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Niechciał E, Michalak M, Skowrońska B, Fichna P. Increasing trend of childhood type 1 diabetes incidence: 20-year observation from Greater Poland Province, Poland. Acta Diabetol 2024:10.1007/s00592-024-02339-5. [PMID: 39023767 DOI: 10.1007/s00592-024-02339-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 07/06/2024] [Indexed: 07/20/2024]
Abstract
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.
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Affiliation(s)
- Elżbieta Niechciał
- Department of Pediatric Diabetes, Clinical Auxology and Obesity, Poznan University of Medical Sciences, 27/33 Szpitalna St., Poznan, 60-572, Poland.
| | - Michał Michalak
- Department of Informatics and Statistics, Poznan University of Medical Sciences, 7 Rokietnicka St., Poznan, 60-529, Poland
| | - Bogda Skowrońska
- Department of Pediatric Diabetes, Clinical Auxology and Obesity, Poznan University of Medical Sciences, 27/33 Szpitalna St., Poznan, 60-572, Poland
| | - Piotr Fichna
- Department of Pediatric Diabetes, Clinical Auxology and Obesity, Poznan University of Medical Sciences, 27/33 Szpitalna St., Poznan, 60-572, Poland
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Tillmann A, Ceklic L, Dysli C, Munk MR. Gender differences in retinal diseases: A review. Clin Exp Ophthalmol 2024; 52:317-333. [PMID: 38348562 DOI: 10.1111/ceo.14364] [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: 08/29/2023] [Revised: 01/05/2024] [Accepted: 01/26/2024] [Indexed: 04/18/2024]
Abstract
Gender medicine is a medical specialty that addresses gender differences in health and disease. Traditionally, medical research and clinical practice have often been focused on male subjects and patients. As a result, gender differences in medicine have been overlooked. Gender medicine considers the biological, psychological, and social differences between the genders and how these differences affect the development, diagnosis, treatment, and prevention of disease. For ophthalmological diseases epidemiological differences are known. However, there are not yet any gender-based ophthalmic treatment approaches for women and men. This review provides an overview of gender differences in retinal diseases. It is intended to make ophthalmologists, especially retinologists, more sensitive to the topic of gender medicine. The goal is to enhance comprehension of these aspects by highlighting fundamental gender differences. Integrating gender medicine into ophthalmological practice helps promote personalized and gender-responsive health care and makes medical research more accurate and relevant to the entire population.
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Affiliation(s)
- Anne Tillmann
- Augenarzt-Praxisgemeinschaft Gutblick, Pfäffikon, Switzerland
| | - Lala Ceklic
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Bern Photographic Reading Center, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Chantal Dysli
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Bern Photographic Reading Center, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Marion R Munk
- Augenarzt-Praxisgemeinschaft Gutblick, Pfäffikon, Switzerland
- Department of Ophthalmology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Bern Photographic Reading Center, Inselspital, University Hospital Bern, Bern, Switzerland
- Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Edwards M, Kudzinskas A, Alazawi A, Hughes W, Goodall R, Harbinson E, Salciccioli J, Marshall D, Shalhoub J. Type 1 diabetes mellitus disease burden in high health expenditure countries between 1990 and 2019. Diab Vasc Dis Res 2023; 20:14791641231221763. [PMID: 38128564 DOI: 10.1177/14791641231221763] [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] [Indexed: 12/23/2023] Open
Abstract
OBJECTIVE This observational study assesses trends in type 1 diabetes mellitus (T1DM) disease burden across the 19 countries of the European Union (EU) 15+ between 1990 and 2019. METHODS The Global Burden of Disease Study database was used to gather T1DM age-standardised incidence (ASIR), prevalence (ASPR), mortality (ASMR), and disability-adjusted life-year (DALY) rates per 100,000 for each EU15+ country (1990 - 2019). Joinpoint regression analysis was used to describe the trends. RESULTS From 1990 to 2019, T1DM ASIRs and ASPRs increased globally except for females in Finland (-2.9% and -9.4%), the largest increase in ASPR for males and females was observed in France (+144.4% and +137.5% respectively). All had reductions in ASMRs for males and females, with the largest observed in Spain (-56.7% and -79.0% respectively). Trends in DALYs were variable across countries, with increases in DALYs noted in 14/19 for males, and 9/19 for females. Denmark, Finland, Norway, Netherlands, and Sweden had a reduction in DALYs for both males and females. CONCLUSIONS Mortality from T1DM is reducing across EU15+ countries, despite concomitant increases in incidence and prevalence rates. Trends in DALYs are variable across countries, reflecting differential trends in the disease burden across countries with similarly high health expenditure.
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Affiliation(s)
- Michael Edwards
- Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
| | | | - Andrew Alazawi
- Barts and the London School of Medicine and Dentistry, Queen Mary University of London, UK
| | | | - Richard Goodall
- Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
| | | | | | | | - Joseph Shalhoub
- Imperial College London and Imperial College Healthcare NHS Trust, London, UK
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Gomber A, Ward ZJ, Ross C, Owais M, Mita C, Yeh JM, Reddy CL, Atun R. Variation in the incidence of type 1 diabetes mellitus in children and adolescents by world region and country income group: A scoping review. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001099. [PMID: 36962669 PMCID: PMC10021400 DOI: 10.1371/journal.pgph.0001099] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 10/06/2022] [Indexed: 11/11/2022]
Abstract
INTRODUCTION Around 18.7 million of the 537 million people with diabetes worldwide live in low-income and middle-income countries (LMIC), where there is also an increase in the number of children, adolescents, and young adults diagnosed with type 1 diabetes (T1D). There are substantial gaps in data in the current understanding of the epidemiological patterns and trends in incidence rates of T1D at the global level. METHODS We performed a scoping review of published studies that established the incidence of T1D in children, adolescents, and young adults aged 0-25 years at national and sub-national levels using PubMed, Embase and Global Health. Data was analyzed using R programming. RESULTS The scoping review identified 237 studies which included T1D incidence estimates from 92 countries, revealing substantial variability in the annual incidence of T1D by age, geographic region, and country-income classification. Highest rates were reported in the 5-9 and 10-14 year age groups than in the 0-4 and 15-19 year age groups, respectively. In the 0-14 year age group, the highest incidence was reported in Northern Europe (23.96 per 100,000), Australia/New Zealand (22.8 per 100,000), and Northern America (18.02 per 100,000), while the lowest was observed in Melanesia, Western Africa, and South America (all < 1 per 100,000). For the 0-19 year age group, the highest incidence was reported in Northern Europe (39.0 per 100,000), Northern America (20.07 per 100,000), and Northern Africa (10.1 per 100,000), while the lowest was observed in Eastern and Western Africa (< 2 per 100,000). Higher incidence rates were observed in high-income countries compared to LMICs. There was a paucity of published studies focusing on determining the incidence of T1D in LMICs. CONCLUSION The review reveals substantial variability in incidence rates of T1D by geographic region, country income group, and age. There is a dearth of information on T1D in LMICs, particularly in sub-Saharan Africa, where incidence remains largely unknown. Investment in population-based registries and longitudinal cohort studies could help improve the current understanding of the epidemiological trends and help inform health policy, resource allocation, and targeted interventions to enhance access to effective, efficient, equitable, and responsive healthcare services.
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Affiliation(s)
- Apoorva Gomber
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Zachary J. Ward
- Division of General Pediatrics, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Carlo Ross
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Maira Owais
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Center for Health Decision, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Carol Mita
- Manchester University NHS Foundation Trust, Manchester, United Kingdom
| | - Jennifer M. Yeh
- Department of Biology, Department of Economics, Amherst College, Amherst, Massachusetts, United States of America
| | - Ché L. Reddy
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Rifat Atun
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Countway Library, Harvard Medical School, Boston, Massachusetts, United States of America
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Baechle C, Stahl-Pehe A, Prinz N, Meissner T, Kamrath C, Holl RW, Rosenbauer J. Prevalence trends of type 1 and type 2 diabetes in children and adolescents in North Rhine-Westphalia, the most populous federal state in Germany, 2002-2020. Diabetes Res Clin Pract 2022; 190:109995. [PMID: 35853531 DOI: 10.1016/j.diabres.2022.109995] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/28/2022] [Accepted: 07/12/2022] [Indexed: 12/28/2022]
Abstract
AIMS To estimate the prevalence and temporal trends of type 1 and type 2 diabetes mellitus in children and adolescents (type 1 diabetes: 0-19 years, type 2 diabetes: 10-19 years) in North Rhine-Westphalia (NRW), Germany, from 2002 to 2020. METHODS The NRW Diabetes Registry records new cases based on three data sources (median completeness of ascertainment 99% for type 1 diabetes, 94% for type 2 diabetes). We determined age- and/or sex-standardized prevalence estimates (95% confidence intervals) per 100,000 individuals. Differences in age and sex, as well as time trends, were examined by Poisson regression. Furthermore, joinpoint regression was used to evaluate changes in prevalence trends over time. RESULTS At the end of 2020, the estimated type 1 diabetes prevalence was 247.1 (240.3; 253.9) with an annual increase of 2.9% (2.7%; 3.1%). The type 2 diabetes prevalence was 12.7 (10.6; 14.9) and increased by 6.4% (5.6%; 7.3%) per year. The prevalence trends were not uniform over the total period and flattened considerably in recent years. CONCLUSIONS The prevalence of type 1 and type 2 diabetes has increased significantly but at a lower rate in recent years. Continued surveillance of the prevalence is essential for the planning of health care resources and prevention measures.
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Affiliation(s)
- C Baechle
- German Diabetes Center, Institute for Biometrics and Epidemiology, Leibniz Center for Diabetes Research at Heinrich Heine University, Auf'm Hennekamp 65, D-40225 Düsseldorf, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.
| | - A Stahl-Pehe
- German Diabetes Center, Institute for Biometrics and Epidemiology, Leibniz Center for Diabetes Research at Heinrich Heine University, Auf'm Hennekamp 65, D-40225 Düsseldorf, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.
| | - N Prinz
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany; University of Ulm, Institute of Epidemiology and Medical Biometry, ZIBMT, Albert-Einstein-Allee 41, D-89081 Ulm, Germany.
| | - T Meissner
- University Children's Hospital, Department of General Paediatrics, Neonatology and Paediatric Cardiology, Medical Faculty at Heinrich Heine University, Moorenstraße 5, D-40225 Düsseldorf, Germany.
| | - C Kamrath
- Justus Liebig University, Center of Child and Adolescent Medicine, Division of Paediatric Endocrinology and Diabetology, Feulgenstraße 10-12, D-35392 Giessen, Germany.
| | - R W Holl
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany; University of Ulm, Institute of Epidemiology and Medical Biometry, ZIBMT, Albert-Einstein-Allee 41, D-89081 Ulm, Germany.
| | - J Rosenbauer
- German Diabetes Center, Institute for Biometrics and Epidemiology, Leibniz Center for Diabetes Research at Heinrich Heine University, Auf'm Hennekamp 65, D-40225 Düsseldorf, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.
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Bratke H, Biringer E, Margeirsdottir HD, Njølstad PR, Skrivarhaug T. Relation of Health-Related Quality of Life with Glycemic Control and Use of Diabetes Technology in Children and Adolescents with Type 1 Diabetes: Results from a National Population Based Study. J Diabetes Res 2022; 2022:8401328. [PMID: 36387938 PMCID: PMC9649325 DOI: 10.1155/2022/8401328] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The primary aim was to analyse the association between diabetes-specific health-related quality of life (HRQOL) and HbA1c in children and adolescents with type 1 diabetes. The secondary aims were to evaluate the associations between diabetes-specific HRQOL and age, sex, diabetes duration, and the use of diabetes technology in diabetes treatment. Research Design and Methods. Children with type 1 diabetes (10-17 years, N = 1,019) and parents (children <10 years, N = 371; 10-17 years, N = 1,070) completed the DISABKIDS diabetes-specific questionnaire (DDM-10) as part of the 2017 data collection for the Norwegian Childhood Diabetes Registry. The DDM-10 consists of two subscales-'impact' and 'treatment'-with six and four items, respectively. In the linear regression models, the items and subscales were outcome variables, while HbA1c, age, sex, diabetes duration, insulin pump use, and continuous glucose monitoring (CGM) system use were predictor variables. RESULTS Lower HbA1c measurements and male sex were associated with higher HRQOL scores on both DDM-10 scales in the age group 10-17 years, but not in children under 10 years. Parents gave lower HRQOL scores than children in the 10-17 age group. Insulin pump and CGM use were not significantly associated with HRQOL on the impact and treatment scale. CONCLUSIONS Low HbA1c and male sex are significantly associated with high HRQOL in children aged 10-17 with type 1 diabetes, but the use of diabetes technology is not positively associated with HRQOL. Differences in child- and parent-reported scores imply that parents might both over- and underestimate their child's HRQOL.
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Affiliation(s)
- Heiko Bratke
- Department of Pediatrics, Haugesund Hospital, Fonna Health Trust, Haugesund, Norway
- Center for Diabetes Research, Department of Clinical Science, University of Bergen, Bergen, Norway
- Oslo Diabetes Research Centre, Oslo, Norway
- Department of Research and Innovation, Fonna Health Trust, Haugesund, Norway
| | - Eva Biringer
- Department of Research and Innovation, Fonna Health Trust, Haugesund, Norway
| | - Hanna D. Margeirsdottir
- Oslo Diabetes Research Centre, Oslo, Norway
- Division of Childhood and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Pål R. Njølstad
- Center for Diabetes Research, Department of Clinical Science, University of Bergen, Bergen, Norway
- Child and Youth Clinic, Haukeland University Hospital, Bergen, Norway
| | - Torild Skrivarhaug
- Oslo Diabetes Research Centre, Oslo, Norway
- Division of Childhood and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- University of Oslo, Institute of Clinical Medicine, Faculty of Medicine, Oslo, Norway
- The Norwegian Childhood Diabetes Registry, Division of Childhood and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
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Manuwald U, Schoffer O, Kugler J, Riemenschneider H, Kapellen TM, Kiess W, Rothe U. Trends in incidence and prevalence of type 1 diabetes between 1999 and 2019 based on the Childhood Diabetes Registry of Saxony, Germany. PLoS One 2021; 16:e0262171. [PMID: 34972197 PMCID: PMC8719733 DOI: 10.1371/journal.pone.0262171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/16/2021] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE The Childhood Diabetes Registry of Saxony has been existing since 1999. The aim of this study was to investigate the incidence rates, cohort and point prevalence, and the trends of type 1 diabetes among children and adolescents based on the registry data over the past 21 years. METHODS A completeness check of the Childhood Diabetes Registry of Saxony for the observation period 2012-2019 was performed using the capture-recapture method. The age-standardized incidence rates per 100,000 person years (PY) were estimated for the observation period 1999-2019. Prevalence was estimated per 100,000 children and adolescents as the point prevalence of five consecutive years, and as a cohort prevalence for the birth cohorts, which result from the difference of age and year at diagnosis. Trend analyses were executed using join point regression. RESULTS A completeness of 98% (95% CI 89-100) was determined for the period from 2012 to 2019. The standardized incidence rate of type 1 diabetes among children and adolescents increased from 17.1 per 100,000 PY in 1999 to 24.7 per 100,000 PY in 2019. If this trend continues, the incidence rate will increase to 34.8 (95% CI 24.4-49.6) per 100,000 PY in 2030. The point prevalence of 5 consecutive years did not show a continuous trend over time. According to this method, the prevalence reached a plateau in the last segment (2013-2019). The calculation of cohort prevalence indicated a continuous increase from 2013 to 2019 with no significant statistical difference in terms of sex. CONCLUSION The point prevalence and the last incidence rates indicate that type 1 diabetes of children and adolescents is slowing down or has reached a plateau in Saxony. Nevertheless, the cohort prevalence predicts a steady increase. Future studies should continue investigating these trends in a longer observation period and consider including possible correlating environmental factors.
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Affiliation(s)
- Ulf Manuwald
- Health Sciences/Public Health, Faculty of Medicine “Carl Gustav Carus”, Technische Universität Dresden, Dresden, Germany
| | - Olaf Schoffer
- Center of Evidence-Based Healthcare, University Hospital “Carl Gustav Carus”, Technische Universität Dresden, Dresden, Germany
| | - Joachim Kugler
- Health Sciences/Public Health, Faculty of Medicine “Carl Gustav Carus”, Technische Universität Dresden, Dresden, Germany
| | - Henna Riemenschneider
- Department of General Practice/MK3, Faculty of Medicine “Carl Gustav Carus”, Technische Universität Dresden, Dresden, Germany
| | - Thomas Michael Kapellen
- Department of Women and Child Health, Center for Pediatric Research, Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany
- Median Childrens Hospital Bad Kösen, Bad Kösen, Germany
| | - Wieland Kiess
- Department of Women and Child Health, Center for Pediatric Research, Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany
| | - Ulrike Rothe
- Health Sciences/Public Health, Faculty of Medicine “Carl Gustav Carus”, Technische Universität Dresden, Dresden, Germany
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Sandy JL, Besançon S, Sidibé AT, Minkailou M, Togo A, Ogle GD. Rapid increases in observed incidence and prevalence of Type 1 diabetes in children and youth in Mali, 2007-2016. Pediatr Diabetes 2021; 22:545-551. [PMID: 33586301 DOI: 10.1111/pedi.13191] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/12/2021] [Accepted: 02/07/2021] [Indexed: 01/15/2023] Open
Abstract
AIMS Determine incidence, prevalence and mortality of Type 1 diabetes (T1D) in children and youth <25 years (y) in Mali during the first 10 years of the Santé Diabète/Life for a Child program. METHODS Data were collected from the prospective program register. Diagnosis of T1D was clinical, based on presentation, clinical features, immediate requirement for insulin, and no suggestion of other diabetes types. RESULTS Total of 460 cases were diagnosed with T1D <25 years in 2007-2016. Male-to-female ratio was 1.04:1. Peak age at onset was 15-16 years (range 1.1-24 years). T1D incidence <25 years per 100,000 population/year increased from 0.12 in 2007 to 0.74 in 2016 (an 18% annualized increase, p < 0.001). Incidence peaked at 0.80 in 2014, the year after an education campaign was conducted. Incidence <15 years rose from 0.12 to 0.35 per 100,000/year in 2007 and 2016, respectively, (14% annualized increase, p < 0.001). There was a steep, consistent increase in prevalence (per 100,000) from 0.43 in 2007 to 2.90 in 2016 (p < 0.001). Prevalence <15 years was 0.34/100,000 in 2007 and 1.02/100,000 by 2016 (p < 0.001). Overall crude mortality rate was 30.0/1000 patient years, equating to a standardized mortality rate of 9.0, with vital status known for 99.8% of cases. CONCLUSION Known incidence and prevalence of diabetes in Mali increased rapidly from 2007 to 2016, contemporaneous with the introduction and development of the Santé Diabète/Life for a Child program. Improved diagnosis and care resulting in lower mortality are likely contributors. True incidence may still be underestimated, with some cases still dying undiagnosed and full study ascertainment being uncertain.
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Affiliation(s)
- Jessica Lynn Sandy
- Life for a Child Program, Diabetes NSW, Glebe, New South Wales, Australia
| | | | | | - Mahamadou Minkailou
- Santé Diabète, Mali delegation, Bamako, Mali.,Endocrinology and Diabetes, Hôpital du Mali, Yirimadio, Bamako, Mali
| | - Amagara Togo
- Endocrinology and Diabetes, Hôpital du Mali, Yirimadio, Bamako, Mali
| | - Graham David Ogle
- Life for a Child Program, Diabetes NSW, Glebe, New South Wales, Australia
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Nishioka Y, Noda T, Okada S, Myojin T, Kubo S, Higashino T, Ishii H, Imamura T. Incidence and seasonality of type 1 diabetes: a population-based 3-year cohort study using the National Database in Japan. BMJ Open Diabetes Res Care 2020; 8:8/1/e001262. [PMID: 32994226 PMCID: PMC7526280 DOI: 10.1136/bmjdrc-2020-001262] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 05/16/2020] [Accepted: 06/06/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION To investigate the incidence of type 1 diabetes by age group (0-19, 20-39, 40-59, ≥60 years) in Japan and whether there is seasonality in this incidence. RESEARCH DESIGN AND METHODS The incidence of type 1 diabetes from September 2014 to August 2017 was estimated using 2013-2018 data from the National Database of Health Insurance Claims and Specific Health Check-ups of Japan. The incidence rate was analyzed using Tango's Index and the self-controlled case series method. RESULTS Overall, 10 400 of the 79 175 553 included individuals were diagnosed with type 1 diabetes. The incidence of type 1 diabetes from September 2014 to August 2017 was 4.42/100 000 person-years. The incidence rates for men aged 0-19, 20-39, 40-59, and ≥60 years were 3.94, 5.57, 5.70, and 3.48, respectively. Among women, the incidence rates for the same age ranges were 5.22, 4.83, 4.99, and 3.31, respectively. Tango's index showed that the incidence rate of type 1 diabetes was significantly associated with seasons among those aged 0-19 years. Further, the self-controlled case series method showed a significant interaction between age and season, with the incidence of type 1 diabetes being higher in spring for patients younger than 20 years of age. CONCLUSIONS In Japan, men aged 40-59 years and women aged 0-19 years are the groups with the highest incidence of type 1 diabetes. Further, the incidence of younger-onset diabetes in Japan was higher in spring (from March to May).
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Affiliation(s)
- Yuichi Nishioka
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
- Department of Diabetes and Endocrinology, Nara Medical University, Kashihara, Nara, Japan
| | - Tatsuya Noda
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Sadanori Okada
- Department of Diabetes and Endocrinology, Nara Medical University, Kashihara, Nara, Japan
| | - Tomoya Myojin
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Shinichiro Kubo
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Tsuneyuki Higashino
- Healthcare and Wellness Division, Mitsubishi Research Institute, Inc, Tokyo, Japan
| | - Hitoshi Ishii
- Department of Diabetes and Endocrinology, Nara Medical University, Kashihara, Nara, Japan
| | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
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Samuelsson U, Westerberg L, Aakesson K, Birkebaek NH, Bjarnason R, Drivvoll AK, Skrivarhaug T, Svensson J, Thorsson A, Hanberger L. Geographical variation in the incidence of type 1 diabetes in the Nordic countries: A study within NordicDiabKids. Pediatr Diabetes 2020; 21:259-265. [PMID: 31702838 DOI: 10.1111/pedi.12943] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 09/19/2019] [Accepted: 10/28/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The incidence of type 1 diabetes (T1D) is high in the Nordic countries with geographic differences between as well as within countries. OBJECTIVE To describe the geographical distribution of the incidence of T1D among children in four Nordic countries, an area where the population is considered genetically similar. METHODS Data on children 0 to 14 years of age and diagnosed with T1D 2006 to 2011 was collected from four Nordic national pediatric quality diabetes registries. Data included year of diagnosis (2006-2011), sex, and age at diagnosis. Figures for number of children at risk during 2006 to 2011-as well as total population, proportion with foreign background and size of populated areas of geographic regions-were collected from official statistics. RESULTS The total incidence during the study period for all four countries was 35.7/100 000 person years but differed between the countries (range 18.2-44.1; P < .001). The incidence difference between the countries was most obvious in the highest age group, 10 to 14 years of age, whereas there was no difference in the youngest age group 0 to 5 years of age. Iceland had similar incidence in the entire country, whereas the other countries had areas with different incidence. Densely populated areas, such as major cities, had the lowest incidence. CONCLUSION The incidence of T1D differed between the Nordic countries and also between the neighboring countries and generally decreased with population density. This indicates that environmental factors may contribute to the level of incidence of T1D.
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Affiliation(s)
- Ulf Samuelsson
- Department of Clinical and Experimental Medicine, Division of Paediatrics and Diabetes, Research Centre, Linköping University, Linköping, Sweden
| | | | - Karin Aakesson
- Department of Pediatrics, County Hospital Ryhov, Jönköping, Sweden.,Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Niels H Birkebaek
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Ragnar Bjarnason
- Landspitali University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Ann K Drivvoll
- Norwegian Childhood Diabetes Registry, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Torild Skrivarhaug
- Norwegian Childhood Diabetes Registry, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jannet Svensson
- Herlev University Hospital, CPH-Direct, Pediatric Department, Herlev, Denmark.,University of Copenhagen, Faculty of Health and Medical Science, Copenhagen, Denmark
| | - Arni Thorsson
- Landspitali University Hospital and Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Lena Hanberger
- Department of Medicine and Health Sciences, Division of Nursing, Linköping University, Linköping, Sweden
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11
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Manuwald U, Schoffer O, Hegewald J, Große J, Kugler J, Kapellen TM, Kiess W, Rothe U. Ketoacidosis at onset of type 1 diabetes in children up to 14 years of age and the changes over a period of 18 years in Saxony, Eastern-Germany: A population based register study. PLoS One 2019; 14:e0218807. [PMID: 31220176 PMCID: PMC6586407 DOI: 10.1371/journal.pone.0218807] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 06/10/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE The aim of this study was to examine the incidence trends of type 1 diabetes diagnosed with ketoacidosis in Saxony, Germany from 1999 to 2016. METHODS The population based Childhood Diabetes Registry of Saxony comprising valid data for all children aged 0-14 years diagnosed with type 1 diabetes from1999 to 2016 were used for the analyses. Direct age-standardized incidence rates were calculated and the effects of age, sex, calendar year, home districts and family history of any types of diabetes on the incidence were modelled using Poisson regression. Trend analyses for standard rate ratios of children with moderate and severe diabetic ketoacidosis versus children with type 1 diabetes with non-diabetic ketoacidosis were performed using join point regression. RESULTS The rate of ketoacidosis at the time of the type 1 diabetes diagnosis was high with 35.2% during the entire observation period in Saxony. The Poisson regression analysis indicated a statistically significant increased occurrence of diabetic ketoacidosis for younger age-groups, but no statistically significant differences between boys and girls. The join point trend analyses show that the proportion of severe and moderate ketoacidosis is increasing disproportionally to the increase in incidence of type 1 diabetes over the years. CONCLUSION Due to the observed increasing incidence of diabetes as well of diabetic ketoacidosis, an educational prevention campaign is needed in Saxony as soon as possible to aid pediatricians, general physicians as well as general public to identify the early signs of type 1 diabetes.
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Affiliation(s)
- Ulf Manuwald
- Health Sciences/Public Health, Faculty of Medicine “Carl Gustav Carus”, TU Dresden, Dresden, Germany
| | - Olaf Schoffer
- Center of Evidence-Based Healthcare, University Hospital “Carl Gustav Carus”, TU Dresden, Dresden, Germany
| | - Janice Hegewald
- Institute and Policlinic for Occupational and Social Medicine, Faculty of Medicine “Carl Gustav Carus”, TU Dresden, Dresden, Germany
- Institute of Sociology, Chemnitz University of Technology, Chemnitz, Germany
| | - Johann Große
- Saxonian Network for Health Promotion "Sächsische Landesvereinigung für Gesundheitsförderung e.V.", Dresden, Germany
| | - Joachim Kugler
- Health Sciences/Public Health, Faculty of Medicine “Carl Gustav Carus”, TU Dresden, Dresden, Germany
| | - Thomas Michael Kapellen
- Hospital for Children and Adolescents, Center for Pediatric Research, Department of Women and Child Health, University of Leipzig, Leipzig, Germany
| | - Wieland Kiess
- Hospital for Children and Adolescents, Center for Pediatric Research, Department of Women and Child Health, University of Leipzig, Leipzig, Germany
| | - Ulrike Rothe
- Health Sciences/Public Health, Faculty of Medicine “Carl Gustav Carus”, TU Dresden, Dresden, Germany
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12
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Al-Koofee DA, Jasim AA, Al-Issawi HA. Identification of +49A/G polymorphism of cytotoxic T lymphocyte-associated protein-4 gene in type 1 diabetes patients in Kerbala province/Iraq. GENE REPORTS 2019. [DOI: 10.1016/j.genrep.2019.100368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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13
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Lesko CR, Jacobson LP, Althoff KN, Abraham AG, Gange SJ, Moore RD, Modur S, Lau B. Collaborative, pooled and harmonized study designs for epidemiologic research: challenges and opportunities. Int J Epidemiol 2019; 47:654-668. [PMID: 29438495 DOI: 10.1093/ije/dyx283] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2018] [Indexed: 01/23/2023] Open
Abstract
Collaborative study designs (CSDs) that combine individual-level data from multiple independent contributing studies (ICSs) are becoming much more common due to their many advantages: increased statistical power through large sample sizes; increased ability to investigate effect heterogeneity due to diversity of participants; cost-efficiency through capitalizing on existing data; and ability to foster cooperative research and training of junior investigators. CSDs also present surmountable political, logistical and methodological challenges. Data harmonization may result in a reduced set of common data elements, but opportunities exist to leverage heterogeneous data across ICSs to investigate measurement error and residual confounding. Combining data from different study designs is an art, which motivates methods development. Diverse study samples, both across and within ICSs, prompt questions about the generalizability of results from CSDs. However, CSDs present unique opportunities to describe population health across person, place and time in a consistent fashion, and to explicitly generalize results to target populations of public health interest. Additional analytic challenges exist when analysing CSD data, because mechanisms by which systematic biases (e.g. information bias, confounding bias) arise may vary across ICSs, but multidisciplinary research teams are ready to tackle these challenges. CSDs are a powerful tool that, when properly harnessed, permits research that was not previously possible.
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Affiliation(s)
- Catherine R Lesko
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Lisa P Jacobson
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Keri N Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alison G Abraham
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Division of Ophthalmology
| | - Stephen J Gange
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Richard D Moore
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Sharada Modur
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Bryan Lau
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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14
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Piffaretti C, Mandereau-Bruno L, Guilmin-Crepon S, Choleau C, Coutant R, Fosse-Edorh S. Trends in childhood type 1 diabetes incidence in France, 2010-2015. Diabetes Res Clin Pract 2019; 149:200-207. [PMID: 30439385 DOI: 10.1016/j.diabres.2018.11.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 10/24/2018] [Accepted: 11/05/2018] [Indexed: 01/21/2023]
Abstract
AIMS To estimate type 1 diabetes incidence in children in France and its evolution between 2010 and 2015, based on comprehensive medico-administrative databases. METHODS The algorithm built to identify new cases of type 1 diabetes selected children aged between 6 months and 14 years who had at least one hospital stay for diabetes, followed by their first insulin treatment, excluding children suffering from another form of diabetes. Age and sex specific annual incidence rates were estimated and time trend was analyzed using Poisson regression. RESULTS A total of 12 067 children were identified as newly diagnosed with type 1 diabetes and the annual incidence rates increased between 2010 and 2015 (from 15.4 [95% Confidence Interval: 14.7; 16.1] to 19.1 [18.3; 19.9] per 100 000 person-years), among boys and girls, and in each age group (4 and under, 5-9, 10-14 year olds). The annual rate of increase was 4.0% [3.4; 4.6]. This trend was not significantly different between each gender, and each age group. CONCLUSIONS Valid database information on disease incidence is essential for healthcare planning and provides a valuable resource for health research. An increase of the incidence rate of type 1 diabetes in children was highlighted in both sexes and in all age groups.
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Affiliation(s)
- Clara Piffaretti
- Santé publique France, The French National Public Health Agency, 12 rue du Val d'Osne, 94410 Saint Maurice, France.
| | - Laurence Mandereau-Bruno
- Santé publique France, The French National Public Health Agency, 12 rue du Val d'Osne, 94410 Saint Maurice, France
| | - Sophie Guilmin-Crepon
- Clinical Epidemiology Unit and Endocrinology and Diabetology Service, University Hospital Robert Debré at Assistance publique - Hôpitaux de Paris, 48 Bd Sérurier, 75019 Paris, France
| | - Carine Choleau
- AJD (Aide aux Jeunes Diabétiques), Help to the Young Diabetics, 38 Rue Eugène Oudiné, 75013 Paris, France
| | - Régis Coutant
- Pediatric Endocinology Service, University Hospital of Angers, 4 Rue Larrey, 49100 Angers, France
| | - Sandrine Fosse-Edorh
- Santé publique France, The French National Public Health Agency, 12 rue du Val d'Osne, 94410 Saint Maurice, France
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15
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Patterson CC, Harjutsalo V, Rosenbauer J, Neu A, Cinek O, Skrivarhaug T, Rami-Merhar B, Soltesz G, Svensson J, Parslow RC, Castell C, Schoenle EJ, Bingley PJ, Dahlquist G, Jarosz-Chobot PK, Marčiulionytė D, Roche EF, Rothe U, Bratina N, Ionescu-Tirgoviste C, Weets I, Kocova M, Cherubini V, Rojnic Putarek N, deBeaufort CE, Samardzic M, Green A. Trends and cyclical variation in the incidence of childhood type 1 diabetes in 26 European centres in the 25 year period 1989-2013: a multicentre prospective registration study. Diabetologia 2019; 62:408-417. [PMID: 30483858 DOI: 10.1007/s00125-018-4763-3] [Citation(s) in RCA: 275] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 09/28/2018] [Indexed: 12/17/2022]
Abstract
AIMS/HYPOTHESIS Against a background of a near-universally increasing incidence of childhood type 1 diabetes, recent reports from some countries suggest a slowing in this increase. Occasional reports also describe cyclical variations in incidence, with periodicities of between 4 and 6 years. METHODS Age/sex-standardised incidence rates for the 0- to 14-year-old age group are reported for 26 European centres (representing 22 countries) that have registered newly diagnosed individuals in geographically defined regions for up to 25 years during the period 1989-2013. Poisson regression was used to estimate rates of increase and test for cyclical patterns. Joinpoint regression software was used to fit segmented log-linear relationships to incidence trends. RESULTS Significant increases in incidence were noted in all but two small centres, with a maximum rate of increase of 6.6% per annum in a Polish centre. Several centres in high-incidence countries showed reducing rates of increase in more recent years. Despite this, a pooled analysis across all centres revealed a 3.4% (95% CI 2.8%, 3.9%) per annum increase in incidence rate, although there was some suggestion of a reduced rate of increase in the 2004-2008 period. Rates of increase were similar in boys and girls in the 0- to 4-year-old age group (3.7% and 3.7% per annum, respectively) and in the 5- to 9-year-old age group (3.4% and 3.7% per annum, respectively), but were higher in boys than girls in the 10- to 14-year-old age group (3.3% and 2.6% per annum, respectively). Significant 4 year periodicity was detected in four centres, with three centres showing that the most recent peak in fitted rates occurred in 2012. CONCLUSIONS/INTERPRETATION Despite reductions in the rate of increase in some high-risk countries, the pooled estimate across centres continues to show a 3.4% increase per annum in incidence rate, suggesting a doubling in incidence rate within approximately 20 years in Europe. Although four centres showed support for a cyclical pattern of incidence with a 4 year periodicity, no plausible explanation for this can be given.
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Affiliation(s)
- Christopher C Patterson
- Centre for Public Health and UKCRC Centre of Excellence for Public Health Northern Ireland, Queen's University Belfast, Grosvenor Road, Belfast, BT12 6BJ, UK.
| | - Valma Harjutsalo
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Helsinki, Finland
| | - Joachim Rosenbauer
- German Diabetes Center, Institute of Biometrics and Epidemiology, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Andreas Neu
- University Children's Hospital, Tübingen, Germany
| | - Ondrej Cinek
- Department of Pediatrics, Second Faculty of Medicine, Charles University and University Hospital Motol, Prague, Czechia
| | - Torild Skrivarhaug
- Division of Adolescent and Paediatric Medicine, Institute of Clinical Medicine, University of Oslo, Oslo University Hospital, Oslo, Norway
| | - Birgit Rami-Merhar
- Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Gyula Soltesz
- Department of Paediatrics, Medical School, University of Pécs, Pécs, Hungary
| | - Jannet Svensson
- Department of Paediatrics and Adolescent Medicine, Copenhagen University Hospital, Herlev and Gentofte, Denmark
| | - Roger C Parslow
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Conxa Castell
- Department of Health, Government of Catalonia, Barcelona, Spain
| | - Eugen J Schoenle
- Department of Endocrinology and Diabetology, University Children's Hospital, Zurich, Switzerland
| | - Polly J Bingley
- Diabetes and Metabolism, Bristol Medical School, University of Bristol, Bristol, UK
| | - Gisela Dahlquist
- Department of Clinical Sciences, Paediatrics, University of Umeå, Umeå, Sweden
| | | | - Dalė Marčiulionytė
- Institute of Endocrinology, Lithuanian University of Health Sciences, Kaunas, Lithuania
- Institute of Microbiology and Virology, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Edna F Roche
- Department of Paediatrics, Tallaght University Hospital, Trinity College Dublin, The University of Dublin, Dublin, Ireland
| | - Ulrike Rothe
- Health Sciences/Public Health, Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - Natasa Bratina
- Diabetes and Metabolic Diseases, University Children's Hospital, Department of Endocrinology, Ljubljana, Slovenia
| | | | - Ilse Weets
- Diabetes Research Center and Laboratory of Clinical Biology, Brussels Free University-Vrije Universiteit Brussel, University Hospital Brussels-Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Mirjana Kocova
- Department of Endocrinology and Genetics, University Children's Hospital, Skopje, Republic of Macedonia
| | | | - Natasa Rojnic Putarek
- Department of Pediatric Endocrinology and Diabetes, University Hospital Zagreb, Zagreb, Croatia
| | - Carine E deBeaufort
- Department of Paediatric Diabetes and Endocrinology, University of Luxembourg, Luxembourg, Luxembourg
| | - Mira Samardzic
- Department of Endocrinology, Institute for Sick Children, Podgorica, Montenegro
| | - Anders Green
- Odense Patient data Exploratory Network (OPEN), Odense University Hospital/Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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16
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Adeloye D, Chan KY, Thorley N, Jones C, Johnstone D, L'Heveder A, Saftic V, Henderson D, Chopra M, Campbell H, Rudan I. Global and regional estimates of the morbidity due to type I diabetes among children aged 0-4 years: a systematic review and analysis. J Glob Health 2018; 8:021101. [PMID: 30410744 PMCID: PMC6214490 DOI: 10.7189/jogh.08.021101] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Epidemiology of type 1 diabetes mellitus (T1DM) among children aged 0-4 years globally is not well understood. We aim to assess the incidence of T1DM in low- and middle-income countries (LMIC) by conducting a systematic review of previous reports. We also aim to address possible contribution to child mortality and to identify any temporal trends. Methods A systematic review was performed using a carefully designed search strategy to explore MEDLINE, EMBASE and Global Health databases. Data was extracted from all studies that satisfied the inclusion criteria –a total of 83 records extracted from 26 830 sources that were analysed. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) process to assess quality of evidence and applied meta-analysis approaches to assess global and regional incidence and time trends. Results The overall pooled incidence of T1DM in children aged 0-4 years globally is 11.2 (95% CI = 10.0-12.3) per 100 000 child years. The regional incidence were the highest for European Region A (EUR A) at 15.5 (95% CI = 13.5-17.5) per 100 000 child years. EUR C had the incidence of 10.0 (95% CI = 6.5-13.6) and EUR B 5.8 (95% CI = 4.7-7.0), Region of the Americas A (AMR A) 11.4 (95% CI = 7.8-14.9), AMR B of 2.5 (95% CI = 0.2-4.8), Eastern Mediterranean Region (EMR B) 7.1 (95% CI = 4.2-10.0) and Western Pacific Region (WPR A) 7.0 (95% CI = 2.9-11.0) per 100 000 child years, while other regions had very low rates or no data. When data points were categorised in the study periods and re-analysed, an increasing trend of the T1DM incidence was observed, with the incidence of 20.9 (95% CI = 7.8-34.1) per 100 000 child years in the years 2010-2015, preceded by 13.2 (95% CI = 11.0-15.5) in 2000-2009 study period, 10.0 (95% CI = 8.4-11.7) in 1990-1999 and 8.3 (95% CI = 5.1-11.6) in 1980-1989, respectively. Although the data are scarce, and variation and uncertainty are large, we estimated that the number of new cases of T1DM among children aged 0-4 years in the world each year is between 100 000 and 150 000. Conclusions The identified large variation in incidence estimates for different parts of the world, along with scarcity of information and the identified strong temporal increase in T1DM incidence suggest a clear need for further research into this subject.
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Affiliation(s)
- Davies Adeloye
- Centre for Global Health Research and World Health Organization's Collaborating Centre for Population Health, Research and Training, The Usher Institute, University of Edinburgh, UK
| | - Kit Yee Chan
- Centre for Global Health Research and World Health Organization's Collaborating Centre for Population Health, Research and Training, The Usher Institute, University of Edinburgh, UK
| | - Natasha Thorley
- Centre for Global Health Research and World Health Organization's Collaborating Centre for Population Health, Research and Training, The Usher Institute, University of Edinburgh, UK
| | - Charlotte Jones
- Centre for Global Health Research and World Health Organization's Collaborating Centre for Population Health, Research and Training, The Usher Institute, University of Edinburgh, UK
| | - David Johnstone
- Centre for Global Health Research and World Health Organization's Collaborating Centre for Population Health, Research and Training, The Usher Institute, University of Edinburgh, UK
| | - Ari L'Heveder
- Centre for Global Health Research and World Health Organization's Collaborating Centre for Population Health, Research and Training, The Usher Institute, University of Edinburgh, UK
| | - Vanja Saftic
- Child and Youth Protection Center of Zagreb, Croatia.,Croatian Catholic University, Zagreb, Croatia
| | - David Henderson
- Centre for Global Health Research and World Health Organization's Collaborating Centre for Population Health, Research and Training, The Usher Institute, University of Edinburgh, UK
| | | | - Harry Campbell
- Centre for Global Health Research and World Health Organization's Collaborating Centre for Population Health, Research and Training, The Usher Institute, University of Edinburgh, UK
| | - Igor Rudan
- Centre for Global Health Research and World Health Organization's Collaborating Centre for Population Health, Research and Training, The Usher Institute, University of Edinburgh, UK
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17
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Cinek O, Kramna L, Mazankova K, Odeh R, Alassaf A, Ibekwe MU, Ahmadov G, Elmahi BME, Mekki H, Lebl J, Abdullah MA. The bacteriome at the onset of type 1 diabetes: A study from four geographically distant African and Asian countries. Diabetes Res Clin Pract 2018; 144:51-62. [PMID: 30121305 DOI: 10.1016/j.diabres.2018.08.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 07/22/2018] [Accepted: 08/13/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Gut bacteriome profiling studies in type 1 diabetes (T1D) to date are mostly limited to populations of Europe, with two studies from China and one study each from Mexico and the USA. We therefore sought to characterize the stool bacteriome in children after onset of T1D along with age- and place-matched control subjects from four geographically distant African and Asian countries. METHODS Samples were collected from 73 children and adolescents shortly after T1D onset (Azerbaijan 19, Jordan 20, Nigeria 14, Sudan 20) and 104 matched control subjects of similar age and locale. Genotyping of major T1D susceptibility genes was performed using saliva or blood samples. The bacteriome was profiled by next-generation sequencing of 16S rDNA. Negative binomial regression was used to model associations, with adjustment for the matched structure of the study. RESULTS A significant positive association with T1D was noted for the genus Escherichia (class Gammaproteobacteria, phylum Proteobacteria), whereas Eubacterium and Roseburia, two genera of class Clostridia, phylum Firmicutes, were inversely associated with T1D. We also confirmed a previously observed inverse association with Clostridium clusters IV or XIVa. No associations were noted for richness, evenness, or enterotypes. CONCLUSIONS Based on our results, some type of distortion of the gut bacteriome appears to be a global feature of T1D, and our findings for four distant populations add new candidates to the existing list of bacteria. It remains to be established whether the observed associations are markers or causative factors.
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Affiliation(s)
- Ondrej Cinek
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague and University Hospital Motol, V Uvalu 84, Prague 5, Czech Republic.
| | - Lenka Kramna
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague and University Hospital Motol, V Uvalu 84, Prague 5, Czech Republic.
| | - Karla Mazankova
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague and University Hospital Motol, V Uvalu 84, Prague 5, Czech Republic.
| | - Rasha Odeh
- Department of Pediatrics, School of Medicine, University of Jordan, Amman, Jordan.
| | - Abeer Alassaf
- Department of Pediatrics, School of Medicine, University of Jordan, Amman, Jordan.
| | - MaryAnn Ugochi Ibekwe
- Department of Pediatrics, Federal Teaching Hospital Abakaliki, Ebonyi State University, Abakaliki, Nigeria.
| | - Gunduz Ahmadov
- Endocrine Centre Baku, Str. I. Hashimov 4A, AZ1114 Baku, Azerbaijan.
| | - Bashir Mukhtar Elwasila Elmahi
- Department of Paediatrics and Child Health, University of Khartoum, Faculty of Medicine, Khartoum, Sudan; Sudan Childhood Diabetes Center, Khartoum, Sudan.
| | - Hanan Mekki
- Department of Paediatrics and Child Health, University of Khartoum, Faculty of Medicine, Khartoum, Sudan.
| | - Jan Lebl
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague and University Hospital Motol, V Uvalu 84, Prague 5, Czech Republic.
| | - Mohammed Ahmed Abdullah
- Department of Paediatrics and Child Health, University of Khartoum, Faculty of Medicine, Khartoum, Sudan; Sudan Childhood Diabetes Center, Khartoum, Sudan.
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18
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Neu A, Feldhahn L, Ehehalt S, Ziegler J, Rothe U, Rosenbauer J, Holl RW. No change in type 2 diabetes prevalence in children and adolescents over 10 years: Update of a population-based survey in South Germany. Pediatr Diabetes 2018; 19:637-639. [PMID: 29235225 DOI: 10.1111/pedi.12622] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 11/04/2017] [Accepted: 11/16/2017] [Indexed: 01/13/2023] Open
Abstract
Objective of this study was to analyze prevalence changes in type 2 diabetes (T2D) among children and adolescents over the last 10 years. We performed a cross-sectional survey in Baden-Württemberg (BW), Germany, by using a written questionnaire and comparing these results with T2D prevalence data from the same area retrieved in 2004/2005. In 2016, 50 patients with T2D under 20 years of age were registered in BW, Germany, which corresponds to a prevalence rate of 2.42 per 100 000 (95% confidence interval [CI]: 1.75-3.09). The prevalence rate found in the same geographic area 10 years prior was 2.30 per 100 000 (95% CI: 1.70-2.90). Overall, 70% of T2D patients of this age group were treated by adult diabetologists. Concisely the prevalence of T2D in children and adolescents is still low in South Germany, remaining practically unchanged over the past decade.
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Affiliation(s)
- A Neu
- University Children's Hospital Tübingen, Tübingen, Germany
| | - L Feldhahn
- Children's Hospital Böblingen, Böblingen, Germany
| | - S Ehehalt
- Department of Pediatrics, Public Health Department Stuttgart, Stuttgart, Germany
| | - J Ziegler
- University Children's Hospital Tübingen, Tübingen, Germany
| | - U Rothe
- Department for Epidemiology and Health Care Research, Technical University of Dresden, Dresden, Germany
| | - J Rosenbauer
- German Diabetes Centre and Leibniz Institute for Diabetes Research, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - R W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University Ulm, Ulm, Germany
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19
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Type 1 Diabetes Mellitus in Saudi Arabia: A Soaring Epidemic. Int J Pediatr 2018; 2018:9408370. [PMID: 29853923 PMCID: PMC5964576 DOI: 10.1155/2018/9408370] [Citation(s) in RCA: 69] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 03/04/2018] [Accepted: 03/28/2018] [Indexed: 12/12/2022] Open
Abstract
Type 1 diabetes mellitus (T1DM) is quite prevalent in the world, with a proportion of 1 in every 300 persons and steadily rising frequency of incidence of about 3% every year. More alarmingly, the incidence of T1DM among infants is also increasing, with children as young as 6 months succumbing to it, instead of that at a rather established vulnerable age of around seven and near puberty, when the hormones antagonize the action of insulin. These reports pose a unique challenge of developing efficient T1DM management system for the young children. The Kingdom of Saudi Arabia (KSA) is the largest country in the Middle East that occupies approximately four-fifths of the Arabian Peninsula supporting a population of more than 33.3 million people, of whom 26% are under the age of 14 years. As per the Diabetes Atlas (8th edition), 35,000 children and adolescents in Saudi Arabia suffer from T1DM, which makes Saudi Arabia rank the 8th in terms of numbers of TIDM patients and 4th country in the world in terms of the incidence rate (33.5 per 100,000 individuals) of TIDM. However, in comparison with that in the developed countries, the number of research interventions on the prevalence, incidence, and the sociodemographic aspects of T1DM is woefully inadequate. In this review we discuss different aspects of T1DM in Saudi Arabia drawing on the published literature currently available.
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Gerasimou P, Nicolaidou V, Skordis N, Picolos M, Monos D, Costeas PA. Combined effect of glutamine at position 70 of HLA-DRB1 and alanine at position 57 of HLA-DQB1 in type 1 diabetes: An epitope analysis. PLoS One 2018; 13:e0193684. [PMID: 29494662 PMCID: PMC5832312 DOI: 10.1371/journal.pone.0193684] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 02/15/2018] [Indexed: 02/06/2023] Open
Abstract
The contribution of specific HLA Class II alleles in type 1 diabetes is determined by polymorphic amino acid epitopes that direct antigen binding therefore, along with conventional allele frequency analysis, epitope analysis can provide important insights into disease susceptibility. We analyzed the highly heterogeneous Cypriot population for the HLA class II loci of T1DM patients and controls and we report for the first time their allele frequencies. Within our patient cohort we identified a subgroup that did not carry the DRB1*03:01-DQA1*05:01-DQB1*02:01 and DRB1*04:xx-DQA1*03:01-DQB1*03:02 risk haplotypes but a novel recombinant one, DRB1*04:XX-DQA1*03:01-DQB1*02:01 designated DR4-DQ2.3. Through epitope analysis we identified established susceptibility (DQB1 A57, DRB1 H13) and resistance (DQB1 D57) residues as well as other novel susceptibility residues DRB1 Q70, DQB1 L26 and resistance residues DRB1 D70, R70 and DQB1 Y47. Prevalence of susceptibility epitopes was higher in patients and was not exclusively a result of linkage disequilibrium. Residues DRB1 Q70, DQB1 L26 and A57 and a 10 amino acid epitope of DQA1 were the most significant in discriminating risk alleles. An extended haplotype containing these epitopes was carried by 92% of our patient cohort. Sharing of susceptibility epitopes could also explain the absence of risk haplotypes in patients. Finally, many significantly associated epitopes were non-pocket residues suggesting that critical immune functions may exist spanning further from the binding pockets.
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Affiliation(s)
- Petroula Gerasimou
- Karaiskakio Foundation, Nicosia, Cyprus
- University of Cyprus, Department of Biological Sciences, Nicosia, Cyprus
| | - Vicky Nicolaidou
- Department of Life and Health Sciences, School of Sciences and Engineering, University of Nicosia, Nicosia Cyprus
| | - Nicos Skordis
- Division of Paediatric Endocrinology, Paedi Centre for Specialized Paediatrics, Nicosia, Cyprus
| | | | - Demetrios Monos
- Department of Pathology and Laboratory Medicine, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, United States of America
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Kotsani K, Antonopoulou V, Kountouri A, Grammatiki M, Rapti E, Karras S, Trakatelli C, Tsaklis P, Kazakos K, Kotsa K. The role of telenursing in the management of Diabetes Type 1: A randomized controlled trial. Int J Nurs Stud 2018; 80:29-35. [PMID: 29353709 DOI: 10.1016/j.ijnurstu.2018.01.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 12/27/2017] [Accepted: 01/05/2018] [Indexed: 01/29/2023]
Abstract
BACKGROUND Diabetes Mellitus type 1 (T1DM) is a chronic disease that requires patients' self-monitoring and self-management to achieve glucose targets and prevent complications. Telenursing implicates technology in the interaction of a specialized nurse with patients with chronic diseases in order to provide personalized care and support. OBJECTIVE To evaluate the effect of telenursing on T1DM patients' compliance with glucose self-monitoring and glycemic control. DESIGN Randomized controlled study. SETTINGS Outpatient Department of Diabetes, Endocrinology and Metabolism of a University Hospital in Northern Greece. METHODS Ninety-four T1DM patients were recruited and randomized in two groups by a random number generator. The intervention group (N = 48) was provided with telenursing services. A specialized nurse made a weekly contact via telephone motivating patients to frequently measure blood glucose and adopt a healthy lifestyle. The control group (N = 46) received standard diabetes advice and care in the clinic. The primary outcome was the effect of the intervention in glucose control and glucose variability. The secondary outcome was the effect on frequency of self-monitoring. SPSS 20.0 was used for data analysis. RESULTS The two groups did not differ in age, sex, physical activity or initial HbA1c. In the intervention group, blood glucose significantly decreased at the end of the study in all predefined measurements, compared to control group: morning (93.18 ± 13.30 mg/dl vs. 105.17 ± 13.74 mg/dl, p < 0.005), pre-prandial (114.76 ± 9.54 mg/dl vs. 120.84 ± 4.05 mg/dl, p < 0.005), post-prandial (193.35 ± 25.36 mg/dl vs. 207.84 ± 18.80 mg/dl, p < 0.005), and HbA1c decreased significantly over time in the intervention group (8.3 ± 0.6% at the beginning of the study vs. 7.8 ± 1% at the end of the study, p = 0.03). In the intervention group there were also fewer omitted glucose measurements than in the control group. CONCLUSIONS Patients in the intervention group achieved better glucose control and more frequent self-monitoring than patients in routine care in the clinic. The findings of our study indicate that telenursing can motivate T1DM patients to better control their disease.
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Affiliation(s)
- Konstantia Kotsani
- Diabetes Center, Department of Endocrinology and Metabolism, 1st Department of Internal Medicine, AHEPA University Hospital, Thessaloniki, Greece
| | - Vasiliki Antonopoulou
- Diabetes Center, Department of Endocrinology and Metabolism, 1st Department of Internal Medicine, AHEPA University Hospital, Thessaloniki, Greece
| | - Aikaterini Kountouri
- Diabetes Center, Department of Endocrinology and Metabolism, 1st Department of Internal Medicine, AHEPA University Hospital, Thessaloniki, Greece
| | - Maria Grammatiki
- Diabetes Center, Department of Endocrinology and Metabolism, 1st Department of Internal Medicine, AHEPA University Hospital, Thessaloniki, Greece
| | - Eleni Rapti
- Diabetes Center, Department of Endocrinology and Metabolism, 1st Department of Internal Medicine, AHEPA University Hospital, Thessaloniki, Greece
| | - Spyridon Karras
- Diabetes Center, Department of Endocrinology and Metabolism, 1st Department of Internal Medicine, AHEPA University Hospital, Thessaloniki, Greece
| | - Christina Trakatelli
- Diabetes Center, Department of Endocrinology and Metabolism, 1st Department of Internal Medicine, AHEPA University Hospital, Thessaloniki, Greece
| | - Panagiotis Tsaklis
- Department of Nursing, Alexander Technological Educational Institute of Thessaloniki, Thessaloniki, Greece
| | - Kiriakos Kazakos
- Department of Nursing, Alexander Technological Educational Institute of Thessaloniki, Thessaloniki, Greece
| | - Kalliopi Kotsa
- Diabetes Center, Department of Endocrinology and Metabolism, 1st Department of Internal Medicine, AHEPA University Hospital, Thessaloniki, Greece.
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22
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Chen YL, Huang YC, Qiao YC, Ling W, Pan YH, Geng LJ, Xiao JL, Zhang XX, Zhao HL. Climates on incidence of childhood type 1 diabetes mellitus in 72 countries. Sci Rep 2017; 7:12810. [PMID: 28993655 PMCID: PMC5634499 DOI: 10.1038/s41598-017-12954-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 09/12/2017] [Indexed: 12/25/2022] Open
Abstract
We are aimed to systematically assess the worldwide trend in incidence of childhood type 1 diabetes mellitus (CT1DM) from 1965 to 2012 and to discuss whether climate affect incidence of CT1DM. We searched the relevant literatures in detail to judge the effect of different climates on incidence of CT1DM. The climates included Mediterranean, monsoon, oceanic, continental, savanna, and rainforest. According to different climates, we further researched relevant factor such as sunshine durations and latitudes. The overall incidence of CT1DM in 72 countries was 11.43 (95% CI 10.31–12.55) per 100,000 children/yr. The incidence of CT1DM in Oceanic climate [10.56 (8.69–12.42)] is highest compared with other climates; the incidence in 40°–66°34′N/S [14.71 (12.30–17.29)] is higher than other latitude groups; the incidence in sunshine durations with 3–4 hours per day [15.17 (11.14–19.20)] is highest compared with other two groups; the incidence of CT1DM from 2000 to 2012 [19.58 (14.55–24.60)] is higher than other periods; all p < 0.01. Incidence of CT1DM was increasing from 1965 to 2012, but incidence in Oceanic climate is higher than other climates. Furthermore, it is higher in centers with higher latitude and lower sunshine durations. The climates might play a key role in inducing CT1DM.
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Affiliation(s)
- Yin-Ling Chen
- Center of Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, 541004, China.,Department of Immunology, Faculty of basic Medicine, Guilin Medical University, Guilin, 541004, China
| | - Yong-Cheng Huang
- Center of Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, 541004, China
| | - Yong-Chao Qiao
- Department of Immunology, Xiangya School of Medicine, Central South University, Changsha, Hunan, 410078, China
| | - Wei Ling
- Center of Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, 541004, China
| | - Yan-Hong Pan
- Center of Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, 541004, China.,Department of Immunology, Faculty of basic Medicine, Guilin Medical University, Guilin, 541004, China
| | - Li-Jun Geng
- Center of Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, 541004, China.,Department of Immunology, Faculty of basic Medicine, Guilin Medical University, Guilin, 541004, China
| | - Jian-Long Xiao
- Center of Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, 541004, China.,Department of Immunology, Faculty of basic Medicine, Guilin Medical University, Guilin, 541004, China
| | - Xiao-Xi Zhang
- Center of Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, 541004, China. .,Department of Immunology, Faculty of basic Medicine, Guilin Medical University, Guilin, 541004, China.
| | - Hai-Lu Zhao
- Center of Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, 541004, China. .,Department of Immunology, Xiangya School of Medicine, Central South University, Changsha, Hunan, 410078, China. .,Department of Immunology, Faculty of basic Medicine, Guilin Medical University, Guilin, 541004, China.
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23
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Manuwald U, Heinke P, Salzsieder E, Hegewald J, Schoffer O, Kugler J, Kapellen TM, Kiess W, Rothe U. Incidence trends of type 1 diabetes before and after the reunification in children up to 14 years of age in Saxony, Eastern Germany. PLoS One 2017; 12:e0183665. [PMID: 28880877 PMCID: PMC5589116 DOI: 10.1371/journal.pone.0183665] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 08/08/2017] [Indexed: 11/21/2022] Open
Abstract
Aims The aim of this study was to analyze the incidence rates of type 1 diabetes in Saxony before and after the German reunification. Methods The study examined two registries: one until 1990 and one since 1999. Only patients under 15 years of age with type 1 diabetes and living in Saxony were included in the study. Standardized incidence rates were described based on direct age standardization procedures using the Standard European Population for each calendar year between the observation periods 1982–1989 and 1999–2014. Age was grouped into three classes: 0–4, 5–9 and 10–14 years of age. Incidence data were presented as age-standardized incidence rates per 100,000 person-years (PY) with 95% confidence intervals [CI]. Joinpoint regression was used for trend analyses and Poisson regression was used to adjust for the effects of age and sex on the incidence. Results A total number of 2,092 incident cases of type 1 diabetes (1,109 males; 983 females) were included. The age-standardized incidence rates of type 1 diabetes per 100,000 PY was 7.9 [95%CI 6.8; 8.9] in the period from 1982–1989 and 20.1 [95%CI 14.0; 26.1] in the period from 1999–2014. The yearly increase in incidence over the entire time period (1982–2014) was 4.3% according to the average annual percent change (AAPC) method, and estimated to be 4.4% [95% CI 4.0; 4.8%] using a Poisson regression model adjusting for sex and age group. Conclusion In this study, a significantly increasing incidence of type 1 diabetes was observed after reunification. In future studies it would be interesting to follow up on the question of which environmental and lifestyle factors could be causing the increasing type 1 diabetes incidence.
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Affiliation(s)
- Ulf Manuwald
- Health Sciences, Public Health, Faculty of Medicine “Carl Gustav Carus”, TU Dresden, Dresden, Germany
- * E-mail:
| | - Peter Heinke
- Institute of Diabetes “Gerhardt Katsch” Karlsburg, Karlsburg, Germany
| | | | - Janice Hegewald
- Institute and Policlinic for Occupational and Social Medicine, Faculty of Medicine “Carl Gustav Carus”, TU Dresden, Dresden, Germany
| | - Olaf Schoffer
- Center of Evidence-Based Healthcare, University Hospital “Carl Gustav Carus”, TU Dresden, Dresden, Germany
| | - Joachim Kugler
- Health Sciences, Public Health, Faculty of Medicine “Carl Gustav Carus”, TU Dresden, Dresden, Germany
| | - Thomas M. Kapellen
- Hospital for Children and Adolescents, Center for Pediatric Research, Department of Women and Child Health, University of Leipzig, Leipzig, Germany
| | - Wieland Kiess
- Hospital for Children and Adolescents, Center for Pediatric Research, Department of Women and Child Health, University of Leipzig, Leipzig, Germany
| | - Ulrike Rothe
- Health Sciences, Public Health, Faculty of Medicine “Carl Gustav Carus”, TU Dresden, Dresden, Germany
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24
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Chobot A, Polanska J, Brandt A, Deja G, Glowinska-Olszewska B, Pilecki O, Szadkowska A, Mysliwiec M, Jarosz-Chobot P. Updated 24-year trend of Type 1 diabetes incidence in children in Poland reveals a sinusoidal pattern and sustained increase. Diabet Med 2017; 34:1252-1258. [PMID: 28257151 DOI: 10.1111/dme.13345] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/27/2017] [Indexed: 12/11/2022]
Abstract
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.
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Affiliation(s)
| | - J Polanska
- Silesian University of Technology, Gliwice
| | - A Brandt
- Medical University of Gdansk, Gdansk
| | - G Deja
- Medical University of Silesia, Katowice
| | | | - O Pilecki
- Provincial Children's Hospital, Bydgoszcz
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25
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Onda Y, Sugihara S, Ogata T, Yokoya S, Yokoyama T, Tajima N. Incidence and prevalence of childhood-onset Type 1 diabetes in Japan: the T1D study. Diabet Med 2017; 34:909-915. [PMID: 27925270 DOI: 10.1111/dme.13295] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 10/24/2016] [Accepted: 11/28/2016] [Indexed: 12/11/2022]
Abstract
AIMS A majority of children with Type 1 diabetes in Japan are registered with the government-subsidized Specified Pediatric Chronic Disease Treatment Research Projects (SPCDTRP). In this study, the incidence and prevalence of childhood-onset (< 15 years) Type 1 diabetes in Japan were estimated by drawing on SPCDTRP data. METHODS Data available for 2005-2012 from the SPCDTRP and Statistics Bureau, Ministry of Internal Affairs and Communications were used to estimate the incidence of Type 1 diabetes for 2005-2010, adjusted to cover those registered within 3 years of disease onset and stratified by sex, age at onset and period of onset. RESULTS The incidence of Type 1 diabetes for 2005-2010 was 2.25/100,000 persons [95% confidence intervals (95% CI), 2.14-2.36] (boys: 1.91, 95% CI, 1.83-1.98; girls: 2.52, 95% CI, 2.34-2.69), with that for the age brackets 0-4, 5-9 and 10-14 years being 1.48 (95% CI, 1.29-1.66), 2.27 (95% CI, 2.08-2.47) and 3.00 (95% CI, 2.74-3.25), respectively. The onset of disease was shown to peak at age 13 among boys (3.28, 95% CI, 3.02-3.55) and at age 10 among girls (3.28, 95% CI, 3.02-3.55). The peak periods of disease onset were April/May and December. The number of children aged < 15 years with Type 1 diabetes for 2005-2012 was estimated to be 2326 (95% CI, 2202-2450) with the prevalence estimated as 13.53/100,000 persons (95% CI, 12.63-14.43). CONCLUSIONS Study findings demonstrated no increase in the incidence of Type 1 diabetes, although suggesting, in agreement with earlier reports, that the onset of disease peaks in adolescence with a female predominance. In addition, the incidence of childhood-onset diabetes exhibited an annual bimodal pattern in this study.
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Affiliation(s)
- Y Onda
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Jikei University School of Medicine
| | - S Sugihara
- Department of Pediatrics, Tokyo Women's Medical University Medical Center East, Tokyo
| | - T Ogata
- Department of Pediatrics, Hamamatsu University School of Medicine, Hamamatsu
| | - S Yokoya
- Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo
| | - T Yokoyama
- Systematic Review Section, Department of Technology Assessment and Biostatistics, National Institute of Public Health, Saitama
| | - N Tajima
- Jikei University School of Medicine, Tokyo, Japan
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26
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Negrato CA, Lauris JRP, Saggioro IB, Corradini MCM, Borges PR, Crês MC, Junior AL, Guedes MFS, Gomes MB. Increasing incidence of type 1 diabetes between 1986 and 2015 in Bauru, Brazil. Diabetes Res Clin Pract 2017; 127:198-204. [PMID: 28391136 DOI: 10.1016/j.diabres.2017.03.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 03/16/2017] [Indexed: 12/21/2022]
Abstract
AIMS To assess temporal trends in the incidence of type 1 diabetes in Bauru, São Paulo State, Brazil from 1986 to 2015. RESEARCH DESIGN AND METHODS The yearly incidence of type 1 diabetes (per 100,000/yr) from 1986 to 2015 was determined in children ≤14yr of age, using individual case notification and the capture and recapture method. RESULTS During thirty years (1986-2015), 302 cases were diagnosed in our population. The overall incidence was of 12.8/100,000 (95% CI: 11.2-14.4), ranging from 2.8/100,000 in 1987 to 25.6/100,000 in 2013 with a 9.1-fold variation. It was non-significantly higher in girls [13.7 (95% CI: 11.4-16.1)] than in boys [12.0 (95% CI: 9.8-14.2)] (p=0.48) and significantly higher in the 5-9yr [14.6 (95% CI: 11.8-17.4)] and 10-14yr [15.8 (95% CI: 12.7-18.8)] age ranges compared to the 0-4yr [8.1 (95% CI: 6.0-10.2)] age range (p<0.001). The majority of diagnoses were made in colder months. The patterns of incidence were very high and high in 80.0% of the study-years. CONCLUSIONS The incidence of type1 diabetes in children ≤14yr has increased in Bauru, Brazil, in the last thirty years, in approximately 3.1% annually, with an absolute crude increase of 2.5-fold. These findings pose Brazil as a country with high incidence of type 1 diabetes. All Brazilian regions should be enrolled in future studies to determine the factors that contribute to the predisposition to type 1 diabetes in our population and to the steep rise in its incidence.
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Affiliation(s)
- Carlos Antonio Negrato
- Bauru's Diabetics Association, Department of Internal Medicine, Bauru, São Paulo, Brazil.
| | - José Roberto Pereira Lauris
- Department of Pediatric Dentistry, Orthodontics and Community Health, Bauru School of Dentistry, University of São Paulo, Bauru, São Paulo, Brazil
| | - Ieso Braz Saggioro
- Bauru's Diabetics Association, Department of Internal Medicine, Bauru, São Paulo, Brazil
| | | | - Pricila Rubia Borges
- Bauru's Diabetics Association, Department of Internal Medicine, Bauru, São Paulo, Brazil
| | - Maria Cristina Crês
- Bauru's Diabetics Association, Department of Internal Medicine, Bauru, São Paulo, Brazil
| | - Aluysio Leal Junior
- Bauru's Diabetics Association, Department of Internal Medicine, Bauru, São Paulo, Brazil
| | | | - Marilia Brito Gomes
- Department of Internal Medicine, Diabetes Unit, State University Hospital of Rio de Janeiro, Rio de Janeiro, Brazil
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Fernández-Ramos C, Arana-Arri E, Jiménez-Huertas P, Vela A, Rica I. Incidence of childhood-onset type 1 diabetes in Biscay, Spain, 1990-2013. Pediatr Diabetes 2017; 18:71-76. [PMID: 26782628 DOI: 10.1111/pedi.12354] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 12/02/2015] [Accepted: 12/11/2015] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To identify the incidence rate (IR) and epidemiologic trends of childhood type 1 diabetes mellitus (T1DM) in children aged 0 to 14-yr-old from 1990 to 2013, in the north of Spain (Biscay). SUBJECTS AND METHODS A prospective-retrospective study was performed. Capture-recapture method was used: primary cases were ascertained from hospital register and a secondary independent data source was obtained from diabetes associations and public health plan database. Age and sex-standardized incidence rates were calculated using direct method, assuming an equal distribution in each age/sex group. In order to identify and analyse trends the period studied was divided into two (1990-2001 and 2002-2013) 11-year periods. The 95% confidence interval (CI) was estimated assuming the Poisson distribution. RESULTS A total of 399 new cases were identified throughout the study. Mean age at diagnosis was 8.9 ± 3.7 yr. Completeness of ascertainment was 99.1%. Mean annual age-standardized IR was 10.7 (95% CI: 9.6-11.7). The mean incidence for the 0-4, 5-9 and 10-14 age groups was 5.1, 14.6 and 13.2 per 100,000 children/yr, respectively. The incidence rate trend in the whole group was not statistically significant. In the 10-14 age group we found a yearly average increase (2.5% [CI 95% 0.4-4.6]; P < 0.05) and analysing by sex, this statistically significant incidence trend was observed only in boys. We did not find a seasonal onset pattern. CONCLUSIONS The IR did not increase in this population during the period studied unlike the results in other Spanish regions and European Countries.
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Affiliation(s)
- Concepción Fernández-Ramos
- Paediatric Endocrinology Unit, Basurto University Hospital, Bilbao, Spain.,BioCruces Health Research Institute.,University of the Basque Country (EHU/UPV)
| | - Eunate Arana-Arri
- Clinical Epidemiology Unit, Cruces University Hospital, Baracaldo, Spain.,BioCruces Health Research Institute
| | - Paloma Jiménez-Huertas
- Paediatric Endocrinology Unit, Cruces University Hospital, Baracaldo, Spain.,BioCruces Health Research Institute
| | - Amaia Vela
- Paediatric Endocrinology Unit, Cruces University Hospital, Baracaldo, Spain.,BioCruces Health Research Institute.,University of the Basque Country (EHU/UPV).,CIBERDEM
| | - Itxaso Rica
- Paediatric Endocrinology Unit, Cruces University Hospital, Baracaldo, Spain.,BioCruces Health Research Institute.,CIBERDEM
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Gagnum V, Stene LC, Leivestad T, Joner G, Skrivarhaug T. Long-term Mortality and End-Stage Renal Disease in a Type 1 Diabetes Population Diagnosed at Age 15-29 Years in Norway. Diabetes Care 2017; 40:38-45. [PMID: 27797927 DOI: 10.2337/dc16-1213] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 10/01/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To study long-term mortality, causes of death, and end-stage renal disease (ESRD) in people diagnosed with type 1 diabetes at age 15-29 years. RESEARCH DESIGN AND METHODS This nationwide, population-based cohort with type 1 diabetes diagnosed during 1978-1982 (n = 719) was followed from diagnosis until death, emigration, or September 2013. Linkages to the Norwegian Cause of Death Registry and the Norwegian Renal Registry provided information on causes of death and whether ESRD was present. A clinical committee reviewed the causes of death. We calculated standardized mortality ratios (SMRs) for comparison with the background population. RESULTS During 30 years' follow-up, 4.6% of participants developed ESRD and 20.6% (n = 148; 106 men and 42 women) died. Cumulative mortality by years since diagnosis was 6.0% (95% CI 4.5-8.0) at 10 years, 12.2% (10.0-14.8) at 20 years, and 18.4% (15.8-21.5) at 30 years. The SMR was 4.4 (95% CI 3.7-5.1). Mean time from diagnosis of diabetes to ESRD was 23.6 years (range 14.2-33.5). Death was caused by chronic complications (32.2%), acute complications (20.5%), violent death (19.9%), or any other cause (27.4%). Death was related to alcohol in 15% of cases. SMR for alcohol-related death was 6.8 (95% CI 4.5-10.3), for cardiovascular death was 7.3 (5.4-10.0), and for violent death was 3.6 (2.3-5.3). CONCLUSIONS The cumulative incidence of ESRD was low in this cohort with type 1 diabetes followed for 30 years. Mortality was 4.4 times that of the general population, and more than 50% of all deaths were caused by acute or chronic complications. A relatively high proportion of deaths were related to alcohol.
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Affiliation(s)
- Vibeke Gagnum
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway .,Oslo Diabetes Research Centre, Oslo, Norway
| | - Lars C Stene
- Oslo Diabetes Research Centre, Oslo, Norway.,Division of Epidemiology, Norwegian Institute of Public Health, Oslo, Norway
| | - Torbjørn Leivestad
- Norwegian Renal Registry, Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Geir Joner
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.,Oslo Diabetes Research Centre, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Torild Skrivarhaug
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.,Oslo Diabetes Research Centre, Oslo, Norway.,Norwegian Childhood Diabetes Registry, Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
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Kim JH, Lee CG, Lee YA, Yang SW, Shin CH. Increasing incidence of type 1 diabetes among Korean children and adolescents: analysis of data from a nationwide registry in Korea. Pediatr Diabetes 2016; 17:519-524. [PMID: 26420382 DOI: 10.1111/pedi.12324] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 08/30/2015] [Accepted: 09/01/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The incidence of type 1 diabetes mellitus (T1DM) in children and adolescents has increased worldwide. However, the epidemiology of T1DM among Korean youth has not been reported since 2001. We investigated the incidence of T1DM in Korean children and adolescents from 2012 to 2014 and compared it with data from 1995 to 2000. PATIENTS AND METHODS Data were obtained from the National Health Insurance Service (NHIS) registry, and age- and sex-specific incidence rates were calculated per 100 000 population. RESULTS In total, 706 patients (326 boys and 380 girls, aged <15 yr) with T1DM were registered in the NHIS during 2012-2014. The incidence rate per 100 000 population was 3.19 (95% confidence interval [CI] 2.96-3.43). We found incidence rates of 1.68, 3.16, and 4.46 in children 0-4, 5-9, and 10-14 yr, respectively. The T1DM incidence was 2.84 in boys and 3.56 in girls. A higher T1DM incidence was seen during 2012-2014 than from 1995-2000 (incidence rate ratio 2.33; p < 0.001). The incidence rate ratios between 1995-2000 and 2012-2014 were 2.31, 2.20, and 2.27 in children 0-4, 5-9, and 10-14 yr, respectively. The annual increase in T1DM incidence was 5.6% (95% CI 5.0-6.3%) between 1995 and 2014. CONCLUSIONS We observed a significant increase in the T1DM incidence. This increase was higher in boys than in girls, and was highest in children aged 0-4 yr. Studies are needed to evaluate the long-term epidemiological trend of T1DM incidence.
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Affiliation(s)
- Jae Hyun Kim
- Department of Pediatrics, Inje University College of Medicine, Ilsan Paik Hospital, Goyang, Korea
| | - Chong Guk Lee
- Department of Pediatrics, Asan Chungmu Hospital, Asan-si, Korea
| | - Young Ah Lee
- Division of Endocrinology and Metabolism, Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Sei Won Yang
- Division of Endocrinology and Metabolism, Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Choong Ho Shin
- Division of Endocrinology and Metabolism, Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.
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Maria LM, Zoltan J, Maria C, Adriana M. Medical Staff’s Opinions Regarding Factors which Influence the Case Management of Children with Insulin-dependent Diabetes Mellitus. ACTA MEDICA MARISIENSIS 2016. [DOI: 10.1515/amma-2016-0040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Insulin-dependent diabetes mellitus (IDDM) is a chronic disease with high incidence, especially in children, and for a better outcome the individual case management is required. The patient and his family can experience different levels of anxiety, with negative effects on disease evolution and prognosis.
Objectives: identify relevant factors which influence the case management of children with IDDM. The implementation of the results of this study will help to elaborate an efficient method of intervention for improving the treatment adherence and obtaining a better outcome of IDDM in children.
Methods: A semi-structured interview was done individually to 10 experts in diabetes for collecting their opinion concerning relevant factors that may influence treatment adherence and what are the characteristics of an efficient method of intervention.
Results: Majority of experts considered that the main factor which influences the outcome is doctor-patient relationship. The need of child, to feel that it is understood and protected, was considered that can directly motivate a better self-management and a good outcome. The increase of importance of individual resources of children with IDDM and accent on the quality of life of those children could be considered a starting point for creating a psychological clinic intervention in this field. The results were compared with scientific literature data.
Conclusions: understanding of the causes which have interfered negatively with therapeutic plan is a starting point for develop a clinical - psychological protocol for children with IDDM.
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Affiliation(s)
- Lica Melania Maria
- Clinical Psychology, Paediatric Department, Diabetic Children and Youth Association Mures, Romania
- Psychiatric Department, University of Medicine and Pharmacy Tirgu Mures, Romania
| | | | - Crainic Maria
- University of Medicine and Pharmacy Iuliu Hatieganu, Cluj Napoca, Romania
- Institute of Psychotherapy and Personal Development, Tirgu Mures, Romania
| | - Mihai Adriana
- Psychiatric Department, University of Medicine and Pharmacy Tirgu Mures, Romania
- Institute of Psychotherapy and Personal Development, Tirgu Mures, Romania
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Praveen PA, Madhu SV, Mohan V, Das S, Kakati S, Shah N, Chaddha M, Bhadada SK, Das AK, Shukla DK, Kaur T, Tandon N. Registry of Youth Onset Diabetes in India (YDR): Rationale, Recruitment, and Current Status. J Diabetes Sci Technol 2016; 10:1034-41. [PMID: 27179010 PMCID: PMC5032954 DOI: 10.1177/1932296816645121] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND With the aim of addressing the relative scarcity of information on youth-onset diabetes in India, the Indian Council of Medical Research (ICMR) decided to establish the Registry of People with Diabetes with Young Age at Onset (YDR) in 2006. The major objectives of YDR are to generate information on disease pattern or types of youth-onset diabetes including their geographical variations within India and to estimate the burden of diabetes complications. METHODS YDR is an observational multicenter clinic based registry enlisting physician diagnosed diabetes in individuals below 25 years of age. Diabetes was classified using symptom based clinical criteria. YDR data collection is coordinated through regional collaborating centers and their interacting reporting centers across India. A baseline and an annual follow-up proformas are used to obtain information on sociodemographic details, clinical profile, and anthropometric and laboratory measurements of the patients. RESULTS In phase 1, the registry has enrolled 5546 patients, in which type 1 diabetes mellitus (T1DM) was the most prevalent (63.9%), followed by youth-onset type 2 diabetes mellitus (T2DM) (25.3%). CONCLUSION This registry provides a unique opportunity to study the natural history of youth-onset diabetes in India.
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Affiliation(s)
| | | | | | | | | | - Nalini Shah
- Seth G S Medical College & K.E.M. Hospital, Mumbai, India
| | - Manoj Chaddha
- PD Hinduja Hospital and Medical Research Centre, Mumbai, India
| | | | - Ashok Kumar Das
- Pondicherry Institute of Medical Sciences, Puducherry, India
| | | | - Tanvir Kaur
- Indian Council of Medical Research, New Delhi, India
| | - Nikhil Tandon
- All India Institute of Medical Sciences, New Delhi, India
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Rasoul MA, Al-Mahdi M, Al-Kandari H, Dhaunsi GS, Haider MZ. Low serum vitamin-D status is associated with high prevalence and early onset of type-1 diabetes mellitus in Kuwaiti children. BMC Pediatr 2016; 16:95. [PMID: 27422640 PMCID: PMC4947357 DOI: 10.1186/s12887-016-0629-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 06/17/2016] [Indexed: 11/16/2022] Open
Abstract
Background Type 1 diabetes mellitus (T1DM) is highly prevalent in Kuwait with incidence of around 40.1/100,000 individuals. Evidence indicate that vitamin D plays an important role in modulating the immune system and could thus impact the onset and high prevalence of T1DM. We report serum vitamin D levels in Kuwaiti children with T1DM and non-diabetic controls to explore its relationship with prevalence and onset of the disease. Methods This study included 216 Kuwaiti Arab children with T1DM. The diagnosis of T1DM was based on the ISPAD criteria. The control subjects (204 Kuwaitis) were age and gender matched, healthy, non-diabetic, and had no close relative with T1DM. Vitamin D levels were determined in serum using an enzyme immunoassay (EIA) method. Results The age of onset of T1DM was <4y in 20 % of the T1DM cases, between 4 and 6y in 28 % cases and >6y in 52 % patients. In T1DM patient group, 84 % subjects were found to be deficient in serum vitamin D level compared to 77 % of the controls (p = 0.046). Collectively, the deficient and insufficient vitamin D status was detected in 99 % of the T1DM patients compared to 92 % of the controls (p = 0.027). The mean serum vitamin D levels were found to be significantly different in early onset cases (age <4y) compared to the late onset sub-group (p = 0.001). A significant correlation was found between some elements of socioeconomic status, SES (i.e. parent’s profession and family’s income) and lower vitamin D levels in Kuwaiti T1DM children. There was no significant difference between mean serum vitamin D levels during winter and summer months in the T1DM patients. Conclusions The proportion of cases with a deficient vitamin D status was significantly high in Kuwaiti T1DM children compared to the controls. The serum vitamin D levels were found to be significantly different in early onset and late onset T1DM patients. Therefore, serum vitamin D status can be considered an important contributor in high prevalence of T1DM in Kuwaiti children.
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Affiliation(s)
- Majedah A Rasoul
- Department of Pediatrics, Faculty of Medicine, Kuwait University, PO Box 24923, Safat, 13110, Kuwait.,Department of Pediatrics, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
| | - Maria Al-Mahdi
- Department of Pediatrics, Adan Hospital, Al-Adan, Kuwait
| | | | - Gursev S Dhaunsi
- Department of Pediatrics, Faculty of Medicine, Kuwait University, PO Box 24923, Safat, 13110, Kuwait.,Department of Pediatrics, Mubarak Al-Kabeer Hospital, Jabriya, Kuwait
| | - Mohammad Z Haider
- Department of Pediatrics, Faculty of Medicine, Kuwait University, PO Box 24923, Safat, 13110, Kuwait.
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Bruno G, Gruden G, Songini M. Incidence of type 1 diabetes in age groups above 15 years: facts, hypothesis and prospects for future epidemiologic research. Acta Diabetol 2016; 53:339-47. [PMID: 26787492 DOI: 10.1007/s00592-015-0835-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Accepted: 12/28/2015] [Indexed: 12/13/2022]
Abstract
Although onset of type 1 diabetes can occur in adulthood, epidemiological data are scarce, limiting our potential to identify unknown determinants of the disease. Paucity of registries expanding the recruitment of incident cases up to adulthood, atypical clinical features of type 1 diabetes at onset, misclassification of type 1 as type 2 diabetes and little use of markers of β-cell autoimmunity represents major obstacles in studying the risk of type 1 diabetes in adults. New strategies in study design, data collection and analyses may overcome these problems in the future. Population-based surveys and registries including adulthood; use of etiological rather than clinical criteria to define type 1 diabetes; availability of electronic health records as prescription data sources to avoid missing data; and application of proper statistical methods will be instrumental to gain better insight on the epidemiology and natural history of the disease.
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Affiliation(s)
- G Bruno
- Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy.
| | - G Gruden
- Department of Medical Sciences, University of Turin, Corso Dogliotti 14, 10126, Turin, Italy
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Song SO, Song YD, Nam JY, Park KH, Yoon JH, Son KM, Ko Y, Lim DH. Epidemiology of Type 1 Diabetes Mellitus in Korea through an Investigation of the National Registration Project of Type 1 Diabetes for the Reimbursement of Glucometer Strips with Additional Analyses Using Claims Data. Diabetes Metab J 2016; 40:35-45. [PMID: 26912154 PMCID: PMC4768049 DOI: 10.4093/dmj.2016.40.1.35] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 06/29/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The aim of this study was to estimate the prevalence and incidence of type 1 diabetes mellitus (T1DM) in Korea. In addition, we planned to do a performance analysis of the Registration Project of Type 1 diabetes for the reimbursement of consumable materials. METHODS To obtain nationwide data on the incidence and prevalence of T1DM, we extracted claims data from July 2011 to August 2013 from the Registration Project of Type 1 diabetes on the reimbursement of consumable materials in the National Health Insurance (NHI) Database. For a more detailed analysis of the T1DM population in Korea, stratification by gender, age, and area was performed, and prevalence and incidence were calculated. RESULTS Of the 8,256 subjects enrolled over the 26 months, the male to female ratio was 1 to 1.12, the median age was 37.1 years, and an average of 136 new T1DM patients were registered to the T1DM registry each month, resulting in 1,632 newly diagnosed T1DM patients each year. We found that the incidence rate of new T1DM cases was 3.28 per 100,000 people. The average proportion of T1DM patients compared with each region's population was 0.0125%. The total number of insurance subscribers under the universal compulsory NHI in Korea was 49,662,097, and the total number of diabetes patients, excluding duplication, was 3,762,332. CONCLUSION The prevalence of T1DM over the course of the study was approximately 0.017% to 0.021% of the entire population of Korea, and the annual incidence of T1DM was 3.28:100,000 overall and 3.25:100,000 for Koreans under 20 years old.
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Affiliation(s)
- Sun Ok Song
- Department of Endocrinology and Metabolism, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Young Duk Song
- Department of Endocrinology and Metabolism, National Health Insurance Service Ilsan Hospital, Goyang, Korea.
| | - Joo Young Nam
- Department of Endocrinology and Metabolism, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Kyeong Hye Park
- Department of Endocrinology and Metabolism, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Ji Hae Yoon
- National Health Insurance Service, Seoul, Korea
| | | | - Young Ko
- National Health Insurance Service, Seoul, Korea
| | - Dong Ha Lim
- National Health Insurance Service, Seoul, Korea
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Velluzzi F, Secci G, Sepe V, Klersy C, Shattock M, Foxon R, Songini M, Mariotti S, Locatelli M, Bottazzo GF, Loviselli A. Prediction of type 1 diabetes in Sardinian schoolchildren using islet cell autoantibodies: 10-year follow-up of the Sardinian schoolchildren type 1 diabetes prediction study. Acta Diabetol 2016; 53:73-9. [PMID: 25896008 DOI: 10.1007/s00592-015-0751-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Accepted: 03/29/2015] [Indexed: 01/12/2023]
Abstract
AIMS Stable genetic background makes individuals from the Mediterranean island of Sardinia ideal to define the predictive power of islet-related autoantibodies (IRAs): glutamic acid decarboxylase antibodies (GADA), tyrosine phosphatase-like antibodies (IA-2A), islet cell antibodies (ICA) to identify T1DM progressors. The aims of the present study were: (1) determination of IRAs reference limits in healthy non-diabetic Sardinian schoolchildren (SSc). (2) Predictive power evaluation of IRAs as single or combined determination to identify islet to identify T1DM progressors. METHODS Between 1986 and 1994, 8448 SSc were tested for IRAs. All were followed up for 10 years. The predictive power of single or combination of IRAs was determined as hazard ratio (HR), sensitivity, specificity, area under the ROC curve, negative and positive predictive value (NPV, PPV). RESULTS All 43 progressors to T1DM, but three showed at least one autoantibody positivity. HR for any single-autoantibody positivity was 55.3 times greater when compared to SSc negative for all IRAs. Any single autoantibody performed at least 64.9 % sensitivity with PPV always lower than 16 %. The best performing combination was ICA, plus IA-2A (showing 52.6 % sensitivity, 99.8 % specificity, 0.76 area under the ROC curve, 51.3 % PPV and 99.8 % NPV. CONCLUSIONS Determination of IRAs reference limits in healthy SSc by standard statistical methods is crucial to establish the power of IRAs as progression markers to T1DM. Our data offer a solid rationale for future testing of ICA and IA-2A as routine laboratory markers to identify individuals at high risk of T1DM in the general population.
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Affiliation(s)
- Fernanda Velluzzi
- Department of Medical Sciences "Mario Aresu", University of Cagliari, AOU, SS 554, Monserrato, Cagliari, Italy
| | - Gianni Secci
- Department of Medical Sciences "Mario Aresu", University of Cagliari, AOU, SS 554, Monserrato, Cagliari, Italy
| | - Vincenzo Sepe
- Unit of Nephrology, Dialysis, Transplantation, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Catherine Klersy
- Service of Biometry and Clinical Epidemiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marion Shattock
- Department of Immunology, St Bartholomew's and the Royal London School of Medicine and Dentistry, London, UK
| | - Richard Foxon
- School of Biomedical and Health Science, King's College, London, UK
| | | | - Stefano Mariotti
- Department of Medical Sciences "Mario Aresu", University of Cagliari, AOU, SS 554, Monserrato, Cagliari, Italy
| | - Mattia Locatelli
- Scientific Directorate, IRCCS Ospedale Pediatrico Bambino Gesù, Rome, Italy
| | | | - Andrea Loviselli
- Department of Medical Sciences "Mario Aresu", University of Cagliari, AOU, SS 554, Monserrato, Cagliari, Italy.
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Patterson CC, Gyürüs E, Rosenbauer J, Cinek O, Neu A, Schober E, Parslow RC, Joner G, Svensson J, Castell C, Bingley PJ, Schoenle E, Jarosz-Chobot P, Urbonaité B, Rothe U, Kržišnik C, Ionescu-Tirgoviste C, Weets I, Kocova M, Stipancic G, Samardzic M, de Beaufort CE, Green A, Soltész G, Dahlquist GG. Seasonal variation in month of diagnosis in children with type 1 diabetes registered in 23 European centers during 1989-2008: little short-term influence of sunshine hours or average temperature. Pediatr Diabetes 2015; 16:573-80. [PMID: 25316271 DOI: 10.1111/pedi.12227] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 09/11/2014] [Accepted: 09/11/2014] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The month of diagnosis in childhood type 1 diabetes shows seasonal variation. OBJECTIVE We describe the pattern and investigate if year-to-year irregularities are associated with meteorological factors using data from 50 000 children diagnosed under the age of 15 yr in 23 population-based European registries during 1989-2008. METHODS Tests for seasonal variation in monthly counts aggregated over the 20 yr period were performed. Time series regression was used to investigate if sunshine hour and average temperature data were predictive of the 240 monthly diagnosis counts after taking account of seasonality and long term trends. RESULTS Significant sinusoidal pattern was evident in all but two small centers with peaks in November to February and relative amplitudes ranging from ± 11 to ± 38% (median ± 17%). However, most centers showed significant departures from a sinusoidal pattern. Pooling results over centers, there was significant seasonal variation in each age-group at diagnosis, with least seasonal variation in those under 5 yr. Boys showed greater seasonal variation than girls, particularly those aged 10-14 yr. There were no differences in seasonal pattern between four 5-yr sub-periods. Departures from the sinusoidal trend in monthly diagnoses in the period were significantly associated with deviations from the norm in average temperature (0.8% reduction in diagnoses per 1 °C excess) but not with sunshine hours. CONCLUSIONS Seasonality was consistently apparent throughout the period in all age-groups and both sexes, but girls and the under 5 s showed less marked variation. Neither sunshine hour nor average temperature data contributed in any substantial way to explaining departures from the sinusoidal pattern.
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Affiliation(s)
- C C Patterson
- Centre of Excellence for Public Health Northern Ireland, Queen's University Belfast, Belfast, UK
| | - E Gyürüs
- Department of Paediatrics, Pécs University, Pecs, Hungary
| | - J Rosenbauer
- Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Institute for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
| | - O Cinek
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague and University Hospital Motol, Prague, Czech Republic
| | - A Neu
- Pediatric Endocrinology & Diabetes, University Children's Hospital, Tübingen, Germany
| | - E Schober
- Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - R C Parslow
- Leeds Institute of Genetics, Health and Therapeutics, University of Leeds, Leeds, UK
| | - G Joner
- Department of Pediatrics, Ullevål University Hospital, Oslo, Norway
| | - J Svensson
- Department of Paediatrics, Herlev University Hospital, Copenhagen, Denmark
| | - C Castell
- Public Health Agency, Department of Health, Government of Catalonia, Barcelona, Spain
| | - P J Bingley
- School of Clinical Sciences, University of Bristol, Bristol, UK
| | - E Schoenle
- Department of Endocrinology and Diabetology, University Children's Hospital, Zurich, Switzerland
| | - P Jarosz-Chobot
- Department of Pediatrics, Endocrinology and Diabetes, Medical University of Silesia, Katowice, Poland
| | - B Urbonaité
- Institute of Endocrinology, Lithuanian University of Health Science, Kaunas, Lithuania
| | - U Rothe
- Department for Epidemiology and Health Care Research, Technical University of Dresden, Dresden, Germany
| | - C Kržišnik
- Department of Pediatrics, University Children's Hospital, Ljubljana, Slovenia
| | - C Ionescu-Tirgoviste
- Nutrition and Metabolic Diseases Clinic, N Paulescu Institute of Diabetes and Metabolic Diseases, Bucharest, Romania
| | - I Weets
- Diabetes Research Center, Brussels Free University, Vrije Universiteit Brussel, Brussels, Belgium
| | - M Kocova
- Department of Endocrinology and Genetics, University Children's Hospital, Skopje, Macedonia
| | - G Stipancic
- Department of Paediatrics, University Hospital Sestre Milosrdnice, Zagreb, Croatia
| | - M Samardzic
- Department of Endocrinology and Diabetes, University Children's Hospital, Podgorica, Montenegro
| | - C E de Beaufort
- Department of Paediatric Diabetes and Endocrinology, Centre Hospitalier de Luxembourg, Luxembourg
| | - A Green
- Odense Patient data Exploratory Network, University of Southern Denmark, Odense, Denmark
| | - G Soltész
- Department of Paediatrics, Pécs University, Pecs, Hungary
| | - G G Dahlquist
- Department of Clinical Science, University of Umeå, Umeå, Sweden
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Valera P, Zavattari P, Sanna A, Pretti S, Marcello A, Mannu C, Targhetta C, Bruno G, Songini M. Zinc and Other Metals Deficiencies and Risk of Type 1 Diabetes: An Ecological Study in the High Risk Sardinia Island. PLoS One 2015; 10:e0141262. [PMID: 26559814 PMCID: PMC4641716 DOI: 10.1371/journal.pone.0141262] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 10/05/2015] [Indexed: 01/10/2023] Open
Abstract
Background Type 1 diabetes incidence presents a decreasing gradient in Europe from the Nordic countries to the Mediterranean ones. Exception to this gradient is represented by Sardinia, the second largest Mediterranean island whose population shows the highest incidence in Europe, after Finland. The genetic features of this population have created a fertile ground for the epidemic of the disease, however, as well as being strikingly high, the incidence rate has suddenly presented a continuous increase from the ‘50s, not explainable by accumulation of new genetic variants. Several environmental factors have been taken into account, possibly interacting with the genetic/epigenetic scenario, but there are no strong evidences to date. Methods The present study investigated the hypothesis that geochemical elements could create permissive environmental conditions for autoimmune diabetes. An ecological analysis was performed to test possible correlations between the values of eight elements in stream sediments and type 1 diabetes incidence rate in Sardinia. Results Analyses revealed negative associations between elements, such as Co, Cr, Cu, Mn, Ni, Zn, and type 1 diabetes incidence. Conclusions The results suggest a possible protective role of some elements against the onset of the disease.
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Affiliation(s)
- Paolo Valera
- Department of Civil-Environmental Engineering and Architecture, University of Cagliari, Cagliari, Italy
- * E-mail: (PV); (PZ)
| | - Patrizia Zavattari
- Department of Biomedical Sciences, University of Cagliari, Cagliari, Italy
- * E-mail: (PV); (PZ)
| | - Alessandro Sanna
- Department of Civil-Environmental Engineering and Architecture, University of Cagliari, Cagliari, Italy
| | - Salvatore Pretti
- Department of Civil-Environmental Engineering and Architecture, University of Cagliari, Cagliari, Italy
| | - Alberto Marcello
- Department of Civil-Environmental Engineering and Architecture, University of Cagliari, Cagliari, Italy
| | - Carla Mannu
- Centre for the Study of Diabetes Complications and Metabolic Diseases, St. Michele Hospital, Cagliari, Italy
| | - Clara Targhetta
- Centre for the Study of Diabetes Complications and Metabolic Diseases, St. Michele Hospital, Cagliari, Italy
| | - Graziella Bruno
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - Marco Songini
- Centre for the Study of Diabetes Complications and Metabolic Diseases, St. Michele Hospital, Cagliari, Italy
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Tondolo V, Manunza R, Pellegrino R, Zamboni F. Pancreas Transplantation: Small-Center Experience in Type 1 Diabetes Mellitus in a High-Incidence Region. Transplant Proc 2015; 47:2169-72. [DOI: 10.1016/j.transproceed.2014.11.070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 11/19/2014] [Indexed: 10/23/2022]
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Affiliation(s)
- Amanda I Adler
- Wolfson Diabetes and Endocrine Clinic, Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, U.K.
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40
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Chobot A, Polanska J, Deja G, Jarosz-Chobot P. Incidence of type 1 diabetes among Polish children ages 0-14 years from 1989-2012. Acta Diabetol 2015; 52:483-8. [PMID: 25381194 DOI: 10.1007/s00592-014-0682-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 10/27/2014] [Indexed: 12/17/2022]
Abstract
AIMS The incidence of pediatric type 1 diabetes mellitus (T1DM) in Poland is intermediate relative to the rest of the world. T1DM prevalence in the region of Silesia approximates national estimates for all of Poland. This epidemiologic study aimed to analyze the changes in incidence rates of T1DM among children ages 0-14 years from 1989 to 2012 in this region. METHODS Data collection methods for the registry followed EURODIAB criteria. To estimate overall population size, data from the Central and regional Statistical Office in Katowice were used. T1DM incidence rates/100,000 children ages 0-14 years/annum and their 95 % CI were calculated for all children and in age subgroups (0-4, 5-9, 10-14 years). For comparative analysis incidence rates were age and sex standardized to the population of Poland in 2005. For statistical analyses open source R Bioconductor software was used. RESULTS During this 24-year period, 2,215 new cases (1,146 boys) were diagnosed. The standardized incidence rate rose about 7 % annually. The mean standardized incidence rates estimated in four 6-year time periods (1989-1994, 1995-2000, 2001-2006, 2007-2012) separately showed significant increases from 5.80/100,000/year (1989-1994) through 10.44/100,000/year (1995-2000) and 15.05/100,000/year (2001-2006) to 18.94/100,000/year (2007-2012). From 1989 to 2012, the greatest relative rise in annual incidence (/100,000/year) was among the very young: 2.58-14.00 (0-4 years); 4.96-19.43 (5-9 years); 8.84-22.15 (10-14 years). The highest average annual increment of the incidence rate was in the middle age subgroup (5-9 years). No significant sex difference was observed. CONCLUSIONS The overall incidence rate increased 3.8 times, suggesting an epidemic of pediatric T1DM in Silesia, Poland. These temporal changes confirm that Poland currently has one of the highest incidence rates of pediatric T1DM in Europe.
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Affiliation(s)
- Agata Chobot
- Clinical Hospital No 1, 3-go Maja 13-15, Zabrze, Poland,
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Samahy MHE, Elbarbary NS, Elmorsi HM. Current status of diabetes management, glycemic control and complications in children and adolescents with diabetes in Egypt. Where do we stand now? And where do we go from here? Diabetes Res Clin Pract 2015; 107:370-6. [PMID: 25649911 DOI: 10.1016/j.diabres.2015.01.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2014] [Revised: 10/31/2014] [Accepted: 01/02/2015] [Indexed: 10/24/2022]
Abstract
THE AIM of this study was to use the Diabetes Registry of the Pediatric Diabetes Clinic, Ain Shams University Hospital to examine risk factors related to poor glycemic control and to provide data to health professionals for planning, evaluation and optimizing diabetes care. SUBJECTS AND METHODS Data from 600 children and adolescents with diabetes with information in the registry provide information on current clinical status, metabolic control, acute and long-term complications, presence of concomitant autoimmune diseases, and psychiatric aspects of patients. RESULTS Mean age of patients was 13.3±5.1 years, mean duration of diabetes was 6.4±3.6 years, mean HbA1c was 8.8±4.6% [73±27 mmol/mol], and 71% had poor glycemic control. Acute complications included ketoacidosis in 19.7% and severe hypoglycemia in 2.8%. Chronic complications including peripheral neuropathy, retinopathy, and persistent microalbuminuria were present in 6.3%, 1.8%, and 6.8%, respectively. The majority (97.2%) were on intensive insulin therapy. Patients with poor glycemic control had higher disease duration, DKA frequency and diabetic microvascular complications. However, regular education lecture attendance and regular SMBG were associated with better glycemic control. CONCLUSIONS These registry data indicate that although the majority of the patients were on intensive insulin therapy, poor glycemic control was common and diabetic microvascular complications were observed. These findings will provide potential avenues to improve quality of care and could be the first step in the development of a national registry for diabetes in Egypt.
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Affiliation(s)
- Mona Hussein El Samahy
- Department of Pediatrics, Diabetes Unit, Faculty of medicine, Ain shams University, Cairo, Egypt..
| | - Nancy Samir Elbarbary
- Department of Pediatrics, Diabetes Unit, Faculty of medicine, Ain shams University, Cairo, Egypt..
| | - Hala Mohammed Elmorsi
- Department of Pediatrics, Diabetes Unit, Faculty of medicine, Ain shams University, Cairo, Egypt..
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Vichi M, Iafusco D, Galderisi A, Stazi MA, Nisticò L. An easy, fast, effective tool to monitor the incidence of type 1 diabetes among children aged 0-4 years in Italy: the Italian Hospital Discharge Registry (IHDR). Acta Diabetol 2014; 51:287-94. [PMID: 24473635 DOI: 10.1007/s00592-014-0556-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 01/09/2014] [Indexed: 12/14/2022]
Abstract
National data of type 1 diabetes incidence are currently missing in Italy. To fill this gap, we estimated the national rate of first hospitalizations for type 1 diabetes among children aged 0-4 years and resident in Italy, as well as rates for each of the twenty-one Italian regions. We extracted the first episode of hospitalization in years 2005-2010 from the Italian Hospital Discharge Registry (IHDR). Record-linkage procedure and cleansing data method were applied to exclude prevalent cases and potentially miscoded patients. At the end, 2,250 incident hospitalizations for type 1 diabetes were extracted. In the years 2005-2010, the mean nation-wide first hospitalization rate for type 1 diabetes in children aged 0-4 years was 13.4 (95% CI 12.8-14.0), 14.1 (95% CI 13.3-14.9) in males and 12.7 (95% CI 11.9-13.4) in females. A geographically heterogeneous pattern of incidence was found: even excluding Sardinia, incidence for this age range and calendar period tended to be slightly higher in Southern than in Northern Italy. Our incidence of first hospitalizations corresponds to the estimates of disease incidence obtained with different data sources by other authors in selected Italian regions. We provide, for the first time ever, the estimate of type 1 diabetes incidence for the overall population aged 0-4 years resident in Italy. When methodological cautions are adopted, IHDR emerges as a reasonable proxy of type 1 diabetes incidence and as a cost-effective tool for public health purposes.
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Affiliation(s)
- Monica Vichi
- Statistics Unit, National Centre of Epidemiology, Surveillance, and Health Promotion (CNESPS), Istituto Superiore di Sanità, 00161, Rome, Italy
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Abstract
Type 1 diabetes mellitus (T1D) can occur at any age, with a peak in incidence around puberty. Classification between T1D and type 2 diabetes becomes more challenging with increasing age of onset of T1D over time develops in genetically predisposed individuals. The main susceptibility is conferred with human leukocyte antigen (HLA) genes. Some of the geographic variation in incidence and familial aggregation is explained by differences in HLA haplotypes. In many populations, the incidence is somewhat higher in males than in females, and a 1.3- to 2.0-fold male excess in incidence after about 15 years of age exists in most populations. The incidence of childhood-onset T1D varies markedly among countries. East Asian and native American populations have low incidences (approximately 0.1-8 per 100 000/year), while the highest rates are found in Finland (>60 per 100 000/year), Sardinia (40 per 100 000/year), and Sweden (47 per 100 000/year). The risk is highest in European-derived populations. About 10 %-20 % of newly diagnosed childhood cases of T1D have an affected first-degree relative. Those with an affected sibling or parent have a cumulative risk of 3 %-7 % up to about 20 years of age, as compared with <1 % in the general population. The cumulative incidence among the monozygotic co-twins of persons with T1D is less than 50 %. Thus, the majority of genetically predisposed people do not develop T1D. Studies assessing temporal trends have shown that the incidence of childhood-onset T1D has increased in all parts of the world. The average relative increase is 3 %-4 % per calendar year. For instance, in Finland, the incidence today is 5 times higher than 60 years ago. At the same time, the age at onset of T1D in children has become younger. It is strongly believed that nongenetic factors are important for the development of T1D and its increase, but the causative evidence is missing. The causes for this increasing trend and current epidemic still remain unknown.
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Affiliation(s)
- Jaakko Tuomilehto
- Centre for Vascular Prevention, Danube-University Krems, Dr-Karl-Dorrek-Strasse 30, 3500, Krems, Austria,
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Radosevic B, Bukara-Radujkovic G, Miljkovic V, Pejicic S, Bratina N, Battelino T. The incidence of type 1 diabetes in Republic of Srpska (Bosnia and Herzegovina) and Slovenia in the period 1998-2010. Pediatr Diabetes 2013; 14:273-9. [PMID: 22925312 DOI: 10.1111/j.1399-5448.2012.00898.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 06/01/2012] [Accepted: 06/01/2012] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVE To establish and compare the incidence and trends of type 1 diabetes mellitus (T1DM) in Republic of Srpska and Slovenia in age group 0-18 yr from 1998 to 2010. METHODS The subjects (413 newly diagnosed T1DM patients in the Republic of Srpska and 664 in Slovenia) were grouped into the age groups: 0-4, 5-9, 10-14, and 15-18 yr. Confidence intervals (CI) for crude incidence rates were estimated assuming numbers of cases were counts from the Poisson distribution. Gender and age-specific standardization was done according to the EURODIAB criteria. Statistical analysis used Poisson-regression models to analyze difference rate between countries and to investigate the incidence trend. RESULTS Case ascertainment was estimated to be 99.95% for the Republic of Srpska and 100% for Slovenia by using the capture-recapture method. The standardized incidence of T1DM for age group 0-18 yr in the Republic of Srpska was 7.5/100 000/yr (95% CI: 6.8-8.3). For the same period and the same age group incidence in Slovenia was 12.5/100 000/yr (95% CI: 11.5-13.5). Annual increase in the incidence in the Republic of Srpska was 2.3% (95% CI: -0.3 to 5.0%), whereas in Slovenia 4.3% (95% CI: 2.2-6.5%). CONCLUSION The incidence for age group 0-18 yr standardized to the world population is remarkably higher in Slovenia than in the Republic of Srpska. Further follow-up and investigations are needed to explain the high difference in incidence of T1DM between the two geographically related countries.
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Affiliation(s)
- Bojana Radosevic
- Clinic for Endocrinology, Diabetes and Metabolic diseases, Clinical Centre Banja Luka, and School of Medicine, University of Banja Luka, 78000, Banja Luka, Republic of Srpska, Bosnia and Herzegovina.
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Şimşek DG, Aycan Z, Özen S, Çetinkaya S, Kara C, Abalı S, Demir K, Tunç Ö, Uçaktürk A, Asar G, Baş F, Çetinkaya E, Aydın M, Karagüzel G, Orbak Z, Orbak Z, Şıklar Z, Altıncık A, Ökten A, Özkan B, Öçal G, Semiz S, Arslanoğlu İ, Evliyaoğlu O, Bundak R, Darcan Ş. Diabetes care, glycemic control, complications, and concomitant autoimmune diseases in children with type 1 diabetes in Turkey: a multicenter study. J Clin Res Pediatr Endocrinol 2013; 5:20-6. [PMID: 23419424 PMCID: PMC3628388 DOI: 10.4274/jcrpe.893] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Epidemiologic and clinical features of type 1 diabetes mellitus (T1DM) may show substantial differences among countries. The primary goal in the management of T1DM is to prevent micro- and macrovascular complications by achieving good glycemic control. The present study aimed to assess metabolic control, presence of concomitant autoimmune diseases, and of acute and long-term complications in patients diagnosed with T1DM during childhood and adolescence. The study also aimed to be a first step in the development of a national registry system for T1DM, in Turkey. METHODS Based on hospital records, this cross-sectional, multicenter study included 1 032 patients with T1DM from 12 different centers in Turkey, in whom the diagnosis was established during childhood. Epidemiological and clinical characteristics of the patients were recorded. Metabolic control, diabetes care, complications, and concomitant autoimmune diseases were evaluated. RESULTS Mean age, diabetes duration, and hemoglobin A1c level were 12.5 ± 4.1 years, 4.7 ± 3.2 years, and 8.5 ± 1.6%, respectively. Acute complications noted in the past year included ketoacidosis in 5.2% of the patients and severe hypoglycemia in 4.9%. Chronic lymphocytic thyroiditis was noted in 12%, Graves' disease in 0.1%, and celiac disease in 4.3% of the patients. Chronic complications including neuropathy, retinopathy, and persistent microalbuminuria were present in 2.6%, 1.4%, and 5.4% of the patients, respectively. Diabetic nephropathy was not present in any of the patients. Mean diabetes duration and age of patients with neuropathy, retinopathy and microalbuminuria were significantly different from the patients without these long-term complications (p<0.01). A significant difference was found between pubertal and prepubertal children in terms of persistent microalbuminuria and neuropathy (p=0.02 and p<0.001, respectively). Of the patients, 4.4% (n:38) were obese and 5% had short stature; 17.4% of the patients had dyslipidemia, and 14% of the dyslipidemic patients were obese. CONCLUSIONS Although the majority of the patients in the present study were using insulin analogues, poor glycemic control was common, and chronic complications were encountered.
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Affiliation(s)
- Damla Gökşen Şimşek
- Ege University School of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
,* Address for Correspondence: Ege University School of Medicine, Department of Pediatric Endocrinology Phone: +90 232 388 63 66 E-mail:
| | - Zehra Aycan
- Dr.Sami Ulus Training and Research Hospital, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Samim Özen
- Ege University School of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Semra Çetinkaya
- Dr.Sami Ulus Training and Research Hospital, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Cengiz Kara
- Ondokuz Mayıs University School of Medicine, Department of Pediatric Endocrinology, Samsun, Turkey
| | - Saygın Abalı
- Istanbul University School of Medicine, Department of Pediatrics, İstanbul, Turkey
| | - Korcan Demir
- Dokuz Eylül University School of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Özgül Tunç
- Dışkapı Pediatric Training and Research Hospital, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Ahmet Uçaktürk
- Ondokuz Mayıs University School of Medicine, Department of Pediatric Endocrinology, Samsun, Turkey
| | - Gülgün Asar
- Ege University School of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Firdevs Baş
- İstanbul University School of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Ergun Çetinkaya
- Dışkapı Pediatric Training and Research Hospital, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Murat Aydın
- Ondokuz Mayıs University School of Medicine, Department of Pediatric Endocrinology, Samsun, Turkey
| | - Gülay Karagüzel
- Karadeniz Technical University School of Medicine, Department of Pediatric Endocrinology, Trabzon, Turkey
| | - Zerrin Orbak
- Atatürk University School of Medicine, Department of Pediatric Endocrinology, Erzurum, Turkey
| | - Zerrin Orbak
- Atatürk University School of Medicine, Department of Pediatric Endocrinology, Erzurum, Turkey
| | - Zeynep Şıklar
- Ankara University School of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| | - Ayça Altıncık
- Dokuz Eylül University School of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
| | - Ayşenur Ökten
- Karadeniz Technical University School of Medicine, Department of Pediatric Endocrinology, Trabzon, Turkey
| | - Behzat Özkan
- Atatürk University School of Medicine, Department of Pediatric Endocrinology, Erzurum, Turkey
| | - Gönül Öçal
- Pamukkale University School of Medicine, Department of Pediatric Endocrinology, Denizli, Turkey
| | - Serap Semiz
- Pamukkale University School of Medicine, Department of Pediatric Endocrinology, Denizli, Turkey
| | - İlknur Arslanoğlu
- Düzce University School of Medicine, Department of Pediatric Endocrinology, Düzce, Turkey
| | - Olcay Evliyaoğlu
- Kırıkkale University School of Medicine, Department of Pediatric Endocrinology, Kırıkkale, Turkey
| | - Rüveyde Bundak
- İstanbul University School of Medicine, Department of Pediatric Endocrinology, İstanbul, Turkey
| | - Şükran Darcan
- Ege University School of Medicine, Department of Pediatric Endocrinology, İzmir, Turkey
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Cinek O, Kulich M, Sumnik Z. The incidence of type 1 diabetes in young Czech children stopped rising. Pediatr Diabetes 2012; 13:559-63. [PMID: 22487027 DOI: 10.1111/j.1399-5448.2012.00858.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Accepted: 01/24/2012] [Indexed: 12/01/2022] Open
Abstract
AIMS The aim was to assess trends in incidence of pediatric type 1 diabetes (T1D) using data recorded by the population-based Czech Childhood Diabetes Register over 1989-2009. METHODS New cases of childhood-onset T1D aged 0-14.9 yr were recorded using the EURODIAB protocol by two independent sources with the combined estimated completeness of 98.6%. The incidence was modeled by Poisson regression, and the effects of age and calendar time on incidence were assessed using piecewise linear functions. RESULTS A total of 5155 cases was ascertained over 1989-2009 from an average pediatric population of 1.76 million. Two points of change in the incidence trend were identified by the modeling: in 1995 the incidence accelerated, while in 2001 the growth in incidence significantly slowed down in all ages up to 10 yr. In the youngest age category, 0-4 yr at onset, the rapid average annual rise of 15% over 1996-2001 suddenly changed into stagnation over 2002-2009. CONCLUSIONS Our data contribute to the notion that long- and intermediate-term predictions from the past incidence developments of incidence are difficult, as abrupt changes in the trend can occur. Caution should be exercised against too far-reaching incidence predictions, even if the population has experienced a previous history of a very fast rise in T1D incidence.
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Affiliation(s)
- Ondrej Cinek
- Department of Paediatrics, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic.
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Usher-Smith JA, Thompson M, Ercole A, Walter FM. Variation between countries in the frequency of diabetic ketoacidosis at first presentation of type 1 diabetes in children: a systematic review. Diabetologia 2012; 55:2878-94. [PMID: 22933123 PMCID: PMC3464389 DOI: 10.1007/s00125-012-2690-2] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Accepted: 07/12/2012] [Indexed: 01/02/2023]
Abstract
AIMS/HYPOTHESIS Type 1 diabetes is the most frequent endocrine disease in children, with 65,000 children diagnosed worldwide every year. Up to 80% of these children present with diabetic ketoacidosis (DKA), which is associated with both short-term risks and long-term consequences. This study aimed to characterise the worldwide variation in presentation of type 1 diabetes to inform future interventions to reduce this excess morbidity and mortality. METHODS This was a systematic review of studies indexed on PubMed, EMBASE, Web of Science, Scopus or CINAHL before March 2011 that included unselected groups of children presenting with new-onset type 1 diabetes, reported the proportion presenting with DKA and used a definition of DKA based on measurement of pH or bicarbonate. RESULTS Sixty-five studies of cohorts comprising over 29,000 children in 31 countries were included. The frequency of DKA at diagnosis ranged from 12.8% to 80%, with highest frequencies in the United Arab Emirates, Saudi Arabia and Romania, and the lowest in Sweden, the Slovak Republic and Canada. Multivariable modelling showed the frequency of DKA was inversely associated with gross domestic product, latitude and background incidence of type 1 diabetes. CONCLUSIONS/INTERPRETATION This is the first description of the variation in frequency of DKA at presentation of type 1 diabetes in children across countries. It demonstrates large variations that may, at least in part, be explained by different levels of disease awareness and healthcare provision and suggests ways to decrease the excess morbidity and mortality associated with DKA at diagnosis.
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Affiliation(s)
- J A Usher-Smith
- The Primary Care Unit, Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, Worts Causeway, Cambridge CB1 8RN, UK.
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Formosa N, Calleja N, Torpiano J. Incidence and modes of presentation of childhood type 1 diabetes mellitus in Malta between 2006 and 2010. Pediatr Diabetes 2012; 13:484-8. [PMID: 22151907 DOI: 10.1111/j.1399-5448.2011.00839.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2011] [Revised: 10/17/2011] [Accepted: 10/31/2011] [Indexed: 01/30/2023] Open
Abstract
AIM To assess the incidence and mode of presentation of type 1 diabetes mellitus (T1DM) in children and adolescents younger than 14 yr of age between January 2006 and December 2010 in Malta. METHODS A nationwide prospective study which collected data from newly diagnosed T1DM children who presented to the only paediatric diabetes team available in Malta. The degree of ascertainment was estimated to be 100%. Incidence rates by age group and year were estimated using real values of diagnosed patients and population statistics. Trend analysis was carried out using Poisson's regression analysis. RESULTS From 2006 to 2010, 81 children below the age of 14 yr were diagnosed with T1DM for the first time. The age- and sex-standardised incidence rate was 21.86/100,000 children/yr. The estimated annual increase in incidence was 21.8%. Compared to data collected retrospectively between 1996-2001, the incidence has increased threefold between 2006 and 2010. Generally, the incidence rate was highest in the 5-9 yr age group, followed by the 0-4 yr age group and finally the10-14 yr age group. However, the highest annual increase occurred in the 0-4 yr age group at 39% per year, closely followed by 5-9 yr age group at 31% per year. In the 10-14 yr age group, the trend appeared to show a reduction in incidence. The proportion of patients presenting in diabetic ketoacidosis (DKA) was high at 41%. CONCLUSION In Malta, the number of children/adolescents with T1DM has been rising at a faster rate than expected, and a distinct shift to younger age at onset has been observed. DKA rate at presentation is still high in Maltese children.
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Affiliation(s)
- Nancy Formosa
- Department of Paediatrics, Mater Dei Hospital, Msida, MSD 2090, Malta.
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Mosaad YM, Auf FA, Metwally SS, Elsharkawy AA, El-Hawary AK, Hassan RH, Tawhid ZE, El-Chennawi FA. HLA-DQB1* alleles and genetic susceptibility to type 1 diabetes mellitus. World J Diabetes 2012; 3:149-55. [PMID: 22919445 PMCID: PMC3425629 DOI: 10.4239/wjd.v3.i8.149] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 06/27/2012] [Accepted: 08/08/2012] [Indexed: 02/05/2023] Open
Abstract
AIM: To determine human leukocyte antigen (HLA)-DQB1 allele association with susceptibility to type 1 diabetes (T1D) and to clinical and laboratory findings.
METHODS: This study was conducted on 85 unrelated Egyptian children with T1D recruited consecutively from the Pediatric Diabetes Endocrinology outpatients Clinic; Mansoura University Children’s Hospital, Egypt. Patient mean follow up period was 2.5 years. Patients were subdivided according to level of HbA1c (optimal/suboptimal control < 8.5% and poor control ≥ 8.5%). The control group consisted of 113 unrelated age- and sex-matched healthy subjects without T1D or other autoimmune diseases. Genomic DNA extraction was done for all subjects using a DNA isolation kit. HLA-Class II-DQB1 allele typing was carried out with a polymerase chain reaction-sequence-specific oligonucleotide probe using a INNO-LiPA HLA-DQB1 update kit.
RESULTS: Significant differences were detected between Egyptian patients with T1D and control groups in the frequencies of DQB1*02 [44.4% vs 18.6%, corrected P value (Pc) < 0.001] and DQB1*03 (41.2% vs 24.4%, Pc < 0.001). Significant differences were also observed between control groups and T1D patients in the frequencies of DQB1*05 (14.6% vs 7.2%, P = 0.029) and DQB1*06 (34.1% vs 7.2%, P < 0.001). However, after correction for multiple comparisons, the significance was retained for HLA-DQB1*06 (Pc < 0.001) but lost for HLA-DQB1*05. HLA-DQB1*0201, *0202, *030201 were positively associated with T1D (Pc = 0.014, Pc < 0.001, and Pc < 0.001 respectively), while HLA-DQB1*060101 was negatively associated (Pc < 0.001) with the condition. Although the HLA-DQB1 alleles 030101 and 050101 were significantly higher in controls (P = 0.016, P = 0.025 respectively), both of them lost statistical significance after correction of P value. The frequency of the HLA-DQB1 genotypes 02/02, 02/03, and 03/03 was higher in T1D patients, and the frequency of the genotypes 03/06, 05/06, and 06/06 was higher in controls, these differences being statistically significant before correction. After correction, the genotypes 02/02, 02/03 in T1D, and the genotypes 03/06, 06/06 in controls were still significant (Pc = 0.01, Pc < 0.001, Pc < 0.001, and Pc = 0.04, respectively). Non-significant associations were found between the frequency HLA-DQB1 alleles and genotypes in T1D in relation to the grade of diabetic control, Microalbuminuria, age, gender, age of presentation, weight, height, frequency of diabetic ketoacidosis (P = 0.42), serum cholesterol, and fasting and post-prandial level of C-peptide (P = 0.83, P = 0.9, respectively).
CONCLUSION: The Current work suggests that HLA-DQB1 alleles *030201, *0202, *0201, and genotypes 02/03, 02/02 may be susceptibility risk factors for development of T1D in Egyptian children, while the HLA-DQB1*060101 allele, and 03/06, 06/06 genotypes may be protective factors. HLA-DQB1 alleles and genotypes do not contribute to microalbuminuria or grade of diabetic control.
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Affiliation(s)
- Youssef M Mosaad
- Youssef M Mosaad, Fatma A Auf, Shereen S Metwally, Ziyad E Tawhid, Farha A El-Chennawi, Unit of Clinical Immunology, Department of Clinical Pathology, Mansoura Faculty of Medicine, Mansoura 35111, Egypt
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Patterson CC, Gyürüs E, Rosenbauer J, Cinek O, Neu A, Schober E, Parslow RC, Joner G, Svensson J, Castell C, Bingley PJ, Schoenle E, Jarosz-Chobot P, Urbonaité B, Rothe U, Krzisnik C, Ionescu-Tirgoviste C, Weets I, Kocova M, Stipancic G, Samardzic M, de Beaufort CE, Green A, Dahlquist GG, Soltész G. Trends in childhood type 1 diabetes incidence in Europe during 1989-2008: evidence of non-uniformity over time in rates of increase. Diabetologia 2012; 55:2142-7. [PMID: 22638547 DOI: 10.1007/s00125-012-2571-8] [Citation(s) in RCA: 310] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2011] [Accepted: 04/02/2012] [Indexed: 12/13/2022]
Abstract
AIMS/HYPOTHESIS The aim of the study was to describe 20-year incidence trends for childhood type 1 diabetes in 23 EURODIAB centres and compare rates of increase in the first (1989-1998) and second (1999-2008) halves of the period. METHODS All registers operate in geographically defined regions and are based on a clinical diagnosis. Completeness of registration is assessed by capture-recapture methodology. Twenty-three centres in 19 countries registered 49,969 new cases of type 1 diabetes in individuals diagnosed before their 15th birthday during the period studied. RESULTS Ascertainment exceeded 90% in most registers. During the 20-year period, all but one register showed statistically significant changes in incidence, with rates universally increasing. When estimated separately for the first and second halves of the period, the median rates of increase were similar: 3.4% per annum and 3.3% per annum, respectively. However, rates of increase differed significantly between the first half and the second half for nine of the 21 registers with adequate coverage of both periods; five registers showed significantly higher rates of increase in the first half, and four significantly higher rates in the second half. CONCLUSIONS/INTERPRETATION The incidence rate of childhood type 1 diabetes continues to rise across Europe by an average of approximately 3-4% per annum, but the increase is not necessarily uniform, showing periods of less rapid and more rapid increase in incidence in some registers. This pattern of change suggests that important risk exposures differ over time in different European countries. Further time trend analysis and comparison of the patterns in defined regions is warranted.
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Affiliation(s)
- C C Patterson
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Science Block B, Grosvenor Road, Belfast, BT12 6BJ, UK.
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