Incidence of type 1 diabetes among Polish children ages 0-14 years from 1989-2012

Increasing trend of childhood type 1 diabetes incidence: 20-year observation from Greater Poland Province, Poland

AIM

Type 1 diabetes is one of the fastest-growing chronic health conditions. Estimating the incidence rate of childhood type 1 diabetes will allow to aid in adequate planning of health care resources. The study's aim was to assess the incidence rate of type 1 diabetes in children below 15 years of age from Greater Poland (Poland) between 2006 and 2018, and then to compare obtained data to records collected between 1998 and 2003 in pediatric population aged 0-14 years from the same area.

METHODS

In this cohort study covering the period from January 1998 to December 2018, data were collected for children and adolescents below 14 years of age with newly diagnosed type 1 diabetes living in Greater Poland. The overall population size was taken from the Statistical Office of Poland. Total, sex-, and age-specific incidence rates per 100,000 person-years were calculated for each calendar year.

RESULTS

Over a 20-year period, the incidence rate of type 1 diabetes in children aged 0-14 years rose around 3.6-fold, from 8.4/100,000 in 1998 to 30.8/100,000 in 2018, with the peak incidence recorded in last year of the study. A clear male predominance of type 1 diabetes was seen in all ages. The rate of type 1 diabetes incidence growth was comparable between all age groups, while the highest incidence rate was mostly observed in children aged 5-9 and 10-14 years.

CONCLUSIONS

The incidence of type 1 diabetes in children aged 0-14 years is rapidly increasing in Greater Poland.

Prevalence of haplotype DQ2/DQ8 and celiac disease in children with type 1 diabetes

Type 1 diabetes (T1D) and celiac disease (CD) coexist very often. Identification of the human leukocyte antigen (HLA) DQ2/DQ8 can confirm the genetic predisposition to CD. Negative result of this test allows to exclude CD with a high probability. It was suggested that in individuals with higher risk of CD, including T1D patients, the implementation of genetic testing should reduce the number of patients requiring systematic immunological screening. The aim of this study was to analyze the prevalence of different haplotypes predisposing to CD in children and adolescents with previously diagnosed T1D.

MATERIAL AND METHODS

A retrospective analysis was performed on 166 T1D children (91 girls) in whom HLA DQ2/DQ8 alleles were tested. In 9.6% CD was also diagnosed.

RESULTS

In 12.7% both HLA DQ2/DQ8 were negative. In 87.3% patients HLA DQ2 and/or DQ8 was positive, including 27.7% patients with both haplotypes DQ2.5 and DQ8 positive. In all CD patients the disease predisposing alleles were positive, while none of the HLA DQ2/DQ8 negative children were diagnosed with CD.

CONCLUSIONS

The prevalence of HLA DQ2.5 and the HLA DQ2.5 / HLA DQ8 configuration is higher in patients with T1D, and CD compared to children with T1D alone. The combination of HLA DQ2 and HLA DQ8 most significantly increases the risk of developing CD. The group of HLA DQ2/DQ8 negative patients with improbable CD diagnosis, is relatively small. Most of T1D patients HLA DQ2/DQ8 positive need further regular antibody assessment. In patients with T1D, who are at high risk of developing CD, genetic testing may be considered to select those who require further systematic serological evaluation. Due to its retrospective nature, the study was not registered in the database of clinical trials and the Clinical trial registration number is not available.

Environmental Factors and the Risk of Developing Type 1 Diabetes-Old Disease and New Data

Simple Summary

Despite many studies, the risk factors of type 1 diabetes (T1DM) in children and adolescents are still not fully understood and remain a big challenge. Therefore, an extensive online search for scientific research on factors related to diabetes has been performed for the identification of new factors of unexplained etiology. A better understanding of the role of viral, bacterial, and yeast-like fungi infections related to the risk of T1DM in children and adolescents and the identification of new risk factors, especially those spread by the droplet route, is of great importance for people and families with diabetes.

Abstract

The incidence of type 1 diabetes (T1D) is increasing worldwide. The onset of T1D usually occurs in childhood and is caused by the selective destruction of insulin-producing pancreatic islet cells (β-cells) by autoreactive T cells, leading to insulin deficiency. Despite advanced research and enormous progress in medicine, the causes of T1D are still not fully understood. Therefore, an extensive online search for scientific research on environmental factors associated with diabetes and the identification of new factors of unexplained etiology has been carried out using the PubMed, Cochrane, and Embase databases. The search results were limited to the past 11 years of research and discovered 143 manuscripts published between 2011 and 2022. Additionally, 21 manuscripts from between 2000 and 2010 and 3 manuscripts from 1974 to 2000 were referenced for historical reference as the first studies showcasing a certain phenomenon or mechanism. More and more scientists are inclined to believe that environmental factors are responsible for the increased incidence of diabetes. Research results show that higher T1D incidence is associated with vitamin D deficiency, a colder climate, and pollution of the environment, as well as the influence of viral, bacterial, and yeast-like fungi infections. The key viral infections affecting the risk of developing T1DM are rubella virus, mumps virus, Coxsackie virus, cytomegalovirus, and enterovirus. Since 2020, i.e., from the beginning of the COVID-19 pandemic, more and more studies have been looking for a link between Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and diabetes development. A better understanding of the role of viral, bacterial, and yeast-like fungi infections related to the risk of T1DM in children and adolescents and the identification of new risk factors, especially those spread by the droplet route, is of great importance for people and families with diabetes.

Time trends in incidence of diabetes mellitus in Austrian children and adolescents <15 years (1989-2017)

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.

Acute Responses to Low and High Intensity Exercise in Type 1 Diabetic Adolescents in Relation to Their Level of Serum 25(OH)D

The main purpose of this study was to investigate the differences in glycaemic reaction in response to various physical activities in 20 young boys (14.4 ± 1.6 years) with type 1 diabetes mellitus (T1DM) and with either vitamin D deficiency or with suboptimal levels of vitamin D. Participants were divided into two groups (deficiency group-DG, n = 10; suboptimal group-SG, n = 10) according to their vitamin D levels. All patients performed aerobic and mixed (aerobic-anaerobic) physical efforts. During the exercise, the respiratory responses and glucose levels were monitored. Biochemical blood analyses were performed before each physical effort. The oxygen consumption was not significantly lower in SG during both aerobic and mixed effort (4.0% and 5.6%, respectively). The glycated haemoglobin (HbA1c) level was higher by 6.1% and the total daily dose of insulin (DDI) was higher by 18.4% in the DG. The differences were not statistically significant. Patients with lower vitamin D levels demonstrated an insignificantly higher glycaemic variability during days with both aerobic and mixed exercises. An appropriate vitamin D concentration in T1DM patients' blood may constitute a prophylactic factor for hyperglycaemia during anaerobic training and hypoglycaemia during aerobic training.

Five-year observation of the relationship between body mass index and glycated hemoglobin in children with Type 1 diabetes mellitus

BACKGROUND

Poor metabolic control is a well-recognized risk factor for cardiovascular disease. However, the relationship between such factor as body weight and metabolic control in children with diabetes mellitus type 1 (DM1) is unclear. The aim of this study was to examine the relationships between body weight, age, metabolic control, sex, and form of insulin therapy in children with DM1.

METHODS

This was a retrospective study of children with DM1 treated at one diabetes center for a minimum of 5 years since diagnosis.

RESULTS

Median body mass index standard deviation score (BMI-SDS) increased annually (p = .0042) on average 0.08 ± 0.27 per year throughout the observation. As well HbA1c and daily dose insulin increased annually (p < .0001; p < .0001, respectively) on average by 0.43 ± 0.79 and by 0.13 ± 0.17 per year. Percentage of good metabolic control - HbA1c cut-off of 6.5% - gradually worsened in all patients over the 5 years, with a higher percentage of girls experiencing poor metabolic control (84.48% of girls vs. 77.87% of boys; p = .01895). No correlation between BMI-SDS and metabolic control (HbA1c) was found (R = 0.09, p = .60).

CONCLUSIONS

Body weight appears to be more affected by non-diabetic factors (e.g. irregular eating and sedentary lifestyle) than by the clinical course of diabetes. Metabolic control and body weight must be maintained in all children with DM1 (males and females) to reduce their future risk of cardiovascular disease.

Epidemiology of type 1 diabetes in Polish children: A multicentre cohort study

BACKGROUND

The incidence of childhood type 1 diabetes (T1D) varies greatly between populations, and the estimates and/or predictions of the rates would aid in adequate planning of health care resources. The study's aim was to assess the incidence of T1D in the paediatric population of eastern and central Poland.

METHODS

In this cohort study covering the period from January 2010 to December 2014, data were collected for children and adolescents below 18 years of age with newly diagnosed T1D living in eastern and central Poland. A total of 2174 children were included in the analysis. The population estimates were from the Central Statistical Office of Poland.

RESULTS

Overall, the annual incidence of T1D increased from 12.84/100,000 in 2010 to 18.46/100,000 in 2014 with the incidence rate (IR) ratio of 1.5 (an increase in the IR by 12.7% per year over 5 years). The lowest increase in the IR by 7.1% per year was seen in 15 to 17-year-olds. In the urban population (age 0-17 years), the overall incidence rate was significantly higher than in subjects from rural communities (P < .02). The incidence of T1D in rural areas was significantly higher (p = .004) in voivodeships of higher population density. Such dependence was not observed in urban areas.

CONCLUSIONS

The incidence of T1D in children living in eastern and central Poland increased 1.5-fold over the 5-year observation period with the highest rise in 10 to 14-year-olds and significantly higher rates in urban children compared with their peers living in rural areas.

High incidence of diabetic ketoacidosis at diagnosis of type 1 diabetes among Polish children aged 10-12 and under 5 years of age: A multicenter study

AIM

Despite its characteristic symptoms, type 1 diabetes (T1D) is still diagnosed late causing the development of diabetic ketoacidosis (DKA). The aim of this study was to estimate the incidence of DKA and factors associated with the development of acidosis at T1D recognition in Polish children aged 0-17.

METHODS

The study population consisted of 2100 children with newly diagnosed T1D in the years 2010-2014 in 7 hospitals in eastern and central Poland. The population living in these areas accounts for 35% of the Polish population. DKA was defined as a capillary pH < 7.3, blood glucose > 11 mmol/L. The analyzed data included age, sex, diabetes recognition, pH, glycated hemoglobin (HbA1c), fasting C-peptide, and body mass index standard deviation score (BMI-SDS).

RESULTS

We observed DKA in 28.6% of children. There were 2 peaks in DKA occurrence: in children <5 years of age (33.9%) and aged 10-12 (34%). The highest incidence of DKA was noted in children aged 0-2 (48.4%). In the group with DKA, moderate and severe DKA occurred in 46.7% of children. Girls and children <2 years of age were more prone to severe DKA. The multiple logistic regression analysis showed the following factors associated with DKA: age (P = .002), fasting C-peptide (P = .0001), HbA1c (P = .0001), no family history of T1D (P = .0001), and BMI-SDS (P = .0001).

CONCLUSIONS

The incidence of DKA is high and remained unchanged over the last 5 years. Increasing the awareness of symptoms of DKA is recommended among children <5 years of age (especially <2 years of age) and aged 10-12. Children <2 years of age and girls were at the highest risk of severe DKA.

Updated 24-year trend of Type 1 diabetes incidence in children in Poland reveals a sinusoidal pattern and sustained increase

AIMS

To present the incidence trend for Type 1 diabetes in Polish children aged 0-14 years, updated using data collected during 2005-2012, and assess the reliability of the predictive model constructed previously using the 1989-2004 database.

METHODS

Children aged < 15 years with newly diagnosed Type 1 diabetes are recorded prospectively (EURODIAB criteria) in several regional registers in Poland. Age- and gender-standardized incidence rates for Type 1 diabetes were calculated per 100 000 persons/year. Incidence rates were analysed in terms of the dependency on age, gender, geographical region and population density. Incidence rate trends over time were modelled using generalized linear models.

RESULTS

The mean standardized incidence for 1989-2012 was 12.72 per 100 000 persons/year [95% confidence interval (CI), 11.35 to 14.21]. Over the 24-year observation period, the incidence increased from 5.36 to 22.74 per 100 000 persons/year. The lowest incidence rate was in children aged 0-4 years (8.35, 95% CI 7.27 to 9.57 per 100 000 persons/year). There was no difference between genders, or urban and rural regions. Incidence rates were higher in northern compared with southern Poland [14.04 (95% CI 12.59 to 15.63) vs. 11.94 (95% CI 10.62 to 13.39) per 100 000 persons/year]. The new data corrected the earlier predictive model by changing the estimates of some factors related to patient age, gender and their interactions with the remaining factors. The incidence rate shows periodic 5.33-year fluctuations. The periodicity component allows for a more accurate prediction of the incidence rate over time.

CONCLUSIONS

This cohort study reveals a sustained increase in Type 1 diabetes incidence in Polish children aged 0-14 years with regular, sinusoidal fluctuations and a slight levelling off in past few years. It is of concern that are the highest increases in incidence are found in children aged 0-4 years.

Increasing incidence of type 1 diabetes between 1986 and 2015 in Bauru, Brazil

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.

High Frequency of Diabetic Ketoacidosis in Children with Newly Diagnosed Type 1 Diabetes

AIM

The aim of this study was to evaluate the incidence of diabetic ketoacidosis in children and adolescents with newly diagnosed type 1 diabetes in 2006-2007 and 2013-2014.

METHOD

The study group consisted of 426 children aged 0-18 years with type 1 diabetes onset admitted to our hospital in 2006-2007 (group A) and 2013-2014 (group B). The study comprised the analysis of medical and laboratory records from patients' medical charts and the electronic database.

RESULTS

There was no difference between groups A and B in the percentage of children admitted with diabetic ketoacidosis (25% versus 28%, resp., P = 0.499). Among children with diabetic ketoacidosis, severe metabolic decompensation (pH < 7.1) appeared in similar frequency in groups A and B (28% versus 30%, resp., P = 0.110). In group B, children with diabetic ketoacidosis were statistically younger compared to patients without ketoacidosis (P = 0.015) and had higher HbA1c levels (P = 0.006). In both groups, a 2-fold increase in diabetic ketoacidosis was noted in children under the age of 3, compared to overall frequency.

CONCLUSION

No decrease in diabetic ketoacidosis has been noted in the recent years. Although the prevalence and severity of diabetic ketoacidosis remain stable, they are unacceptably high. The youngest children are especially prone to ketoacidosis.

Analysis of the influence of type of diabetes mellitus on the development and type of glaucoma

AIM

Main the goal of the research is to analyze the occurrence of glaucoma in patients with diabetes mellitus type 1 (DM type 1) and diabetes mellitus type 2 (DM type 2).

PATIENTS AND METHODS

The study involved 140 patients, 34 with DM type 1 and 106 with DM type2. In relation to the type of glaucoma to the patients are divided into two groups: Primary and Secondary glaucoma. According to the stage of diabetic retinopathy (DR) patients were analyzed in three groups: non-proliferative, preproliferative and proliferative DR. Since ophthalmological parameters were analyzed: best corrected visual acuity (BCVA), intraocular pressure (IOP), visual field (VF) of computerized perimetry, excavatio optic nerve (E/D) by optic coherent tomography (OCT).

RESULTS

Applying the test of quotient chance found that subjects with DM type 1 have a 5.94 times greater chance of developing secondary glaucoma, but is of primary (P <0.0001). In patients with DM type 2, where the chance of getting the subjects of secondary glaucoma 4.43 times larger than that of the primary (P = 0.0002).

CONCLUSION

Patients with DM type have great chance of developing secondary glaucoma of the primary. Primary glaucoma more common in NPDR but secondary glaucoma more common in PDR.