBP) are noninvasive techniques for quantification of the ocular neurodegenerative changes in individuals with type 1 diabetes mellitus (T1DM). In adult T1DM patients these changes are hardly related to T1DM only. Instead, ageing and/or lifestyle associated comorbidities have to be considered as putative confounding variables. Therefore, we investigated pediatric T1DM patients (n = 28; 14.2 ± 2.51 y; duration of disease: 5.39 ± 4.16 y) without clinical signs of diabetic retina disease, neuropathy, vasculopathy or nephropathy and compared our findings with those obtained in healthy controls (n = 46; 14.8 ± 1.89 y). The SBP was characterized by the averaged length, thickness, and tortuosity of nerve fibers as well as the number of branching and connecting points. OCT was used to determine the total thickness of the retina (ALL) and the thickness of each retinal layer. Both methods revealed signs of early neurodegenerative changes, e.g. thinning of distinct retinal layers at the pericentral ring and shortening of corneal nerve fibers that are already present in pediatric T1DM patients. Standardization of instruments and algorithms are urgently required to enable uniform comparison between different groups and define normative values to introduce in the clinical setting.
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28
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O'Dea MI, O'Connell SM, O'Grady MJ. Prevalence and characteristics of paediatric Type 2 diabetes in the Republic of Ireland. Diabet Med 2017; 34:1603-1607. [PMID: 28703902 DOI: 10.1111/dme.13425] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/10/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To establish the prevalence of paediatric Type 2 diabetes in the Republic of Ireland and describe patient demographics, initial presentation, management, outcomes, comorbidities and complications. METHODS Using a standardized proforma we conducted a cross-sectional survey of children and adolescents aged < 16 years with a diagnosis of Type 2 diabetes between October and December 2015 in each of the 19 centres in the Republic of Ireland responsible for the care of children with diabetes. RESULTS Twelve cases of Type 2 diabetes were identified, giving a prevalence in children aged <16 years of 1.2/100 000 (95% CI 0.6 to 2). Six of these children (50%) were white, two (33%) of whom were members of the travelling community. Four (33%) were of black ethnicity. The prevalence of Type 2 diabetes in traveller children was 16.1/100 000 (95% CI 1.9 to 58.1) and was similar to that in black children, a known high-risk group, which was 13.3/100 000 (95% CI 3.6 to 34.1). The median current HbA1c value was 51 mmol/mol (6.8%) and four (33%) of the children achieved the International Society for Pediatric and Adolescent Diabetes target HbA1c of ≤48 mmol/mol (6.5%). Seven (59%) children were managed on metformin monotherapy, three (25%) were managed on insulin and metformin in combination, and two (16%) were receiving dietary management. CONCLUSION This was the first national study to estimate the prevalence of childhood Type 2 diabetes in Ireland. Despite their white ethnicity, traveller children appear to be a high-risk group, but this finding requires further study.
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Affiliation(s)
- M I O'Dea
- Department of Paediatrics, Midland Regional Hospital, Mullingar, Co, Westmeath
| | - S M O'Connell
- Department of Paediatrics and Child Health, Cork University Hospital, Wilton, Cork, Ireland
| | - M J O'Grady
- Department of Paediatrics, Midland Regional Hospital, Mullingar, Co, Westmeath
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