High incidence of childhood type 1 diabetes in Al-Madinah, North West Saudi Arabia (2004-2009)

Perceived School Experience of Children and Adolescents With Type 1 Diabetes in the Kingdom of Saudi Arabia

BACKGROUND AND OBJECTIVE

Type 1 diabetes mellitus (T1DM) is one of the most common chronic diseases in children globally affecting more than 1.2 million children worldwide. It is challenging to manage in children and adolescents, as it can have much more serious psychosocial impacts in these groups. The objective of this study was to investigate the perceived experience of children and adolescents with T1DM regarding the management of their condition while in school.

METHODS

 We used a cross-sectional study design with descriptive statistics and non-probability consecutive sampling in this work. This study was conducted at the Department of Pediatrics, Qassim Armed Forces Hospital, Al-Qassim, Saudi Arabia, from July 2018 to December 2018. In this study, we included 84 school-aged children and adolescents from various schools in the Qassim region of the Kingdom of Saudi Arabia who had T1DM and met the inclusion criteria. After we obtained written informed consent from the participants, they filled out a survey questionnaire about their perceived school experience while being a T1DM patient.

RESULTS

 Although most of the children believed that they were not prevented from managing their diabetes at school, most also believed that school personnel did not have adequate knowledge about diabetes.

CONCLUSION

 In this study, adolescents and children with T1DM had mixed perceptions of their experience at school.

Epidemiological profile and diabetes control of Type 1 Diabetes Mellitus patients in Karbala Governorate, Iraq

Background: Type1 Diabetes Mellitus is a common chronic diseases among children, and associated with morbidity, mortality, and enormous healthcare expenditures. Objectives; to estimate the prevalence, incidence, and describe the epidemiological characteristics of Type 1 Diabetes Mellitus among children in Karbala governorate. Methods: A cross-sectional study was conducted among all children who attended the main DM center in Karbala Teaching Hospital for Children, Public Clinics, and Primary Health Care centers. Data was collected by structured questionnaire and biochemical and anthropometric measurements. The statistical analysis data entry was conducted using Statistical Package for Social Sciences. Results: Total number of Type 1 Diabetes Mellitus patients aged 0-15 years in Karbala in 2015 was 199; making 44.66/100 5. Fifty-four patients were newly diagnosed patients making an incidence of 12.11/100 5. There was nearly equal distribution among both sexes. Most of the cases were from urban areas and most of the patients had a Family history of Type 2 Diabetes Mellitus. Diabetic ketoacidosis was reported in 16.8% of the patients. Only 31.6% of patients had HbA1c < 7%. Half of the patients had a history of admission to the hospital for diabetes. Logistic regression analysis revealed that the only independent variables significantly correlated with poor glycemic control were lack of Self-Monitoring Blood Glucose, irregular visits to the Diabetic Center, and positive family history of diabetes. Conclusion: Only one-third of T1DM children in Karbala city had controlled blood sugar. Lack of regular blood glucose monitoring and irregular contact with health care providers were the main determinants of uncontrolled blood sugar.

Type 1 diabetes in diverse ancestries and the use of genetic risk scores

Over 75 genetic loci within and outside of the HLA region influence type 1 diabetes risk. Genetic risk scores (GRS), which facilitate the integration of complex genetic information, have been developed in type 1 diabetes and incorporated into models and algorithms for classification, prognosis, and prediction of disease and response to preventive and therapeutic interventions. However, the development and validation of GRS across different ancestries is still emerging, as is knowledge on type 1 diabetes genetics in populations of diverse genetic ancestries. In this Review, we provide a summary of the current evidence on the evolutionary genetic variation in type 1 diabetes and the racial and ethnic differences in type 1 diabetes epidemiology, clinical characteristics, and preclinical course. We also discuss the influence of genetics on type 1 diabetes with differences across ancestries and the development and validation of GRS in various populations.

Diabetic Ketoacidosis at the Onset of Type 1 Diabetes Mellitus Among Children and Adolescents in Jeddah, Saudi Arabia: A Study From the Emergency Department

BACKGROUND

Diabetic ketoacidosis (DKA) is a life-threatening complication of type 1 diabetes mellitus (T1DM) and a leading cause of morbidity and mortality in children. We aim to assess the frequency, clinical characteristics, biochemical findings, and outcomes of DKA at the onset of T1DM in young children and adolescents.

DESIGN AND METHODS

This retrospective cohort study analyzed the medical records of patients ≤ 16 years old seen in the emergency department at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, between April 2015 and June 2019. The severity of DKA was classified according to the International Society for Pediatric and Adolescent Diabetes (ISPAD) criteria.

RESULTS

Out of 207 patients with T1DM, 53 presented with DKA as a new onset. The mean age was 8.51 ± 3.81 years, with the majority being 5-10 years old (52.8%). Polyuria (98.1%), polydipsia (86.8%), weight loss (62.3%), and abdominal pain and vomiting (45.3%) were the most frequent symptoms. Mean random blood glucose was 424.09 ± 108.67 mg/dL and mean venous pH was 7.15 ± 0.36 mmol/L. Of patients, 66% had no associated complications, 24.4% had hypokalemia, 20.8% developed hypoglycemia, and 18.9% developed hyperchloremic metabolic acidosis. One patient had cerebral edema and coma. Based on metabolic acidosis, 24.5% had mild DKA, an equal percentage had severe DKA, and 9.4% had moderate DKA. Of patients, 88.7% were admitted to the pediatric ward and 15.1% to the intensive care unit.

CONCLUSION

A total of 25% of patients diagnosed with T1DM below the age of 17 years presented with DKA. No permanent disabilities or deaths were reported. Forming a registry dedicated to T1DM is needed to follow up on these patients, especially among school-age children, as well as aid in the development of future research locally.

Diabetes Mellitus and Dental Health in Children: A Review of Literature

Aim and objective

To illustrate the most important general findings significant for dentists dealing with pediatric diabetic patients, as well as the effect of type 1 diabetes mellitus (T1DM) on children's oral health.

Background

Type 1 DM is considered to be the most popular type of diabetes in children and adolescents which has a strong impact on their lifestyle. Diabetes mellitus (DM) mainly affect organs and tissues that are affluent with blood vessels including kidneys, eyes, and nerves. Adding to that oral cavity is covered with epithelial tissues that are rich with small blood vessels.

Materials and methods

An electronic search of English scientific papers was accomplished using PubMed, Google Scholar, and King Abdulaziz University digital library. Search terms used were children, DM, dental health, gingival health, oral hygiene, periodontal health, and teeth eruption.

Review results

Thirty-six articles were obtained from the electronic search and references of selected studies. In addition, other references were included from selected studies about DM and its relationship to oral health. Multiple studies confirmed that T1DM has a negative impact on oral hygiene, gingival and periodontal health, and teeth eruption. While other studies contradict these results.

Conclusion

There are contradictory studies regarding the effect of T1DM on oral health in children and adolescents. Well-established high-quality research with clear and concise materials and methods are required to have representative results.

Clinical significance

Studying the effect of T1DM on oral health in children and adolescents is indicated to set well-established guidelines to reach a high standard of care for those children.

How to cite this article

Mandura RA, El Meligy OA, Attar MH, et al. Diabetes Mellitus and Dental Health in Children: A Review of Literature. Int J Clin Pediatr Dent 2021;14(5):719–725.

Prevalence of and risk factors for diabetes mellitus in the school-attending adolescent population of the United Arab Emirates: a large cross-sectional study

OBJECTIVES

The prevalence of diabetes has reportedly increased among adolescents in low-income and middle-income countries of the Middle East and may be linked to social, demographic and economic contextual factors. This study aimed: (1) to estimate the prevalence of self-reported diagnosis of diabetes in the adolescent population of the United Arab Emirates (UAE); (2) to assess differences in the prevalence based on gender and (3) to identify other characteristics of those with diabetes including parental marital status, smoking/illegal drug use, quality of life and nationality.

DESIGN

A secondary data analysis was performed on data from the National Study of Population Health in the UAE, conducted between 2007 and 2009.

SETTING

Large cross-sectional population-based survey study.

PARTICIPANTS

Survey was administered to a stratified random sample of 151 public and private schools from the UAE, across 7 emirates. 6365 school-attending adolescents (12-22 years; mean=16 years) participated.

OUTCOMES

Multivariable logistic regression analysis was used to examine the relationships between diabetes diagnosis and characteristics of participants after adjusting for confounding from other predictors.

RESULTS

The overall prevalence of self-reported diabetes was 0.9% (95% CI 0.7% to 1.2%) and was higher in males 1.5% (95% CI 1.0% to 2.1%) than females 0.5% (95% CI 0.3% to 0.8%), (p<0.001). Children of parents who were not currently married had more than twice the odds of self-reporting diabetes (p=0.031) compared with those with married parents. Adolescents who reported ever smoking/using illegal drugs had more than three times the odds of diabetes (p<0.001).

CONCLUSION

We found a positive association between certain characteristics of adolescents and their diabetes status, including male gender, parental marital status and smoking/illegal drug use. The high prevalence of smoking/illegal drug use among those reporting a diagnosis of diabetes suggests the need for behavioural and mental health interventions for adolescents with diabetes, as well as strong parental support and involvement.

Association of HLA-DRB1 and -DQ Alleles and Haplotypes with Type 1 Diabetes in Jordanians

BACKGROUND

The Human Leukocyte Antigen (HLA) class II genes, particularly the HLADR and -DQ loci, have been shown to play a crucial role in Type 1 Diabetes (T1D) development.

OBJECTIVE

This study is the first to examine the contribution of the HLA-DR/DQ alleles and haplotypes to T1D susceptibility in Jordanians.

METHODS

Polymerase chain reaction sequence-specific primers (PCR-SSP) were used to genotype 41 Jordanian healthy controls and 50 insulin-dependent diabetes mellitus (IDDM) patients.

RESULTS

The following alleles were found to be significant high risk alleles in T1D Jordanian patients: DRB1*04 (OR=3.95, p<0.001), DRB1*0301(OR=5.27, p<0.001), DQA1*0301 (OR=5.67, p<0.001), DQA1*0501(OR=3.18, p=0.002), DQB1*0201(OR=2.18, p=0.03), DQB1*0302 (OR=5.67, p<0.001). However, Jordanians harboring the DRB1*0701 (OR=0.37, p=0.01), DRB1*1101 (OR=0.2, p=0.01), DQA1*0505 (OR=0.31, p=0.02), DQA1*0103 (OR=0.33, p=0.04), DQA1*0201 (OR=0.45, p=0.04), DQB1*0301 (OR=0.23, p=0.001), DQB1*0501 (OR=0.18, p=0.009) alleles had a significantly lower risk of developing T1D.

CONCLUSION

A strong positive association of DRB1*04-DQA1*0301-DQBl*0302 (OR=5.67, p<0.001) and DRB1*0301-DQA1*0501-DQB1*0201 (OR=6.24, p<0.001) putative haplotypes with IDDM was evident in Jordanian IDDM patients whereas DRB1*1101-DQA1*0505- DQB1*0301 (OR=0.23, p=0.03) was shown to have a protective role against T1D in Jordanians. Our findings show that specific HLA class II alleles and haplotypes are significantly associated with susceptibility to T1D in Jordanians.

Very High Incidence of Type 1 Diabetes Among Children Aged Under 15 Years in Tlemcen, Northwest Algeria (2015-2018)

Objective

In Algeria, there is a lack of epidemiological data concerning childhood type 1 diabetes (T1D). The International Diabetes Federation estimated in 2019 that Algeria ranked 7th among countries with the highest prevalence of T1D. This study aimed to determine the incidence of T1D in children <15 years, living in Tlemcen in Northwest Algeria.

Methods

A retrospective study using data from children (<15 years) who have been diagnosed with T1D in Tlemcen between 2015 and 2018, using the two-source capture–recapture method to estimate the completeness of ascertainment (%). Total average incidences, by sex, by onset age group, and by season of onset were calculated per 100,000 and per year.

Results

During the study period, 437 new cases of T1D were registered, among them, 233 boys and 204 girls, with a sex ratio of 1.14. The average annual incidence rate of childhood T1D was 38.5/100,000 with a 95% confidence interval (CI): 35.20-41.79; boys: 40.51, 95% CI: 38.16-42.85; girls: 36.49, 95% CI: 34.17-38.80. Overall incidence rates in 2015, 2016, 2017 and 2018 were respectively 36.6 (95% CI: 33.72-39.48), 38.7 (95% CI: 35.43-41.97), 39.3 (95% CI: 35.97-42.62) and 39.5 (95% CI: 36.12-42.87)/100,000. Newly diagnosed children were more likely to present in winter and autumn. Ketoacidosis at diagnosis was diagnosed in 29.2%.

Conclusion

The mean incidence of childhood T1D in Tlemcen was 38.5/100,000, this incidence is in the “extremely high” category of the World Health Organization DiaMond project classification of diabetes giving this region a very high risk.

Association of HLA-DR-DQ alleles, haplotypes, and diplotypes with type 1 diabetes in Saudis

AIMS

Type 1 diabetes (T1D) is an autoimmune disease that affects many children worldwide. Genetic factors and environmental triggers play crucial interacting roles in the aetiology. This study aimed to assess the contribution of HLA-DRB1-DQA1-DQB1 alleles, haplotypes, and genotypes to the risk of T1D among Saudis.

METHODS

A total of 222 children with T1D and 342 controls were genotyped for HLA-DRB1, -DQA1, and -DQB1 using reverse sequence-specific oligonucleotide (rSSO) Lab Type high definition (HD) kits. Alleles, haplotypes, and diplotypes were compared between cases and controls using the SAS statistical package.

RESULTS

DRB1*03:01-DQA1*05:01-DQB1*02:01 (32.4%; OR = 3.68; P_c < .0001), DRB1*04:05-DQA1*03:02-DQB1*03:02 (6.6%; OR = 6.76; P_c < .0001), DRB1*04:02-DQA1*03:01-DQB1*03:02 (6.0%; OR = 3.10; P_c = .0194), DRB1*04:01-DQA1*03:01-DQB1*03:02 (3.7%; OR = 4.22; P_c = .0335), and DRB1*04:05-DQA1*03:02-DQB1*02:02 (2.7%; OR = 6.31; P_c = .0326) haplotypes were significantly increased in cases compared to controls, whereas DRB1*07:01-DQA1*02:01-DQB1*02:02 (OR = 0.41; P_c = .0001), DRB1*13:01-DQA1*01:03-DQB1*06:03 (OR = 0.05; P_c < .0001), DRB1*15:01-DQA1*01:02-DQB1*06:02 (OR = 0.03; P_c < .0001), and DRB1*11:01-DQA1*05:05-DQB1*03:01 (OR = 0.07; P_c = .0291) were significantly decreased. Homozygous DRB1*03:01-DQA1*05:01-DQB1*02:01 genotypes and combinations of DRB1*03:01-DQA1*05:01-DQB1*02:01 with DRB1*04:05-DQA1*03:02-DQB1*03:02, DRB1*04:02-DQA1*03:01-DQB1*03:02, and DRB1*04:01-DQA1*03:01-DQB1*03:02 were significantly increased in cases than controls. Combinations of DRB1*03:01-DQA1*05:01-DQB1*02:01 with DRB1*07:01-DQA1*02:01-DQB1*02:02 and DRB1*13:02-DQA1*01:02-DQB1*06:04 showed low OR values but did not remain significantly decreased after Bonferroni correction.

CONCLUSIONS

HLA-DRB1-DQA1-DQB1 alleles, haplotypes, and diplotypes in Saudis with T1D are not markedly different from those observed in Western and Middle-Eastern populations but are quite different than those of East Asians.

Enteroviruses and Type 1 Diabetes Mellitus: An Overlooked Relationship in Some Regions

Enteroviruses (EVs) infect millions of people annually. EV infections can be asymptomatic or symptomatic with conditions ranging from mild illnesses to serious diseases such as dilated cardiomyopathy. A causal relationship between EV infections and type 1 diabetes mellitus (T1DM) has been heavily debated, with some studies suggesting that this relationship is not yet conclusive and requires additional evidence, whereas others strongly argue for this correlation. While this relationship is well investigated in some developed countries like the USA and Finland, it is understudied or neglected in other countries like Russia for many reasons such as the low incidence of T1DM. Although the Middle East and North Africa (MENA) are highly affected by T1DM, the role of EVs in the disease in MENA has not been investigated extensively. Therefore, we aimed to address the relationship between T1DM and EVs in MENA and other regions globally.

Incidence, prevalence and mortality of diabetes in children and adolescents aged under 20 years in the Republic of Maldives

AIM

There is little published data on diabetes in youth in the Maldives. This study aimed to determine incidence, prevalence and mortality of diabetes in children and adolescents <20 years.

METHODS

Data on all known existing cases in 2009 and all new cases from 2009 to 2018 was collected from the Diabetes Society of the Maldives registry.

RESULTS

Thirty-nine subjects <20 years were known to have diabetes at the start of 2009 and 92 new cases were diagnosed from 2009 to 2018. Of the 92 new cases, 76 had type 1 diabetes (T1D), 15 type 2 diabetes (T2D) and one secondary diabetes. Of the 76 new T1D cases, 64 were diagnosed <15 years. Mean age of onset for T1D <20 years was 10 ± 4.6 years, with 42 (55.3%) female. Ten (13.2%) were diagnosed 0-4 years, 27 (35.5%) 5-9 years, 27 (35.5%) 10-14 years and 12 (15.8%) 15-19 years. Annual T1D mean incidence rates/per 100 000 subjects for <15/<20 years, respectively, increased from 3.6/2.7 in 2009 to 11.0/9.1 in 2018, representing 12.0%/13.0% annualised increases (P = 0.01 for both). T1D prevalence in 2018 for <15 and <20 years was 47.1/100 000 and 52.0/100 000, respectively. No young person with T1D died during this period, with a total of 262 patient-years of follow-up for T1D cases. The child with secondary diabetes died of other causes.

CONCLUSION

T1D incidence in Maldives is higher than that reported from other South Asian countries, and an increasing trend was observed. T2D also occurs relatively frequently. A zero mortality rate was observed for children and young adults with T1D and T2D from 2009 to 2018.

Final-year medical students' awareness and knowledge about DKA: A cross-sectional study from a Saudi University

Background:

Final-year medical students are soon to be physicians who are expected to have sufficient knowledge about a life-threatening condition such as diabetic ketoacidosis (DKA); thus, the present study aimed to evaluate awareness and knowledge of medical students about DKA in a large Saudi University.

Methods:

An online survey was conducted using a convenience sample of 81 participants aged 18 years and above from Jazan region, Saudi Arabia. Awareness and knowledge about DKA were assessed using a prestructured questionnaire. Statistical analysis using the Statistical Package of Social Sciences (SPSS) included descriptive studies and Chi-square or Fisher's exact test, with the significance level set at P value < 0.05.

Results:

A total of 81 valid responses were analyzed (85.3% response rate), of which 51.9% were males. The mean age was 23.06 (Standard deviation 1.66 years). Regarding basic information about diabetes mellitus, most of the respondents correctly answered questions related to the system involved in diabetes, classic symptoms, glycemic control test, and the meaning of postprandial blood sugar. Also, students had a good knowledge regarding DKA definition and management. However, inadequate knowledge was found regarding electrolyte disturbance in DKA (59% of males vs. 30.8% of females P = 0.014) and fluid replacement in DKA patients (P < 0.05).

Conclusion:

The present study revealed that students had a good knowledge regarding basic information about diabetes and DKA definition and management. Students’ knowledge was deficient regarding electrolyte disturbance and fluid replacement in DKA. Interventions using study seminars and workshops are warranted to increase knowledge about DKA among final-year medical students.

Correlating the global increase in type 1 diabetes incidence across age groups with national economic prosperity: A systematic review

BACKGROUND

The global epidemiology of type 1 diabetes (T1D) is not yet well known, as no precise data are available from many countries. T1D is, however, characterized by an important variation in incidences among countries and a dramatic increase of these incidences during the last decades, predominantly in younger children. In the United States and Europe, the increase has been associated with the gross domestic product (GDP) per capita. In our previous systematic review, geographical variation of incidence was correlated with socio-economic factors.

AIM

To investigate variation in the incidence of T1D in age categories and search to what extent these variations correlated with the GDP per capita.

METHODS

A systematic review was performed to retrieve information about the global incidence of T1D among those younger than 14 years of age. The study was carried out according to the PRISMA recommendations. For the analysis, the incidence was organized in the periods: 1975-1999 and 2000-2017. We searched the incidence of T1D in the age-groups 0-4, 5-9 and 10-14. We compared the incidences in countries for which information was available for the two periods. We obtained the GDP from the World Bank. We analysed the relationship between the incidence of T1D with the GDP in countries reporting data at the national level.

RESULTS

We retrieved information for 84 out of 194 countries around the world. We found a wide geographic variation in the incidence of T1D and a worldwide increase during the two periods. The largest contribution to this increase was observed in the youngest group of children with T1D, with a relative increase of almost double when comparing the two periods (P value = 2.5 × e^-5). Twenty-six countries had information on the incidence of T1D at the national level for the two periods. There was a positive correlation between GDP and the incidence of T1D in both periods (Spearman correlation = 0.52 from 1975-1999 and Spearman correlation = 0.53 from 2000-2017).

CONCLUSION

The incidence increase was higher in the youngest group (0-4 years of age), and the highest incidences of T1D were found in wealthier countries.

Socio-economic inequalities in diabetes prevalence in the Kingdom of Saudi Arabia

BACKGROUND

Rising prevalence of non-communicable diseases, including diabetes in the Middle East, is a major public health concern of the 21st century. However, there is a paucity of literature to understand and measure socio-economic inequalities in diabetes prevalence in this region, including the Kingdom of Saudi Arabia (KSA).

METHODS

This study investigated socio-economic inequalities in diabetes prevalence in the KSA using data from the Saudi Arabia Health Interview Survey. Concentration curve, concentration index, and multivariate logistic regression were used to measure and examine income- and education-related inequalities in diabetes prevalence.

RESULTS

The results showed significant socio-economic inequalities in the prevalence of diabetes through analysing a nationally representative sample of the KSA population. Diabetes prevalence was concentrated among the poor and among people with less education. In addition, education-related inequality was higher than income-related inequality.

CONCLUSIONS

The findings of this study are important for policymakers to combat both the increasing prevalence of and socio-economic inequalities in diabetes. The government should promote health education programmes and increase the level of public awareness of diabetes management, especially among the lower educated population in the KSA.

Glycemic Control in Children and Youth With Type 1 Diabetes Mellitus in Saudi Arabia

Objective:

To determine the glycemic control and cardio-metabolic complications of children and adolescents with type 1 diabetes mellitus (T1DM) attending a tertiary care diabetes clinic in Saudi Arabia.

Methods:

We conducted a retrospective cross-sectional study of children and adolescents with T1DM attending King Abdulaziz Medical City-Jeddah from 2010 to 2013. We assessed their glycemic control and diabetes management. Vitamin D status was compared with glycemic control and gender differences.

Results:

We identified 301 subjects (53.5% females); mean age was 13.9 ± 3.8 years. The mean duration of diabetes was 7.7 ± 3.7 years, body mass index (BMI) was 21.1 ± 4.5 kg/m², and hemoglobin A_1c (HbA_1c) was 9.6% ± 1.9% in both genders. There were modest gender-specific differences in Saudi patients with T1DM, with males having more symptoms than females. Mean age at diagnosis of T1DM was slightly younger in males (6.01 ± 3.65 years) than in females (6.33 ± 3.45 years). Education was the most common reason for admission in males (32.9%), whereas diabetic ketoacidosis (DKA) was the most common reason in females (38.8%). Frequency of symptomatic hypoglycemic attacks was relatively higher in males (47.1%) than in females (42.9%). The majority of our patients (83%) were on intensive insulin regimen, having 4 injections or more per day. The remaining (17%) were on conventional insulin therapy. Only 26.2% had satisfactory HbA_1c (⩽8%). The mean level of 25-hydroxyvitamin D was 35.15 ± 15.9 nmol/L and cholesterol was 4.75 ± 1.1 nmol/L. Vitamin D deficiency (25-hydroxyvitamin D ⩽ 37.5 nmol/L) was detected in 63.6% males and 67.7% females. No significant correlation between HbA_1c and vitamin D deficiency was observed.

Conclusions:

Metabolic control among Saudi children with T1DM is less satisfactory compared with other countries. The high prevalence of vitamin D deficiency in this population supports the recommendation of vitamin D supplementation in T1DM subjects. Further studies in a larger cohort are needed to confirm our findings.

A Systematic Review of Childhood Diabetes Research in the Middle East Region

Background: Diabetes mellitus (DM) is a common chronic disorder in children and is caused by absolute or relative insulin deficiency, with or without insulin resistance. There are several different forms of childhood DM. Children can suffer from neonatal diabetes mellitus (NDM), type 1 diabetes (T1DM), type 2 diabetes (T2DM), Maturity Onset Diabetes of the Young (MODY), autoimmune monogenic, mitochondrial, syndromic and as yet unclassified forms of DM. The Middle East has one of the highest incidences of several types of DM in children; however, it is unclear whether pediatric diabetes is an active area of research in the Middle East and if ongoing, which research areas are of priority for DM in children. Objectives: To review the literature on childhood DM related to research in the Middle East, summarize results, identify opportunities for research and make observations and recommendations for collaborative studies in pediatric DM. Methods: We conducted a thorough and systematic literature review by adhering to a list recommended by PRISMA. We retrieved original papers written in English that focus on childhood DM research, using electronic bibliographic databases containing publications from the year 2000 until October 2018. For our final assessment, we retrieved 429 full-text articles and selected 95 articles, based on our inclusion and exclusion criteria. Results: Our literature review suggests that childhood DM research undertaken in the Middle East has focused mainly on reporting retrospective review of case notes, a few prospective case studies, systemic reviews, questionnaire-based studies, and case reports. These reported studies have focused mostly on the incidence/prevalence of different types of DM in childhood. No studies report on the establishment of National Childhood Diabetes Registries. There is a lack of consolidated studies focusing on national epidemiology data of different types of childhood DM (such as NDM, T1DM, T2DM, MODY, and syndromic forms) and no studies reporting on clinical trials in children with DM. Conclusions: Investing in and funding basic and translational childhood diabetes research and encouraging collaborative studies, will bring enormous benefits financially, economically, and socially for the whole of the Middle East region.

Incidence and trend of type 1 diabetes and the underlying environmental determinants

A wealth of epidemiological studies concerning the distribution of type 1 diabetes (T1D) around the world have pointed to the appreciable variation in the incidence of T1D among disparate age groups, ethnicities, and geographical locations. On the whole, the incidence of childhood T1D has been on the rise, and a plausible inverse relationship between the initial incidence rate and the following annual increase in incidence has been raised. Countries that used to exhibit lower incidences tend to have steep annual increase whereas those with already-established high incidences are more likely to show a modest increase or even stabilization in T1D incidence. Environmental agents considered responsible for the current evolving pattern of T1D incidence will be detailed, mainly including the increasing prevalence of childhood obesity, viral infections in a chronic manner, maternal-child interaction such as breastfeeding, and latitude-ultraviolet B-vitamin D pathway. Certain rationale has been put forward in an attempt to explain the potential association between environmental agents and development of T1D. For instance, accelerator hypothesis regards insulin resistance as the promoter of earlier disease onset in obese children whereas the negative correlation of microbial infections in background populations with incidence of T1D represents the basic component of the hygiene hypothesis. Further investigations are still warranted to verify these theories across multiple ethnic groups and to identify additional contributors to the variation in T1D incidence.

Global and regional estimates of the morbidity due to type I diabetes among children aged 0-4 years: a systematic review and analysis

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.

Incidence of type 1 and type 2 diabetes, between 2012-2016, among children and adolescents in Qatar

INTRODUCTION

Diagnoses of type 1 DM (T1DM) and type 2 diabetes mellitus (T2DM) in youths present a substantial clinical and public health burden. The aim of this study was to determine the incidence and trend of T1DM and T2DM, among children aged 0-14 years, in Qatar.

METHODS

This prospective cohort study was performed to ascertain all new cases of T1DM and T2DM 2 in Qatar as per the registry of the National Paediatric Diabetes Centre (the only tertiary care center treating children with DM in Qatar. Age-standardized and age-specific annual incidence rates for age groups 0.5-14 years were calculated.

RESULTS

A total of 440 youths with T1DM (0.5 to 14 years of age) and 45 with T2DM (5 to 14 years of age) were identified in Qatar. The inclusive unadjusted estimated incidence rates of T1DM in this population over the period between 2012-2016 was 28.39/100,000 with a 95% CI of 31.82-40.03. This was significantly higher compared to the unadjusted estimated incidence registered between 2006-2011 (23.15/100,000). No case of T2DM were registered before 2008. In the following years the incidence of T2DM increased from 1.82 per 100,000 in 2012 to 2.7 per 100,000 in 2016, with an incidence of T2DM equal to 2.9/100,000 per year.

CONCLUSIONS

A relatively higher incidence of T1DM compared to incidence reported worldwide have been documented in Qatar. The incidence rate increased in the period 2012-2016 compared to 2006-2011. Further studies are required to determine the causes of these increases.

Type 1 Diabetes Mellitus in Saudi Arabia: A Soaring Epidemic

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.

Prevalence and clinical presentation at the onset of type 1 diabetes mellitus among children and adolescents in AL-Baha region, Saudi Arabia

BACKGROUND

The objectives were to describe the frequency of clinical presentation at the onset of type 1 diabetes mellitus (T1DM) and to estimate the prevalence of T1DM among children and adolescents in the AL-Baha region, Saudi Arabia, aiming for early diagnosis of T1DM.

METHODS

The clinical and laboratory data of 471 children and adolescents who presented with T1DM and received medical care at an AL-Baha diabetic center during the period from 2007 to 2016 were retrospectively analyzed based on the records.

RESULTS

The prevalence of T1DM in the AL-Baha region was 355 per 100,000 population in participants aged from 0 to 19 years. T1DM was more common among girls than boys (57.5% vs. 42.5%, respectively; p=0.3), and the female/male ratio was 1.36 in favor of girls. Hyperglycemic symptoms were the most frequent symptoms at presentation [59.2% vs. 40.8% with diabetic ketoacidosis (DKA)], and 37% of them presented with loss of weight. Most of the ketoacidosis was mild to moderate (80.2%), while only 19.8% of children had the severe type and DKA was more common (55.2%) among females. The mean age at diagnosis of T1DM was 8.2±3.5 years for all patients, and 8.3±3.9 and 8.9±3.6 years for boys and girls, respectively (p=0.06). Hyperglycemic symptoms were more common in spring (15.9%).

CONCLUSIONS

The prevalence of type 1 diabetes in the AL-Baha region was 355 per 100,000 population, which is one of the highest reported prevalences in this age group. Hyperglycemic symptoms were the most encountered symptoms at the onset of the presentation of T1DM and this may help in early detection of diabetic symptoms by patients and physicians to avoid the more severe types of presentation.

Evaluation of vitamin D receptor gene polymorphisms (Fok-I and Bsm-I) in T1DM Saudi children

BACKGROUND

Vitamin D deficiency conferred strongest susceptibility to pathogenesis of type 1 diabetes mellitus (T1DM). Altered gene expression and function have strong effect on VDR gene polymorphism.

OBJECTIVES

We aimed to check for the association of two single nucleotide polymorphisms (SNPs) in VDR gene (Fok-I and Bsm-I) with T1DM in Saudi children.

SUBJECTS AND METHODS

Cross-sectional study included 100 T1DM Saudi children, plus 102 unrelated healthy subjects. PCR technique was used for detection of Fok-I and Bsm-I SNPs in VDR gene.

RESULTS

Regarding the Fok-I polymorphisms, T1DM cases showed a significant increased frequency of the heterozygous genotype (Ff) than controls (33% vs 21%, OR = 1.9, 95% CI = 1.006-3.587, P = .04). In the meantime, they showed significantly lower frequency of the homozygous (ff) genotype (64% vs 79%, OR = 0.51, 95% CI = 0.28-0.96, P = .03). Cases showed also a significantly lower frequency of the (f) allele than controls (80.5% vs 87.7%, OR = 0.57, 95% CI = 0.33-0.995, P = .04). On the other hand, cases showed significantly higher frequency of the Bsm-I homozygous (bb) and heterozygous (Bb) genotypes (25% vs 11.8%, P = .01, OR = 2.5, 95% CI = 1.18-5.31) & (45% vs 27.5%, P = .0, OR = 2.1, 95 % CI = 1.20-3.89, respectively). Cases showed also significantly higher frequency of (b) allele compared to control (47.5% vs 25.5%, P = .0, OR = 2.6, 95% CI = 1.74-4.02). Haplotype analysis showed an increased risk with the fB and fb haplotypes.

CONCLUSION

This study emphasizes a positive association between SNPs (Fok-I and Bsm-I) and T1DM among Saudi children with increased risk with the Fok-I F and Bsm-I b alleles.

Incidence of type 1 diabetes has doubled in Kuwaiti children 0-14 years over the last 20 years

AIMS

This study had 2 aims: to report data on the incidence of childhood-onset type 1 diabetes in Kuwaiti children aged 0-14 years during 2011 to 2013 and to compare the recent data with those collected during 1992 to 1997.

METHODS

All newly diagnosed patients were registered through the Childhood-Onset Diabetes eRegistry (CODeR) in 2011-2013, based on the DiaMond protocol used in 1992-1997.

RESULTS

A total of 515 Kuwaiti children (247 boys and 268 girls) aged 0-14 years newly diagnosed with type 1 diabetes were registered from 1 January 2011 to 31 December 2013. Data ascertainment were 96.7%. The mean age ± SD at diagnosis was 8.7 ± 3.4 years in boys and 7.9 ± 3.1 years in girls. The crude incidence rate (95% CI) was 40.9 (37.4-44.6) and the age standardized rate 41.7 (95% 38.1-45.4) per 100,000 per year, 39.3 (34.6-44.4) among boys and 44.1 (39.0-49.7) among girls. A statistically significant increasing trend in incidence was observed as the overall crude incidence rose from 17.7 in 1992-1994 to 40.9 per 100,000 per year in 2011-2013. The Poisson regression model depicting the trend in incidence revealed that, the incidence rates adjusted for age and sex in 2011 to 2013 was 2.3 (95% CI 1.9-2.7) times higher than 1992-1997.

CONCLUSIONS

The incidence of type 1 diabetes in Kuwaiti children 0-14 years has doubled in the last 2 decades. The reasons for this increase requires further investigation.

Epidemiology of type 1 diabetes mellitus in Basrah, Southern Iraq: A retrospective study

AIMS

To investigate the epidemiology of type 1 diabetes mellitus (T1DM) in Basrah city, Southern Iraq, between 2012 and 2016 among people 0-40year old.

METHODS

This was a retrospective data analysis of electronic archives for patients with T1DM registered in Faiha Specialized Diabetes, Endocrine, and Metabolism Center (FDEMC), which is a tertiary referring Center in Basrah. The data include electronic database from August 2008 to February 2016. Incidence and prevalence rates are expressed per 100,000. Population of Basrah estimates were derived from official data of The Ministry of Planning of Iraq.

RESULTS

There were 2536 people registered at FDEMC. Of them 53.5% were males. The overall mean age at first diagnosis was 15.3±9years and it was significantly higher in males; p value 0.0005. The prevalence rate of T1DM in people 40years old and younger in 2016 was 87 per 100,000. Between 1 January 2012 and 31 December 2016, there were 818 identified new cases of T1DM. Of these, 417 (50%) were males. The average annual incidence rate of T1DM was 7.4 per 100,000 (95% CI, 7.1-8.1).

CONCLUSIONS

The incidence of T1DM in Basrah lies in the "intermediate group" according to DIAMOND project group classification. The incidence was increasing over the last three years. The data produced by this study provide a baseline for assessing future changes in the epidemiology of T1DM in Iraq.

Climates on incidence of childhood type 1 diabetes mellitus in 72 countries

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.

Incidence and prevalence rates of diabetes mellitus in Saudi Arabia: An overview

Objective: This study aimed to report on the trends in incidence and prevalence rates of diabetes mellitus in Saudi Arabia over the last 25 years (1990–2015).

Design: A descriptive review.

Methods: A systematic search was conducted for English-language, peer reviewed publications of any research design via Medline, EBSCO, PubMed and Scopus from 1990 to 2015. Of 106 articles retrieved, after removal of duplicates and quality appraisal, 8 studies were included in the review and synthesised based on study characteristics, design and findings.

Findings: Studies originated from Saudi Arabia and applied a variety of research designs and tools to diagnosis diabetes. Of the 8 included studies; three reported type 1 diabetes and five on type 2 diabetes. Overall, findings indicated that the incidence and prevalence rate of diabetes is rising particularly among females, older children/adolescent and in urban areas.

Conclusion: Further development are required to assess the health intervention, polices, guidelines, self-management programs in Saudi Arabia.

A study on the prevalence of risk factors for diabetes and hypertension among school children in Majmaah, Kingdom of Saudi Arabia

BACKGROUND

The prevalence of risk factors for diabetes and hypertension in Saudi school children has achieved epidemic proportions because of enriched lifestyles. The aim of this study is to conduct a baseline study of such risk factors in a young population at the cusp of high-end technology and material comfort.

MATERIALS AND METHODS

A cross-sectional study was done among school children using parental assisted self-questionnaires and anthropometric assessment of their vital statistics. This study, including planning, data collection and analysis, and the writing of the first draft, was conducted from March 2015 to October 2016 after ethical approval was obtained. Cluster sampling was done for the schools, and stratified randomized sampling was performed to choose a total of 794 male and female school children. SPSS software was used for data analysis.

RESULTS

It was found that 11.6% of the children had a body mass index (BMI) above the normal range. The waist-to-height ratio was elevated in 16.8% of the children. Other risk factors of note were a high prevalence of sedentary habits (43%), daily consumption of carbonated sugary drinks (36.4%), and eating at fast food restaurants most days of the week (17%).

CONCLUSIONS

This gradual buildup of risk factors for diabetes and hypertension at an early age is a morbid indicator of an epidemic whose outcome has been determined. Most of these modifiable risk factors are amenable to change through concentrated efforts to educate, train and inculcate healthy habits among children and their families.

Neuropathy of type 1 diabetes in the Arab world: A systematic review and meta-analysis

AIMS

Although type 1 diabetes (T1D) is a common disease in the Arab nations, there is no data available on the prevalence of peripheral neuropathy (PN) among T1D subjects in Arab countries. The aim of this study is to analyze the prevalence of PN in T1D subjects via published literature and to draw attention to the dearth of the published work in this serious complication of T1D.

METHODS

A meta-analysis was performed on studies representing different Arab countries with a total number of 2243 T1D subjects.

RESULTS

The pooled prevalence of PN among T1D subjects in the Arab region was estimated as 18% with 95% confidence intervals (CI): 0.09-0.34. The PN prevalence was significantly higher in the >16-yr age group, with 59.1% (95% CI: 0.45-0.72) compared to 9.5% (95% CI: 0.05-0.19) in the <16-yr age group. Furthermore, the PN prevalence was significantly higher in the group with more than 10-yr T1D, 35% (95% CI: 0.15-0.62) than in the group with less than 10-yr T1D, 9.4% (95% CI: 0.04-0.21).

CONCLUSION

In Arab countries, PN is common in adults and children with T1D, but prevalence varies widely. Older age Arab people (>16years) with T1D are affected more with PN than younger age Arab people (<16years). PN is more frequently present in Arab subjects with a longer duration of T1D diabetes than in those with shorter duration.

First report on the nationwide incidence and prevalence of Type 1 diabetes among children in Turkey

AIM

To report, for the first time, the incidence and prevalence of childhood Type 1 diabetes in Turkey using a nationwide registry.

METHODS

Information on birth date, city of birth, diagnosis date and gender of all patients with Type 1 diabetes aged < 18 years were obtained from the Turkish Social Security Institute for the period from January 2011 to December 2013.

RESULTS

There were 17 175 prevalent cases of Type 1 diabetes over the 3-year period. The prevalence of Type 1 diabetes was 0.75/1 000 (95% CI 0.74-0.76) and was higher in girls than in boys (0.79 vs 0.72 /1 000; P < 0.01). There were 2465 incident cases in 2013. The incidence was slightly higher among girls (50.6%) than boys (49.4%); the girl:boy case ratio was 1.02. The incidence was 10.4/100 000 for boys and 11.3/100 000 for girls. The age-standardized incidence rate was 10.8 per 100 000 (95% CI 10.1-11.5) according to the WHO standard population, estimated using the direct method. The mean patient age at diagnosis was 10.6 ± 4.6 years. The highest proportion of cases (40.6%) was diagnosed in children aged 10-14 years.

CONCLUSIONS

This is the first study to report the incidence and prevalence of Type 1 diabetes in children in Turkey. The incidence of Type 1 diabetes reflects the geographical location of Turkey, bridging Asia and Europe, with the incidence being higher than in Asia but lower than in Europe.

An Arab registry for type 1 diabetes: global benefits for type 1 diabetes patients

BACKGROUND

The Arab world encompasses twenty-two Arabic-speaking countries, where the rate of consanguinity can exceed 50%. Type 1 diabetes (T1D), a chronic disorder that requires lifelong treatment, is believed to be largely due to genetic predisposition. The objective of this review is to discuss the benefits of establishing an Arab population-based diabetes registry, which will provide a reference for T1D prevalence and incidence.

METHODS

An online search was carried out through various websites, including PubMed, government, hospitals and health ministries of the 22 Arab countries to understand the reporting activities of diabetes in the Arab world.

RESULTS AND CONCLUSION

The prevalence and incidence of T1D is variable among Arabs, with the availability of only a few national/regional diabetes registries to support diabetes research, provide reliable data, and to cope with the widespread threat of this disease. Hence, the need of establishing a population based Arab diabetes registry.

Genetic Epidemiology of Type 1 Diabetes in the 22 Arab Countries

Type 1 diabetes (T1D) is a complex autoimmune disorder that results from the T cell-mediated destruction of the pancreatic β cells and is due to interactions between environmental and genetic factors. Although Arabs have one of the highest global incidence and prevalence rates of T1D, unfortunately, there is a dearth of information regarding the genetic epidemiology of T1D in the Arab world. Arabs share several HLA haplotypes with other ethnic groups, which confer either susceptibility or protection to T1D, but they have specific haplotypes that are distinctive from other ethnicities. Among different Arab countries, several non-HLA genes were reported to be associated with susceptibility to T1D, including CTLA4, CD28, PTPN22, TCRβ, CD3z, IL15, BANK1, and ZAP70. In Arab countries, consanguinity, endogamy, and first-cousin marriage rates are some of the highest reported worldwide and are responsible for the creation of several inbreeding communities within the Arab world that have led to an increase in homozygosity of both the HLA haplotypes and non-HLA genes associated with either protection or susceptibility to T1D among Arabs. Homozygosity reduces the HLA complexity and is expected to facilitate our understanding of the mode of inheritance of HLA haplotypes and provide valuable insight into the intricate genotype-phenotype correlations in T1D patients. In this review, based on literature studies, I will discuss the current epidemiological profile and molecular genetic risks of Arabs with T1D.

Association of HLA-DQA1 and -DQB1 alleles with type I diabetes in Arabs: a meta-analyses

This study aimed at assessing the nature and significance of associations between various alleles of HLA-DQA1, HLA-DQB1, and type I diabetes (T1D) in Arab populations. Evidence from literature (published before 20 April 2015) was amassed and analysed through multiple meta-analyses, which yielded effect summary odds ratios and 95% confidence intervals for 24 alleles and 4 haplotypes. A total of 1273 cases and 1747 controls from 16 studies were analysed. High levels of significance were obtained to support higher T1D risk when harbouring DQA1*03:01. The alleles DQB1*02:01 and *03:02 and the haplotypes DR3 and DR4 were significant risk factors, albeit with high publication heterogeneity. The protective effects of DQA1*01:01, DQB1*05:03, *06:02, *06:03, and *06:04 were robustly suggested by all indicators of meta-analyses. The haplotypes DR7 and DR11 were strongly suggested to be protective in Arabs. A relatively small number of studies have emerged from Arab countries, mostly with inadequate power on an individual basis. This study fills the gap by providing significant size effect of human leukocyte antigen (HLA) alleles and completes the continuum of global ethnic differences in this context.

Impact of Vitamin D Status on Cardiometabolic Complications among Children and Adolescents with Type 1 Diabetes Mellitus

OBJECTIVE

There is an ongoing interest in the relationship between vitamin D status and diabetes control and complications. However, data from Saudi Arabia are limited. To determine the impact of vitamin D status on glycemic control and cardiometabolic complications of children and adolescents with type 1 diabetes mellitus (T1DM) attending a tertiary care diabetes clinic in Saudi Arabia.

METHODS

Demographic, clinical, and laboratory data of 301 children and adolescent subjects with T1DM (53.5% females) of a mean age of 13.9 years attending King Abdulaziz Medical City-Jeddah during 2010-2013 were retrospectively collected. Relationships between vitamin D status and frequency of hypoglycemia, hemoglobin A1c (HbA1c) level, body mass index (BMI), blood pressure, and lipid profile were evaluated.

RESULTS

The mean duration of diabetes was 7.7±3.7 years. Mean BMI value was 21.1±4.5 kg/m2 and HbA1c was 9.6±1.9% in both genders. Only 26.2% of the patients had a satisfactory HbA1c level. The mean level of 25-hydroxyvitamin D [25(OH)D] was 35.15 and that of cholesterol was 4.75. Vitamin D deficiency [25(OH)D≤37.5 nmol/L] was detected in 63.6% of the male and 67.7% of the female subjects. In males, it was inversely associated with frequency of hypoglycemia (p<0.01), BMI (p<0.05), diastolic blood pressure (p<0.05), and triglyceride levels (p<0.01), while in females, it was inversely associated with current age (p<0.05), age at diagnosis (p<0.01), and triglyceride levels (p<0.01). No significant correlation between HbA1c and vitamin D deficiency was observed.

CONCLUSION

Vitamin D deficiency was highly prevalent in our study sample and was found to be associated with frequency of hypoglycemic episodes and with adverse cardiometabolic control.

Epidemiology of diabetic ketoacidosis in Arab patients with type 1 diabetes: a systematic review

AIMS

Diabetic ketoacidosis (DKA) is an acute and risky complication of type 1 diabetes. The aim of this study is to build the overall rate of DKA in Arab patients with type 1 diabetes in the 22 Arab nations. This is expected to tailor the healthcare approaches in Arab countries where attention is needed to save lives from the devastating consequences of DKA.

METHODS

The study here is a quantitative analysis of the articles indexed in four different scientific literature databases: Web of Science, PubMed, Science Direct and Scopus, from inception to June 2015. Arab patients with type 1 diabetes who presented with DKA have been captured. Key information was possible to extract for patients belong to only 12 Arab countries out of the 22 Arab patients.

RESULTS

Twenty-nine studies in 12 different Arab countries captured 4,688 type 1 diabetes patients with overall rates of 46.7% patients presented with DKA, ranging from a low of 17% in Egypt to a high of 100% in Morocco, Algeria and Tunisia.

CONCLUSION

This is the first descriptive quantitative study to determine the overall DKA rate in 46 years of studies in the Arab world of patients with type 1 diabetes; DKA rates were found to range from 17% to 100% with overall rate of 46.7%.

The prevalence of type 1 diabetes mellitus among 15-34-year-aged Lithuanian inhabitants during 1991-2010

AIMS

To summarize the data on the prevalence of type 1 diabetes mellitus among 15-34-year-aged Lithuania inhabitants (1991-2010).

METHODS

New prevalent cases consist of growing-up patients with diabetes onset in childhood, i.e., up to 14 years, new onset 15-34-year-aged type 1 diabetic patients Lithuanian inhabitants, and immigrants. The data on type 1 diabetes was collected with the help of general practitioners and regional endocrinologists in Lithuania.

RESULTS

On 31 December 1991, there were 1202 adolescent and adult 15-34-year-aged patients with type 1 diabetes mellitus or 103.59 per 100,000 inhabitants of the same age group (95% Poisson CI 97.90-109.62), and at the end of 2010 - 1533 or 187.80 (178.63-197.44), respectively in Lithuania. During 19-year period the mean increase of type 1 diabetic patients was 1.25±1.94% per year or 1.47±2.74 per 100,000 inhabitants per mean year of the study period (for males 1.42±2.14% or 1.69±3.05/100,000 and for females 1.05±1.99%, or 1.24±2.92/100,000). Regression-based linear trends showed that the prevalence of type 1 diabetes mellitus in 15-34-year-age group had a tendency to increase among males (r=0.953; p<0.001) and females (r=0.970; p<0.001). The age adjusted prevalence frequencies for males and females in 1991 were correspondingly 102.81/100,000 and 104.55/100,000, and in 2010 - 193.75 and 182.01.

CONCLUSION

The prevalence of type 1 diabetes mellitus among 15-34-year-age males and females had a tendency to increase during 1991-2010.

Diabetes in the Middle-East and North Africa: an update

In recent decades, the prevalence of diabetes has risen dramatically in many countries of the International Diabetes Federation's (IDF) Middle-East and North Africa (MENA) Region. This increase has been driven by a range of factors that include rapid economic development and urbanisation; changes in lifestyle that have led to reduced levels of physical activity, increased intake of refined carbohydrates, and a rise in obesity. These changes have resulted in the countries of MENA Region now having among the highest rates of diabetes prevalence in the world. The current prevalence of diabetes in adults in the Region is estimated to be around 9.2%. Of the 34 million people affected by diabetes, nearly 17 million were undiagnosed and therefore at considerable risk of diabetes complications and poor health outcomes. Enhanced research on the epidemiology of diabetes in the MENA Region needs to be combined with more effective primary prevention of diabetes; and early detection and improved management of patients with established diabetes, including an increased focus on self-management and management in primary care and community settings.

Diabetes in the young - a global view and worldwide estimates of numbers of children with type 1 diabetes

This paper describes the methodology, results and limitations of the 2013 International Diabetes Federation (IDF) Atlas (6th edition) estimates of the worldwide numbers of prevalent cases of type 1 diabetes in children (<15 years). The majority of relevant information in the published literature is in the form of incidence rates derived from registers of newly diagnosed cases. Studies were graded on quality criteria and, if no information was available in the published literature, extrapolation was used to assign a country the rate from an adjacent country with similar characteristics. Prevalence rates were then derived from these incidence rates and applied to United Nations 2012 Revision population estimates for 2013 for each country to obtain estimates of the number of prevalent cases. Data availability was highest for the countries in Europe (76%) and lowest for the countries in sub-Saharan Africa (8%). The prevalence estimates indicate that there are almost 500,000 children aged under 15 years with type 1 diabetes worldwide, the largest numbers being in Europe (129,000) and North America (108,700). Countries with the highest estimated numbers of new cases annually were the United States (13,000), India (10,900) and Brazil (5000). Compared with the prevalence estimates made in previous editions of the IDF Diabetes Atlas, the numbers have increased in most of the IDF Regions, often reflecting the incidence rate increases that have been well-documented in many countries. Monogenic diabetes is increasingly being recognised among those with clinical features of type 1 or type 2 diabetes as genetic studies become available, but population-based data on incidence and prevalence show wide variation due to lack of standardisation in the studies. Similarly, studies on type 2 diabetes in childhood suggest increased incidence and prevalence in many countries, especially in Indigenous peoples and ethnic minorities, but detailed population-based studies remain limited.