Prevention of IDDM: the genetic epidemiologic perspective

Stressful life events and psychological dysfunctions before the onset of type 1 diabetes mellitus

AIM

To test the hypothesis that stressful life events and psychological dysfunction increase the risk for development of type 1 diabetes mellitus (DM1).

METHOD

A case-control study comprising 105 children with DM1 and 210 controls matched by age +/- 1 year), sex and place of residence. Conditional univariate and multivariate logistic regressions were used to analyze the data.

RESULTS

After adjustment for possible confounders, the following factors were positively related to DM1: parents' job-related issues changed or lost job (odds ratio [OR] 11.5, 95% confidence interval [CI] 1.6-81.8); other severe life events--severe accident, hospitalization or death of close friend, quarrels between parents, war in republics of former Yugoslavia, near-drowning in a pool, falling down, unhurt participant of an accident (OR 68.5, 95% CI 13.5-349.0); other minor life events--conflicts with parents/teacher/neighbors, lost in town, physical attack, failure in competition, penalty, examination, death of pet, presence at lightning strike, thrown out of dwelling (OR 32.7, 95% CI 6.3-169.6); and learning problems (OR 17.5, 95% CI 4.3-71.6).

CONCLUSION

These results support the hypothesis that stressful life events and psychological dysfunctions are associated with DM1.

The Belgrade childhood diabetes study - comparison of children with type 1 diabetes with their siblings

A case-control study was conducted in Belgrade (about 320,000 inhabitants 0-16 years old) during the period 1994-97, comprising 68 diabetic children (cases) and 68 controls chosen from the siblings of the cases. Analysis using multivariable logistic regression analysis indicated the following independent risk factors for Type 1 diabetes: higher birth order, infections during the 6 months preceding the onset of the disease and stressful events. Out of individual stressful and psychological factors, 'other' stressful events (severe accident or hospitalisation or death of a close friend, conflict with a teacher, death of a pet, failure in competition, quarrel between parents, punishment, physical attack, war in republics of former Yugoslavia and near drowning in the pool) and learning problems were independent risk factor for Type 1 diabetes. The results obtained in this study of siblings supports the hypothesis that environmental factors play a role in the development of Type 1 diabetes.

The Belgrade childhood diabetes study: a multivariate analysis of risk determinants for diabetes

BACKGROUND

The aim of this study was to evaluate some hypotheses about factors related to the development of type 1 diabetes mellitus.

METHODS

A case-control study was conducted in Belgrade during the period 1994-1997. A total of 105 recently onset diabetic and 210 control children, individually matched by age (+/-1 year), sex and place of residence, were included in the study.

RESULTS

According to multivariate regression analysis, the following factors were related to type 1 diabetes: stressful events and symptoms of psychological dysfunction during the 12 months preceding the onset of the disease [odds ratio (OR) 3.48, 95% confidence interval (CI) 2.15-5.65; and OR 2.15, 95% CI 1.33-3.48], irregular vaccination (OR 16.98, 95% CI 1.38-208.92), infection during 6 months preceding the onset of the disease (OR 4.23, 95% CI 1.95-9.17), higher education of father (OR 1.50, 95% CI 1.05-2.14), mother's consumption of nitrosoamines-rich food during pregnancy (OR 4.33, 95% CI 1.95-9.61), alcohol consumption by father (OR 3.80, 95% CI 1.64-8.78), insulin-dependent and non-insulin-dependent diabetes mellitus in three generations of children's relatives (OR 20.04, 95% CI 4.73-84.81; and OR 5.52, 95% CI 2.45-12.46), and use of ultrasound diagnostic techniques during pregnancy (OR 0.42, 95% CI 0.17-1.00).

CONCLUSIONS

Among non-genetic factors, those affecting the child during pregnancy are especially important because of their preventability.

[Characteristics and habits of parents of children with insulin-dependent diabetes mellitus]

The aim of this case-control study conducted in Belgrade during 1994-1997 was to investigate whether parental demographic characteristics and habits are associated with insulin-dependent diabetes mellitus (IDDM). Case group comprised 105 children up to 16 years old with IDDM and control group comprised 210 children with skin diseases. Cases and controls were individually matched by age (+/- one year), sex and place of residence (Belgrade). According to chi 2 test results, children with IDDM significantly had five or more family members and they also significantly more frequently had poor socio-economic status than their controls. Higher education of fathers was significantly more frequently reported in diabetic children, in comparison with their controls. Parents of diabetic children were significantly more frequently occupationally exposed to radiation, petroleum, and its derivates, organic solvents, dyes and lacquers. During pregnancy mothers of diabetic children significantly more frequently smoked cigarettes and consumed coffee, coca-cola, alcohol and foods containing nitrosamines. Fathers of diabetic children more frequently consumed alcohol.