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Subramanian S, Khan F, Hirsch IB. New advances in type 1 diabetes. BMJ 2024; 384:e075681. [PMID: 38278529 DOI: 10.1136/bmj-2023-075681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
Type 1 diabetes is an autoimmune condition resulting in insulin deficiency and eventual loss of pancreatic β cell function requiring lifelong insulin therapy. Since the discovery of insulin more than 100 years ago, vast advances in treatments have improved care for many people with type 1 diabetes. Ongoing research on the genetics and immunology of type 1 diabetes and on interventions to modify disease course and preserve β cell function have expanded our broad understanding of this condition. Biomarkers of type 1 diabetes are detectable months to years before development of overt disease, and three stages of diabetes are now recognized. The advent of continuous glucose monitoring and the newer automated insulin delivery systems have changed the landscape of type 1 diabetes management and are associated with improved glycated hemoglobin and decreased hypoglycemia. Adjunctive therapies such as sodium glucose cotransporter-1 inhibitors and glucagon-like peptide 1 receptor agonists may find use in management in the future. Despite these rapid advances in the field, people living in under-resourced parts of the world struggle to obtain necessities such as insulin, syringes, and blood glucose monitoring essential for managing this condition. This review covers recent developments in diagnosis and treatment and future directions in the broad field of type 1 diabetes.
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Affiliation(s)
- Savitha Subramanian
- University of Washington Diabetes Institute, Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, WA, USA
| | - Farah Khan
- University of Washington Diabetes Institute, Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, WA, USA
| | - Irl B Hirsch
- University of Washington Diabetes Institute, Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, WA, USA
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2
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Shi H, Wu S, Ran Z, Tang H, Xiong Q. A New Mouse Model of Whole Pancreas Transplant With Graft Blood Through the Portal Vein. EXP CLIN TRANSPLANT 2024; 22:52-62. [PMID: 38284375 DOI: 10.6002/ect.2023.0305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
OBJECTIVES Pancreas transplant is currently the most effective method for maintaining physiological blood sugar levels and reversing small blood vessel injuries. Our team developed a model of whole pancreas transplant based on microsurgical techniques following the investigation of more than 300 mice. MATERIALS AND METHODS A mouse pancreatic transplant model is required to investigate the pathophysiological process of pancreas transplant and pancreatic preservation technologies. Recently, the segment-neck pancreas transplant has been the most utilized mouse pancreatic transplant model. The innovative mouse pancreatic transplant modelthat we developed in this study uses the whole pancreas and returns heart blood flow into the liver via the portal vein. RESULTS With our mouse pancreatic transplant model, the survivalrate of mice aftertransplant was >80%, and the success rate of pancreatic transplant was >90%. CONCLUSIONS The segment-neck and the whole pancreas model can guarantee that the transplanted pancreas functions effectively, and both have excellent postoperative outcomes, survivalrates and pancreatic active rates.
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Affiliation(s)
- Huizhong Shi
- From the Faculty of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital, Beijing, China
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3
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Tojjar J, Cervin M, Hedlund E, Brahimi Q, Forsander G, Elding Larsson H, Ludvigsson J, Samuelsson U, Marcus C, Persson M, Carlsson A. Sex Differences in Age of Diagnosis, HLA Genotype, and Autoantibody Profile in Children With Type 1 Diabetes. Diabetes Care 2023; 46:1993-1996. [PMID: 37699205 DOI: 10.2337/dc23-0124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 08/11/2023] [Indexed: 09/14/2023]
Abstract
OBJECTIVE To examine sex differences in children with newly diagnosed type 1 diabetes (T1D) with respect to age at diagnosis, presence of autoantibodies (GAD antibody [GADA], insulinoma-associated protein 2 [IA-2A], insulin autoantibody [IAA], and zinc transporter 8 autoantibody), and HLA risk. RESEARCH DESIGN AND METHODS A population-based nationwide sample of 3,645 Swedish children at T1D diagnosis was used. RESULTS Girls were younger at T1D diagnosis (9.53 vs. 10.23 years; P < 0.001), more likely to be autoantibody-positive (94.7% vs. 92.0%; P = 0.002), more often positive for multiple autoantibodies (P < 0.001), more likely to be positive for GADA (64.9% vs. 49.0%; P < 0.001), and less likely to be positive for IAA (32.3% vs. 33.8%; P = 0.016). Small sex differences in HLA risk were found in children <9 years of age. CONCLUSIONS The disease mechanisms leading to T1D may influence the immune system differently in girls and boys.
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Affiliation(s)
- Jasaman Tojjar
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Matti Cervin
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Emma Hedlund
- Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Paediatrics, Kristianstad Central Hospital, Kristianstad, Sweden
| | - Qefsere Brahimi
- Department of Clinical Sciences, Malmö, Clinical Research Center, Lund University, Malmö, Sweden
| | - Gun Forsander
- The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Helena Elding Larsson
- Department of Clinical Sciences, Malmö, Clinical Research Center, Lund University, Malmö, Sweden
- Skåne University Hospital, Malmö, Sweden
| | - Johnny Ludvigsson
- Crown Princess Victoria Childreńs Hospital, Linköping University Hospital, Linköping, Sweden
- Division of Pediatrics, Department of Biomedical and Clinical Sciences (BKV), Medical Faculty, Linköping University, Linköping, Sweden
| | - Ulf Samuelsson
- Crown Princess Victoria Childreńs Hospital, Linköping University Hospital, Linköping, Sweden
- Division of Pediatrics, Department of Biomedical and Clinical Sciences (BKV), Medical Faculty, Linköping University, Linköping, Sweden
| | - Claude Marcus
- Division of Pediatrics, Department of Clinical Science Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Martina Persson
- Department of Medicine, Clinical Epidemiology, Karolinska Institute, Stockholm, Sweden
- Department of Clinical Science and Education, Karolinska Institute, Södersjukhuset, Stockholm, Sweden
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McVoy M, Miller D, Bransteter I, Gubitosi-Klug R, Segal T, Surdam J, Sajatovic M, Dusek JA. A self-management plus mind body intervention for adolescents and young adults with type 2 diabetes: Trial design and methodological report. Contemp Clin Trials 2023; 133:107317. [PMID: 37625585 DOI: 10.1016/j.cct.2023.107317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 07/25/2023] [Accepted: 08/22/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND The onset of type 2 diabetes (T2D) is increasingly common in adolescents and young adults (AYAs). Improving self-management skills and the mental health of this population is important, but understudied. METHODS The goal of this research was to develop a mind-body intervention which could serve as an adjunctive therapy to support AYAs with T2D (INTEND intervention). Toward that end, we used an iterative process, including use of focus groups, advisory board, and cognitive semi-structured interviews with patients, parents of patient and clinical providers, to understand the gaps in the current information provided to AYAs with T2D. Based on the data gathered from the focus groups and interviews, we enhanced an existing self-management intervention for adults with T2D to include an additional mind body intervention for AYAs with T2D. The INTEND intervention will be piloted in a group of AYAs with T2D. RESULTS This report describes the methodology and design of the InterveNTion for Early oNset type 2 Diabetes (INTEND) study. The details of this single arm pre-post pilot feasibility trial are described. DISCUSSION If successful, the INTEND approach has the potential to advance care for vulnerable youth with T2D.
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Affiliation(s)
- Molly McVoy
- Case Western Reserve University School of Medicine (CWRU SOM), USA; University Hospitals Cleveland Medical Center (UHCMC), USA; Rainbow Babies and Children, UHCMC, USA.
| | | | | | - Rose Gubitosi-Klug
- Case Western Reserve University School of Medicine (CWRU SOM), USA; Rainbow Babies and Children, UHCMC, USA
| | - Tracy Segal
- University Hospitals Connor Whole Health, USA
| | | | - Martha Sajatovic
- Case Western Reserve University School of Medicine (CWRU SOM), USA; University Hospitals Cleveland Medical Center (UHCMC), USA
| | - Jeffery A Dusek
- Case Western Reserve University School of Medicine (CWRU SOM), USA; University Hospitals Connor Whole Health, USA
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Matsuda F, Itonaga T, Maeda M, Ihara K. Long-term trends of pediatric type 1 diabetes incidence in Japan before and after the COVID-19 pandemic. Sci Rep 2023; 13:5803. [PMID: 37037893 PMCID: PMC10085994 DOI: 10.1038/s41598-023-33037-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 04/06/2023] [Indexed: 04/12/2023] Open
Abstract
Type 1 diabetes incidence has increased worldwide, although the long-term trends on pediatric type 1 diabetes in Japan remain elusive. To investigate the incidence and secular trend of pediatric type 1 diabetes from 1999 to 2021, including the coronavirus disease 2019 (COVID-19) pandemic years, in Oita Prefecture, Japan. We investigated the number of newly diagnosed patients with type 1 diabetes aged < 15 years from 1999 to 2021. We surveyed hospital databases in Oita Prefecture in Japan. The type 1 diabetes incidence in children aged < 15 years increased annually by 5.3% among all children, especially in boys aged 10-14 years by 8.1%, over the past 23 years. The average incidence rate of 3.9/100,000/year was nearly consistent with the previous reports on Asian countries. No significant change was found in the increasing incidence trend of type 1 diabetes before and during the COVID-19 pandemic. The incidence of pediatric type 1 diabetes has significantly increased over the past 23 years in Oita Prefecture, Japan, which is consistent with the worldwide trend.
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Affiliation(s)
- Fumika Matsuda
- Department of Pediatrics, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Tomoyo Itonaga
- Department of Pediatrics, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Miwako Maeda
- Department of Pediatrics, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Kenji Ihara
- Department of Pediatrics, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan.
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Hashemipour M, Maracy M, Javanmard SH, Zamaneh F, Mostofizadeh N, Hovsepian S. Trends in incidence rates of childhood type 1 diabetes mellitus: A retrospective study in Isfahan province, Iran. J Diabetes Investig 2023; 14:376-386. [PMID: 36695001 PMCID: PMC9951581 DOI: 10.1111/jdi.13975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 12/20/2022] [Accepted: 12/27/2022] [Indexed: 01/26/2023] Open
Abstract
AIMS/INTRODUCTION We aimed to determine the incidence trend of childhood type 1 diabetes mellitus in Isfahan province over a period of 12 years. MATERIALS AND METHODS In this retrospective study, children aged <20 years at the time of type 1 diabetes mellitus diagnosis, from March 2007 to March 2019, were included. The crude and adjusted incidence rate of type 1 diabetes mellitus is calculated as the number of cases per 100,000 person-years by the period. The cumulative, age- and sex-specific incidence rates were also calculated. Age-specific incidence rates were calculated for age and sex groups. RESULTS A total of 1,954 (983 boys and 971 girls) cases of type 1 diabetes mellitus were identified. The mean age at diagnosis in all studied populations was 9.89 (standard deviation 4.76). There were no significant differences between the proportion of boys and girls in different years (P = 0.12) and different age groups (P = 0.19). The average annual percent change of incidence rate for the total population, for girls and boys, was 6.9%, 6.7% and 6.3% respectively. The type 1 diabetes mellitus incidence rate had a significant trend to be increased from 2007 to 2019 (P < 0.001, t = 3.6). CONCLUSION Our findings showed that currently our region is considered a region with a high incidence rate of type 1 diabetes mellitus. Although we have had fluctuations in the incidence rate over the 12 years, the overall trend is increasing.
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Affiliation(s)
- Mahin Hashemipour
- Metabolic Liver Diseases Research Center, Isfahan Endocrine and Metabolism Research CenterIsfahan University of Medical SciencesIsfahanIran
| | - Mohammadreza Maracy
- Department of Epidemiology and Biostatistics, School of HealthIsfahan University of Medical SciencesIsfahanIran
| | | | - Farzane Zamaneh
- Metabolic Liver Diseases Research CenterIsfahan University of Medical SciencesIsfahanIran
| | - Neda Mostofizadeh
- Department of Pediatric Endocrinology, Isfahan Endocrine and Metabolism Research Center, Imam Hossein Children's HospitalIsfahan University of Medical SciencesIsfahanIran
| | - Silva Hovsepian
- Metabolic Liver Diseases Research Center, Imam Hossein Children's HospitalIsfahan University of Medical SciencesIsfahanIran
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Stahl-Pehe A, Kamrath C, Prinz N, Kapellen T, Menzel U, Kordonouri O, Schwab KO, Bechtold-Dalla Pozza S, Rosenbauer J, Holl RW. Prevalence of type 1 and type 2 diabetes in children and adolescents in Germany from 2002 to 2020: A study based on electronic health record data from the DPV registry. J Diabetes 2022; 14:840-850. [PMID: 36515004 PMCID: PMC9789390 DOI: 10.1111/1753-0407.13339] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/26/2022] [Accepted: 11/17/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND To provide estimates of the nationwide prevalence of type 1 diabetes (T1D) and type 2 diabetes (T2D) in individuals younger than 20 years of age in Germany from 2002 to 2020 and to identify trends. METHODS Data were obtained from the electronic health record "Diabetes Prospective Follow-up Registry (DPV)" specific to diabetes care. Prevalence was estimated based on prevalent cases at the end of each year for the years 2002, 2008, 2014, and 2020 per 100 000 persons assuming a Poisson distribution and directly age- and/or sex-standardized to the population in 2020. Individuals younger than 20 years of age with a clinical diagnosis of T1D or 10-19-year-olds with T2D were eligible for inclusion in the study. RESULTS The standardized T1D prevalence per 100 000 persons was 138.9 (95% CI: 137.1; 140.6) in 2002 and 245.6 (243.1; 248.0) in 2020. The standardized T2D prevalence per 100 000 persons was 3.4 (3.1; 3.8) in 2002 and 10.8 (10.1; 11.5) in 2020. The annual percent change (APC) in prevalence declined over the three periods 2002-2008/2008-2014/2014-2020 (T1D: 6.3% [3.6%; 9.0%]/3.1% [0.7%; 5.5%]/0.5% [-1.7%; 2.85], T2D: 12.3% [5.3%; 20.8%]/4.7% [-0.6%; 10.3%]/3.0% [-1.8%; 8.0%]). From 2014 to 2020, the highest APCs were observed among 15-19-year-olds (T1D: 2.5% [1.3%; 3.6%], T2D: 3.4% [-0.5%; 7.5%]). CONCLUSIONS The increase in diabetes prevalence has slowed, but medical care should be prepared for an increase in adolescents with diabetes.
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Affiliation(s)
- Anna Stahl-Pehe
- German Diabetes Center, Institute for Biometrics and Epidemiology, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München, Germany
| | - Clemens Kamrath
- Center of Child and Adolescent Medicine, Justus Liebig University, Giessen, Germany
| | - Nicole Prinz
- German Center for Diabetes Research (DZD), München, Germany
- Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology (ZIBMT), Ulm University, Ulm, Germany
| | - Thomas Kapellen
- Hospital for Children and Adolescents "Am Nicolausholz" Bad Kösen, Bad Kösen, Germany
| | - Ulrike Menzel
- Department of Pediatric Endocrinology, AKK Altonaer Kinderkrankenhaus, Hamburg, Germany
| | - Olga Kordonouri
- Children's Hospital AUF DER BULT, Hannover Medical School, Hannover, Germany
| | - K Otfried Schwab
- Department of Pediatrics and Adolescent Medicine, Pediatric Endocrinology, Diabetology and Lipidology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Susanne Bechtold-Dalla Pozza
- Pediatric Endocrinology and Diabetology, Dr. von Haunersches Kinderspital, Ludwig-Maximilians Medical University Munich, Munich, Germany
| | - Joachim Rosenbauer
- German Diabetes Center, Institute for Biometrics and Epidemiology, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany
- German Center for Diabetes Research (DZD), München, Germany
| | - Reinhard W Holl
- German Center for Diabetes Research (DZD), München, Germany
- Institute of Epidemiology and Medical Biometry, Central Institute for Biomedical Technology (ZIBMT), Ulm University, Ulm, Germany
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Silva C, Zhang Q, Bone JN, Amed S. Anthropometric Measurements and Laboratory Investigations in Children and Youth With Type 1 Diabetes Before and During the COVID-19 Pandemic. Can J Diabetes 2022; 46:S1499-2671(22)00087-9. [PMID: 35987748 PMCID: PMC9009070 DOI: 10.1016/j.jcjd.2022.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 03/08/2022] [Accepted: 04/08/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Our aim in this study was to compare rates of anthropometric, blood pressure (BP) and glycated hemoglobin (A1C) measurements and laboratory screening for hypothyroidism, nephropathy and dyslipidemia in children and youth with type 1 diabetes (T1D), 1 year before and after the onset of COVID-19. METHODS Clinical data were analyzed from a voluntary registry of children and youth with T1D followed at the BC Children's Hospital between March 2019 and 2021. Logistic and Poisson mixed-effect models were used. RESULTS Four hundred forty patients, with median (interquartile range) age and time since diagnosis 12.7 (9.5 to 15.4) and 4.7 (2.6 to 7.9) years, respectively, were included. Clinic visits were all in-person before March 2020, and 99% via telemedicine afterward. The number of visits per patient was 2 (2 to 3), with a 6% increase during the pandemic (relative risk [RR], 1.06; 95% confidence interval [CI], 1.01 to 1.10). There was a substantial decrease in height, weight and BP measurements (RR, 0.32; 95% CI, 0.28 to 0.36; RR, 0.34, 95% CI, 0.31 to 0.38; RR, 0.005, 95% CI, 0.002 to 0.014, respectively); only 49% of patients had anthropometric and 1% BP data during the pandemic year, compared with >97% before the pandemic. A1C measurements dropped from 3 (2 to 4) to 1 (1 to 2) per patient per year (RR, 0.53; 95% CI, 0.48 to 0.57). Rates of screening investigations were suboptimal before the pandemic, and these rates continued to decline. CONCLUSIONS Shifting to telemedicine allowed ongoing care during the pandemic, but the frequency of anthropometric, BP and A1C measurements decreased dramatically. A combined telemedicine/in-person model may be needed to ensure adequate care for this population.
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Affiliation(s)
- Carolina Silva
- Department of Pediatrics, University of British Columbia and British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Qian Zhang
- Research Informatics, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Jeffrey N Bone
- Research Informatics, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Shazhan Amed
- Department of Pediatrics, University of British Columbia and British Columbia Children's Hospital, Vancouver, British Columbia, Canada.
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Boesen MS, Thygesen LC, Blinkenberg M, Born AP, Uldall P, Magyari M, Eriksson F. Employment, health visits, mental health, and mortality in parents with a chronically ill child: a Danish nationwide population-based cohort study. Eur J Pediatr 2022; 181:1547-1555. [PMID: 35059826 DOI: 10.1007/s00431-021-04334-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/26/2021] [Accepted: 11/29/2021] [Indexed: 11/24/2022]
Abstract
UNLABELLED Chronic diseases in children can impact their parents; this may be overlooked in a clinical setting. Our aim was to investigate associations of chronic diseases in children with their parents' employment, health care utilization, mental health, and mortality. In a matched cohort study using nationwide and population-based data in Denmark, we included parents to children (< 18 years) with acute disseminated encephalomyelitis, multiple sclerosis, type 1 diabetes, inflammatory bowel disease, and rheumatoid arthritis/juvenile idiopathic arthritis during 2008-2015. The reference group was parents to unaffected children. Outcomes were parental employment (early retirement, cash benefits, income), health care utilization (e.g., general practitioner, or hospital visits), mental health (visits to psychiatry/psychology clinics, antidepressant drug redemptions), and mortality. We included 13,769 parents with a chronically ill child and 138,606 control parents. Annual income was unaffected for two-parent families after the child's disease onset, but two-parent families had increased hazard of early retirement of 25% (95% CI = 1.01-1.54; p = 0.04). Parents with a chronically ill child had (a) increased rate of antidepressant drug redemptions or psychology/psychiatry visits (hazard ratio 1.37; 95% CI = 1.28-1.46 at 1-year follow-up); (b) increased health care utilization, with an increased marginal mean in primary care of 1% (95% CI = 1.00-1.02; p = 0.005), hospital-affiliated visits of 19% (95% CI = 1.14-1.24; p < 0.0001), and hospital admissions of 14% (95% CI = 1.09-1.20; p < 0.0001); and (c) 69% increased mortality hazard (95% CI = 1.30-2.18; p < 0.0001) in parents younger than 50 years with no comorbidities, albeit small in absolute numbers. CONCLUSION Pediatric chronic diseases were negatively associated with parental employment, mental health, and mortality, and increased health care utilization. WHAT IS KNOWN • Studies on the impact of pediatric chronic diseases on parental health are qualitative. • Knowledge is unavailable regarding the impact on parental work, health care utilization, and mortality. WHAT IS NEW • Among 13,769 parents with a chronically ill child and 138,606 control parents, parents with a chronically ill child had 37% increased antidepressant drug redemptions, and these parents <50 years without comorbidities had 69% increased mortality hazard. • Medical doctors should consider the parental health condition and societal challenges related to having child with a chronic disease.
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Affiliation(s)
- Magnus Spangsberg Boesen
- Department of Neurology, Zealand University Hospital, Sygehusvej 10, 4000, Roskilde, Denmark.
- Department of Pediatrics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Morten Blinkenberg
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Alfred Peter Born
- Department of Pediatrics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Peter Uldall
- Department of Pediatrics, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Melinda Magyari
- Danish Multiple Sclerosis Center, Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Neurology, Danish Multiple Sclerosis Registry, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Frank Eriksson
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Corsenac P, Parent MÉ, Benedetti A, Richard H, Stäger S, Rousseau MC. Association between Bacillus Calmette-Guerin vaccination and type 1 diabetes in adolescence: A population-based birth cohort study in Quebec, Canada. Prev Med 2022; 154:106893. [PMID: 34798196 DOI: 10.1016/j.ypmed.2021.106893] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 10/12/2021] [Accepted: 11/14/2021] [Indexed: 10/19/2022]
Abstract
The Bacillus Calmette-Guerin (BCG) vaccine could reduce the incidence of type 1 diabetes through non-specific immunomodulation. Previous epidemiological studies, presenting some limitations, report no association. We examined this association of early life BCG vaccination and age at vaccination with type 1 diabetes incidence in adolescence in a large representative cohort in Quebec. The cohort included 387,704 individuals born in Quebec between 1970 and 1974 whose BCG vaccination status was determined from a provincial registry. Individuals were followed up from 1985 to their 19th birthday (maximum to 1993) for their use of physician services. Individuals were defined as type 1 diabetes cases if they had ≥4 related physician claims over a 2-year period, with at least 30 days between two claims. Cox proportional hazards regression was used to estimate the association of BCG vaccination and age at vaccination with type 1 diabetes. Covariates were selected based on a directed acyclic graph. Interaction according to sex was evaluated. A total of 178,133 (45.9%) individuals were vaccinated and 442 (0.11%) incident cases of type 1 diabetes were identified. The risk of type 1 diabetes was similar in vaccinated compared with unvaccinated individuals (adjusted hazard ratio = 1.06 [95% CI: 0.88-1.29]). There was no association with age at vaccination, and results did not differ by sex (Interaction, p = 0.60). Our results suggest that BCG vaccination does not prevent type 1 diabetes in adolescence.
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Affiliation(s)
- Philippe Corsenac
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut national de la recherche scientifique (INRS), Laval, QC, Canada.
| | - Marie-Élise Parent
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut national de la recherche scientifique (INRS), Laval, QC, Canada.
| | - Andrea Benedetti
- Respiratory Epidemiology and Clinical Research Unit, Research Institute of the McGill University Health Centre, McGill University, Montréal, QC, Canada; Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montréal, QC, Canada.
| | - Hugues Richard
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut national de la recherche scientifique (INRS), Laval, QC, Canada.
| | - Simona Stäger
- Centre Armand-Frappier Santé Biotechnologie, Institut national de la recherche scientifique (INRS), Laval, QC, Canada.
| | - Marie-Claude Rousseau
- Epidemiology and Biostatistics Unit, Centre Armand-Frappier Santé Biotechnologie, Institut national de la recherche scientifique (INRS), Laval, QC, Canada.
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Mohini P, Palaganas M, Elia Y, Motran L, Sochett E, Curtis J, Scholey JW, McArthur L, Mahmud FH. Exploring the Motivational Drivers of Young Adults with Diabetes for Participation in Kidney Research. J Patient Exp 2022; 9:23743735221138236. [PMID: 36388087 PMCID: PMC9663656 DOI: 10.1177/23743735221138236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Understanding motivational drivers and barriers to patient participation in diabetes research are important to ensure research is relevant and valuable. Young adults with type 1 diabetes (T1D) completed a 31-question qualitative survey evaluating participant experience, understanding, and motivators and barriers to research involvement. A total of 35 participants, 19–28 years of age, 60% female, completed the survey. Motivating factors included personal benefit, relationship with the study team, curiosity, financial compensation, altruism, and nostalgia. Older participants (>22 years) reported higher levels of trust in the study team (p = 0.02) and their relationship with the study team positively influenced their decision to participate (p = 0.03). Financial compensation was a strong motivator for participants with higher education (p = 0.02). Age, sex, education level, and trust in the study team influenced participants’ understanding. Barriers included logistics and lack of familial support. Important motivational drivers and barriers to participation in research by young adults with T1D must be considered to increase research engagement and facilitate the discovery of new knowledge.
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Affiliation(s)
- P Mohini
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - M Palaganas
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Y Elia
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - L Motran
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - E Sochett
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - J Curtis
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - JW Scholey
- Division of Nephrology, Department of Medicine, University Health Network, Toronto, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
| | - L McArthur
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - FH Mahmud
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Canada
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12
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Ayub A, Ng C, Portales-Casamar E, Metzger D, Amed S. Towards Building a Provincial Diabetes Registry of Children & Youth Living with Diabetes in British Columbia, Canada. Can J Diabetes 2021; 46:346-352.e1. [DOI: 10.1016/j.jcjd.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/27/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
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13
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Mameli C, Scaramuzza A, Macedoni M, Marano G, Frontino G, Luconi E, Pelliccia C, Felappi B, Guerraggio LP, Spiri D, Macellaro P, Chiara Redaelli F, Cardani R, Zampolli M, Calcaterra V, Sordelli S, Calzi E, Cogliardi A, Brambilla I, Pistone C, Rigamonti A, Boracchi P, Biganzoli E, Zuccotti GV, Bonfanti R. Type 1 diabetes onset in Lombardy region, Italy, during the COVID-19 pandemic: The double-wave occurrence. EClinicalMedicine 2021; 39:101067. [PMID: 34430836 PMCID: PMC8365462 DOI: 10.1016/j.eclinm.2021.101067] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/09/2021] [Accepted: 07/19/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The Italian Lombardy region has been the epicenter of COVID-19 since February 2020. This study analyses the epidemiology of pediatric type 1 diabetes (T1D) onset during the first two pandemic waves and three previous years. METHODS All the 13 pediatric diabetes centers in Lombardy prospectively evaluated charts of children at T1D onset (0-17 years), during year 2020. After calculating the annual incidence, the data were compared with those of the 3 previous years, using generalized linear models, adjusted for age and sex. Monthly T1D new onsets and diabetic ketoacidosis (DKA) were investigated yearly from 2017 to 2020. Data were extracted from outpatients charts of the pediatric diabetes centers and from the database of the national institute of statistics. FINDINGS The estimated incidence proportion of T1D was 16/100·000 in 2020, compared to 14, 11 and 12 in 2019, 2018 and 2017, respectively. When adjusting for age and gender, the incidence was significantly lower in 2018 and 2017 compared to 2020 (adjusted incidence ratio: 0.73 and 0.77 respectively, with 95% CI: 0.63 to 0.84, and 0.67 to 0.83; p = 0·002 and p = 0·01), but no difference was found between the years 2020 and 2019. A reduction trend in the percentage of T1D diagnosis during the first wave (March-April) over the total year diagnoses was observed compared to previous years (11·7% in 2020, 17·7% in 2019, 14·1% in 2018 and 14·4% 2017). No difference was observed during the second wave (October-December) (32·8% in 2020, 33·8% in 2019, 34% in 2018, 30·7% in 2017). The proportion of DKA over the total T1D diagnoses during the second wave had higher trend than the first one (41·7% vs 33·3%), while severe DKA over the total DKA appeared higher during the first wave (60% vs 37·1%). INTERPRETATION The study suggests an increase in the incidence of pediatric T1D in Lombardy throughout the past five years. Pandemic waves may have affected the clinical presentation at onset. FUNDING None.
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Affiliation(s)
- Chiara Mameli
- Department of Pediatrics, V Buzzi Children's Hospital, Università di Milan, Italy
- Corresponding author at: Department of Paediatrics, Vittore Buzzi Children's Hospital, Department of Biomedical and Clinical Science L. Sacco, Università degli Studi di Milano, Italy.
| | - Andrea Scaramuzza
- Department of Pediatrics, Ospedale Maggiore, ASST Cremona, Cremona, Italy
| | - Maddalena Macedoni
- Department of Pediatrics, V Buzzi Children's Hospital, Università di Milan, Italy
| | - Giuseppe Marano
- Laboratory of Medical Statistics, Biometry and Epidemiology "Giulio A. Maccacaro", Department of Clinical Sciences and Community Health & DSRC, University of Milan, Italy
| | - Giulio Frontino
- Pediatric Diabetology Unit, Diabetes Research Institute, Istituto Scientifico San Raffaele, Milano, Italy
| | - Ester Luconi
- Laboratory of Medical Statistics, Biometry and Epidemiology "Giulio A. Maccacaro", Department of Clinical Sciences and Community Health & DSRC, University of Milan, Italy
| | | | - Barbara Felappi
- Department of Pediatrics, ASST Spedali Civili, Brescia, Italy
| | | | - Daniele Spiri
- Department of Pediatrics, Ospedale di Legnano, ASST Ovest milanese, Legnano, Italy
| | - Patrizia Macellaro
- Department of Pediatrics, Ospedale di Legnano, ASST Ovest milanese, Legnano, Italy
| | | | - Roberta Cardani
- Department of Pediatrics, Ospedale Del Ponte Varese, ASST Sette Laghi, Varese, Italy
| | - Maria Zampolli
- Department of Pediatrics, Ospedale Sant'Anna, Como, Italy
| | - Valeria Calcaterra
- Department of Pediatrics, V Buzzi Children's Hospital, Università di Milan, Italy
- Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - Silvia Sordelli
- Department of Pediatrics, Ospedale Carlo Poma, Mantova, Italy
| | - Elena Calzi
- Department of Pediatrics, Ospedale Maggiore, ASST Crema, Italy
| | - Anna Cogliardi
- Department of Pediatrics, Ospedale Alessandro Manzoni, Lecco, Italy
| | - Ilaria Brambilla
- Department of Pediatrics, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Carmelo Pistone
- Department of Pediatrics, IRCCS Policlinico San Matteo, Pavia, Italy
| | - Andrea Rigamonti
- Pediatric Diabetology Unit, Diabetes Research Institute, Istituto Scientifico San Raffaele, Milano, Italy
| | - Patrizia Boracchi
- Laboratory of Medical Statistics, Biometry and Epidemiology "Giulio A. Maccacaro", Department of Clinical Sciences and Community Health & DSRC, University of Milan, Italy
| | - Elia Biganzoli
- Laboratory of Medical Statistics, Biometry and Epidemiology "Giulio A. Maccacaro", Department of Clinical Sciences and Community Health & DSRC, University of Milan, Italy
| | | | - Riccardo Bonfanti
- Pediatric Diabetology Unit, Diabetes Research Institute, Istituto Scientifico San Raffaele, Milano, Italy
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Increasing incidence of type 1 and 2 diabetes among Canadian children. Can J Diabetes 2021; 46:189-195. [DOI: 10.1016/j.jcjd.2021.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/13/2021] [Accepted: 08/14/2021] [Indexed: 11/20/2022]
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15
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McKenna A, O'Regan M, Ryder K, Fitzgerald H, Hoey H, Roche E. Incidence of childhood type 1 diabetes mellitus in Ireland remains high but no longer rising. Acta Paediatr 2021; 110:2142-2148. [PMID: 33690888 DOI: 10.1111/apa.15836] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 03/05/2021] [Accepted: 03/09/2021] [Indexed: 11/30/2022]
Abstract
AIM The global incidence of type 1 diabetes mellitus (T1DM) varies considerably geographically. Ireland has a high incidence of T1DM. Incidence accelerated between 1997 and 2008, although more recent data (2008-2013) suggested stabilisation in the incidence rate (IR). This study sought to determine IRs for 2014 to 2018. METHODS Incident cases were prospectively recorded through the established Irish Childhood Diabetes National Register (ICDNR). Cases were verified, and IRs were calculated. Capture-recapture methodology was identical to previous studies. Age and seasonality data were compared. RESULTS A total of 1429 cases were reported (age range 0.45-14.98 years), with significantly more males (772, 54%) and male-to-female ratio of 1.17 (95% CI 1.05, 1.29). Standardised IRs for T1DM in the period were 28.0; 29.6; 30.9; 27.0; and 27.1/100,000/year, respectively. There was a slight reduction in standardised IR, more marked in females than males (9.9% v 1.6%). The highest IR remains in the 10- to 14-year-old age group (44% of total cases). Seasonality of diagnosis is persistently higher in autumn and winter. CONCLUSION Ireland remains a high incidence country, despite a minor reduction in incidence rates. Ongoing incidence monitoring through national registers is vital to inform healthcare services, research relating to aetiology and paediatric diabetes management.
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Affiliation(s)
- Amanda McKenna
- The Department of Paediatrics Trinity College Dublin The University of Dublin Dublin Ireland
| | - Myra O'Regan
- The Department of Statistics Trinity College Dublin The University of Dublin Dublin Ireland
| | - Kerry Ryder
- The National Immunisation Office Dublin Ireland
| | - Helen Fitzgerald
- The Department of Paediatric Growth, Diabetes and Endocrinology Children’s Health Ireland (CHI) at Tallaght University Hospital Dublin Ireland
| | - Hilary Hoey
- The Department of Paediatrics Trinity College Dublin The University of Dublin Dublin Ireland
| | - Edna Roche
- The Department of Paediatrics Trinity College Dublin The University of Dublin Dublin Ireland
- The Department of Paediatric Growth, Diabetes and Endocrinology Children’s Health Ireland (CHI) at Tallaght University Hospital Dublin Ireland
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16
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Ho J, Rosolowsky E, Pacaud D, Huang C, Lemay J, Brockman N, Rath M, Doulla M. Diabetic ketoacidosis at type 1 diabetes diagnosis in children during the COVID-19 pandemic. Pediatr Diabetes 2021; 22:552-557. [PMID: 33745226 PMCID: PMC8251027 DOI: 10.1111/pedi.13205] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/02/2021] [Accepted: 03/06/2021] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE The COVID-19 pandemic has led to significant public health measures that have resulted in decreased acute pediatric care utilization. We evaluated whether the rate of severe presentations of new onset type 1 diabetes (DM1), such as, diabetic ketoacidosis (DKA) has changed since the COVID-19 public health measures were enacted. RESEARCH DESIGN AND METHODS A retrospective chart review of children less than 18 years of age presenting with new onset DM1 during the pandemic period of March 17, 2020 to August 31, 2020 was conducted at two tertiary care pediatric hospitals in Alberta, Canada. Rates of DKA and severe DKA were compared to the same time period in the year 2019 (pre-pandemic control). RESULTS The number of children presenting with newly diagnosed DM1 was similar during the pandemic year of 2020 compared with 2019 (107 children in 2020 vs. 114 in 2019). The frequency of DKA at DM1 onset was significantly higher in the pandemic period (68.2% vs 45.6%; p < 0.001) and incidence of severe DKA was also higher (27.1% in 2020 vs 13.2% in 2019; p = 0.01). CONCLUSIONS There was a significant increase in DKA and severe DKA in children presenting with new onset DM1 during the COVID-19 pandemic period. This emphasizes the need for educating health care professionals and families to be aware of the symptoms of hyperglycemia and the importance of early diagnosis and treatment even during public health measures for COVID-19.
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Affiliation(s)
- Josephine Ho
- Division of Pediatric Endocrinology, Department of Pediatrics, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Elizabeth Rosolowsky
- Division of Pediatric Endocrinology, Department of PediatricsUniversity of AlbertaEdmontonAlbertaCanada
| | - Daniele Pacaud
- Division of Pediatric Endocrinology, Department of Pediatrics, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Carol Huang
- Division of Pediatric Endocrinology, Department of Pediatrics, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | | | | | | | - Manpreet Doulla
- Division of Pediatric Endocrinology, Department of PediatricsUniversity of AlbertaEdmontonAlbertaCanada
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Gad H, Al-Jarrah B, Saraswathi S, Mohamed S, Kalteniece A, Petropoulos IN, Khan A, Ponirakis G, Singh P, Khodor SA, Elawad M, Almasri W, Hendaus MA, Akobeng AK, Hussain K, Malik RA. Corneal confocal microscopy identifies a reduction in corneal keratocyte density and sub-basal nerves in children with type 1 diabetes mellitus. Br J Ophthalmol 2021; 106:1368-1372. [PMID: 33931390 DOI: 10.1136/bjophthalmol-2021-319057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 04/10/2021] [Accepted: 04/20/2021] [Indexed: 11/08/2022]
Abstract
PURPOSE To assess whether alterations in stromal keratocyte density are related to loss of corneal nerve fibres in children with type 1 diabetes mellitus (T1DM). METHODS Twenty participants with T1DM and 20 age-matched healthy controls underwent corneal confocal microscopy. Corneal sub-basal nerve morphology and corneal keratocyte density (KD) were quantified. RESULTS Corneal nerve fibre density (CNFD) (p<0.001), corneal nerve branch density (p<0.001), corneal nerve fibre length (CNFL) (p<0.001) and inferior whorl length (IWL) (p<0.001) were lower in children with T1DM compared with healthy controls. Anterior (p<0.03) and mid (p=0.03) stromal KDs were lower with no difference in posterior KD (PKD) in children with T1DM compared with controls. Age, duration of diabetes, height, weight and body mass index did not correlate with anterior (AKD), mid (MKD) or PKD. Inverse correlations were found between glycated haemoglobin and PKD (r=-0.539, p=0.026), bilirubin with MKD (r=-0.540, p=0.025) and PKD (r=-0.531, p=0.028) and 25-hydroxycholecalciferol with MKD (r=-0.583, p=0.018). CNFD, CNFL and IWL did not correlate with AKD, MKD or PKD. CONCLUSION This study demonstrates a reduction in corneal nerves and anterior and mid stromal KD in children with T1DM, but no correlation between corneal nerve and keratocyte cell loss.
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Affiliation(s)
- Hoda Gad
- Department of Medicine, Weill Cornell Medicine, Doha, Qatar
| | | | | | - Sara Mohamed
- Department of Medicine, Weill Cornell Medicine, Doha, Qatar
| | - Alise Kalteniece
- Cardiovascular Medicine, University of Manchester, Manchester, UK
| | | | - Adnan Khan
- Department of Medicine, Weill Cornell Medicine, Doha, Qatar
| | | | | | | | | | | | | | | | | | - Rayaz A Malik
- Department of Medicine, Weill Cornell Medicine, Doha, Qatar .,Cardiovascular Medicine, University of Manchester, Manchester, UK
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Stankovic S, Vukovic R, Vorgucin I, Zdravkovic V, Folic N, Zivic S, Ignjatovic A, Rancic N, Milenkovic T, Todorovic S, Mitrovic K, Jesic M, Sajic S, Bojic V, Katanic D, Dautovic S, Cvetkovic V, Saranac L, Markovic S, Tucakovic T, Lesovic S, Ljubojevic M, Ilic T, Vrebalov M, Mikic M, Jelenkovic B, Petrovic R, Saric S, Simić D, Cukanovic M, Stankovic M. First report on the nationwide prevalence of paediatric type 1 diabetes in Serbia and temporal trends of diabetes ketoacidosis at diagnosis-a multicentre study. J Pediatr Endocrinol Metab 2021; 34:225-229. [PMID: 33544544 DOI: 10.1515/jpem-2020-0405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/15/2020] [Indexed: 12/30/2022]
Abstract
We aimed to collect data on all paediatric patients who were diagnosed with type 1 diabetes mellitus (T1DM) between the years 2000 and 2019 in Serbia and estimate for the first time its prevalence. Also, the trends of diabetes ketoacidosis (DKA) occurrence at the time of diagnosis are monitored. We collected and retrospectively analysed the data of patients <19 years with newly diagnosed T1DM. T1DM was diagnosed in 3134 patients (53.2% male). Total number of youth <19 years with T1DM was 1735 with prevalence of 135.25/100000 at the end of study period. T1DM was diagnosed most frequently between the ages of 5 and 11 years (42.1%). At the time of diagnosis, 35.7% presented in DKA. The incidence and severity of DKA were more significant at the youngest age (p<0.001). There were significant annual percentage increase (2.2%) in the number of new cases of DKA (p=0.007). Conclusion: This first report of nationwide prevalence of T1DM in youth shows that Serbia is among countries with high prevalence of T1DM in youth. System changes are needed in order to provide better quality of health care to these patients.
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Affiliation(s)
- Sandra Stankovic
- Pediatric Endocrinology, Children Clinic, Medical Faculty, Nis, Serbia
| | - Rade Vukovic
- Department of Endocrinology, Mother and Child Health Care Institute of Serbia "Dr Vukan Cupic", Belgrade, Serbia
| | - Ivana Vorgucin
- Endocrinology, Institute for Children and Youth Health Care of Vojvodina, Medical Faculty, Novi Sad, Serbia
| | - Vera Zdravkovic
- Department of Endocrinology, University Children Hospital, Medical Faculty, Belgrade, Serbia
| | - Nevena Folic
- Paediatric Clinic, Clinical Centre Kragujevac, Medical Faculty, University of Kragujevac, Serbia
| | - Sasa Zivic
- Department of Endocrinology, Pediatric Clinic, Faculty of Medicine Nis, University of Nis, Nis, Serbia
| | - Aleksandra Ignjatovic
- Department of Medical Statistics, University of Niš, Faculty of Medicine Niš, Nis, Serbia
| | - Natasa Rancic
- Epidemiology, University of Nis Faculty of Medicine, Nis, Serbia
| | - Tatjana Milenkovic
- Department of Endocrinology, Mother and Child Health Care Institute of Serbia "Dr Vukan Cupic", Belgrade, Serbia
| | - Slađana Todorovic
- Department of Endocrinology, Mother and Child Health Care Institute of Serbia "Dr Vukan Cupic", Belgrade, Serbia
| | - Katarina Mitrovic
- Department of Endocrinology, Mother and Child Health Care Institute of Serbia "Dr Vukan Cupic", Belgrade, Serbia
| | - Maja Jesic
- Department of Endocrinology, University Children Hospital, Medical Faculty, Belgrade, Serbia
| | - Silvija Sajic
- Department of Endocrinology, University Children Hospital, Medical Faculty, Belgrade, Serbia
| | - Vlada Bojic
- Department of Endocrinology, University Children Hospital, Medical Faculty, Belgrade, Serbia
| | - Dragan Katanic
- Endocrinology, Institute for Children and Youth Health Care of Vojvodina, Medical Faculty, Novi Sad, Serbia
| | - Slavica Dautovic
- Endocrinology, Institute for Children and Youth Health Care of Vojvodina, Novi Sad, Serbia
| | | | - Ljiljana Saranac
- Department of Endocrinology, Pediatric Clinic, Faculty of Medicine Nis, University of Nis, Nis, Serbia
| | - Slavica Markovic
- Paediatric Clinic, Clinical Centre Kragujevac, Medical Faculty, University of Kragujevac, Serbia
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Insulin-Mimetic Dihydroxanthyletin-Type Coumarins from Angelica decursiva with Protein Tyrosine Phosphatase 1B and α-Glucosidase Inhibitory Activities and Docking Studies of Their Molecular Mechanisms. Antioxidants (Basel) 2021; 10:antiox10020292. [PMID: 33672051 PMCID: PMC7919472 DOI: 10.3390/antiox10020292] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/04/2021] [Accepted: 02/08/2021] [Indexed: 01/04/2023] Open
Abstract
As a traditional medicine, Angelica decursiva has been used for the treatment of many diseases. The goal of this study was to evaluate the potential of four natural major dihydroxanthyletin-type coumarins—(+)-trans-decursidinol, Pd-C-I, Pd-C-II, and Pd-C-III—to inhibit the enzymes, protein tyrosine phosphatase 1B (PTP1B) and α-glucosidase. In the kinetic study of the PTP1B enzyme’s inhibition, we found that (+)-trans-decursidinol, Pd-C-I, and Pd-C-II led to competitive inhibition, while Pd-C-III displayed mixed-type inhibition. Moreover, (+)-trans-decursidinol exhibited competitive-type, and Pd-C-I and Pd-C-II mixed-type, while Pd-C-III showed non-competitive type inhibition of α-glucosidase. Docking simulations of these coumarins showed negative binding energies and a similar proximity to residues in the PTP1B and α-glucosidase binding pocket, which means they are closely connected and strongly binding with the active enzyme site. In addition, dihydroxanthyletin-type coumarins are up to 40 µM non-toxic in HepG2 cells and have substantially increased glucose uptake and decreased expression of PTP1B in insulin-resistant HepG2 cells. Further, coumarins inhibited ONOO−-mediated albumin nitration and scavenged peroxynitrite (ONOO−), and reactive oxygen species (ROS). Our overall findings showed that dihydroxanthyletin-type coumarins derived from A. decursiva is used as a dual inhibitor for enzymes, such as PTP1B and α-glucosidase, as well as for insulin susceptibility.
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Jensen ET, Dabelea DA, Praveen PA, Anandakumar A, Hockett CW, Isom SP, Ong TC, Mohan V, D'Agostino R, Kahn MG, Hamman RF, Wadwa P, Dolan L, Lawrence JM, Madhu SV, Chhokar R, Goel K, Tandon N, Mayer-Davis E. Comparison of the incidence of diabetes in United States and Indian youth: An international harmonization of youth diabetes registries. Pediatr Diabetes 2021; 22:8-14. [PMID: 32196874 PMCID: PMC7748376 DOI: 10.1111/pedi.13009] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 01/22/2020] [Accepted: 02/12/2020] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE Incidence of youth-onset diabetes in India has not been well described. Comparison of incidence, across diabetes registries, has the potential to inform hypotheses for risk factors. We sought to compare the incidence of diabetes in the U.S.-based registry of youth onset diabetes (SEARCH) to the Registry of Diabetes with Young Age at Onset (YDR-Chennai and New Delhi regions) in India. METHODS We harmonized data from both SEARCH and YDR to the Observational Medical Outcomes Partnership (OMOP) Common Data Model. Data were from youth registered with incident diabetes (2006-2012). Denominators were from census and membership data. We calculated diabetes incidence by averaging the total cases across the entire follow-up period and dividing this by the estimated census population corresponding to the source population for case ascertainment. Incidence was calculated for each of the registries and compared by type and within age and sex categories using a 2-sided, skew-corrected inverted score test. RESULTS Incidence of type 1 was higher in SEARCH (21.2 cases/100 000 [95% CI: 19.9, 22.5]) than YDR (4.9 cases/100 000 [95% CI: 4.3, 5.6]). Incidence of type 2 diabetes was also higher in SEARCH (5.9 cases/100 000 [95% CI: 5.3, 6.6] in SEARCH vs 0.5/cases/100 000 [95% CI: 0.3, 0.7] in YDR). The age distribution of incident type 1 diabetes cases was similar across registries, whereas type 2 diabetes incidence was higher at an earlier age in SEARCH. Sex differences existed in SEARCH only, with a higher rate of type 2 diabetes among females. CONCLUSION The incidence of youth-onset type 1 and 2 diabetes was significantly different between registries. Additional data are needed to elucidate whether the differences observed represent diagnostic delay, differences in genetic susceptibility, or differences in distribution of risk factors.
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Affiliation(s)
- Elizabeth T. Jensen
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC
| | - Dana A. Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO
| | | | | | - Christine W. Hockett
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO
| | - Scott P. Isom
- Department of Biostatistics and Data Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Toan C. Ong
- Department of Pediatrics, University of Colorado, Aurora, CO
| | | | - Ralph D'Agostino
- Department of Biostatistics and Data Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Michael G. Kahn
- Department of Pediatrics, University of Colorado, Aurora, CO
| | - Richard F. Hamman
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO
| | - Paul Wadwa
- Department of Pediatrics, University of Colorado, Aurora, CO
| | - Lawrence Dolan
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Jean M. Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - SV Madhu
- University College of Medical Science, GTB Hospital, Delhi, India
| | - Reshmi Chhokar
- All India Institute of Medical Sciences, New Delhi, India
| | - Komal Goel
- All India Institute of Medical Sciences, New Delhi, India
| | - Nikhil Tandon
- All India Institute of Medical Sciences, New Delhi, India
| | - Elizabeth Mayer-Davis
- Departments of Nutrition and Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Carino M, Elia Y, Sellers E, Curtis J, McGavock J, Scholey J, Hamilton J, Clarson C, Pinto T, Hadjiyannakis S, Mertens L, Samaan MC, Ho J, Nour M, Panagiotopoulos C, Jetha M, Gabbs M, Mahmud FH, Wicklow B, Dart A. Comparison of Clinical and Social Characteristics of Canadian Youth Living With Type 1 and Type 2 Diabetes. Can J Diabetes 2021; 45:428-435. [PMID: 33714663 DOI: 10.1016/j.jcjd.2021.01.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/11/2021] [Accepted: 01/16/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Our aim in this study was to describe the clinical and social characteristics of 2 Canadian cohorts of adolescents with diabetes. METHODS Participants from the Improving renal Complications in Adolescents with type 2 diabetes through REsearch (iCARE) study (n=322) and the Early Determinants of Cardio-Renal Disease in Youth With Type 1 Diabetes (n=199) study were compared. RESULTS Adolescents were 10 to 18 years of age (mean ± standard deviation: 14.8±2.4 years). The T2DM cohort had a shorter duration of diabetes. Both groups had glycated hemoglobin levels above target. The type 2 diabetes (T2D) cohort was comprised of predominantly Indigenous youth. The type 1 diabetes (T1D) cohort was 58.3% European/Caucasian, with a high proportion (41.7%) of visible minority groups (Afro-Caribbean, Asian/Pacific Islander, Hispanic). The prevalence of obesity, hypertension, left ventricular hypertrophy, albuminuria and hyperfiltration was higher in the T2D cohort. The T1D cohort was more socially and economically advantaged in all 4 dimensions of health inequality. CONCLUSIONS There are significant differences in clinical and social characteristics of adolescents with T2D and T1D in Canada. Both have inadequate glycemic control with evidence of onset and progression of diabetes-related complications.
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Affiliation(s)
- Marylin Carino
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Yesmino Elia
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Can-SOLVE CKD SPOR Network, Canada
| | - Elizabeth Sellers
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada; Department of Pediatrics and Child Health, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jacqueline Curtis
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jon McGavock
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada; Department of Pediatrics and Child Health, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - James Scholey
- Can-SOLVE CKD SPOR Network, Canada; Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jill Hamilton
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Cheril Clarson
- Department of Pediatrics, University of Western Ontario, Western University, London, Ontario, Canada
| | - Teresa Pinto
- Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Stasia Hadjiyannakis
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Luc Mertens
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - M Constantine Samaan
- Department of Pediatrics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Josephine Ho
- Department of Paediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Munier Nour
- Department of Pediatrics, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Constadina Panagiotopoulos
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mary Jetha
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Melissa Gabbs
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Farid H Mahmud
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Can-SOLVE CKD SPOR Network, Canada
| | - Brandy Wicklow
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada; Department of Pediatrics and Child Health, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Can-SOLVE CKD SPOR Network, Canada
| | - Allison Dart
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada; Department of Pediatrics and Child Health, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada; Can-SOLVE CKD SPOR Network, Canada.
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Seth A, Yen YM, Tourn D, Smit K, Carsen S. A Unique and Characteristic Cam FAI Morphology in Young Patients with Comorbid Inflammatory Conditions. J Bone Joint Surg Am 2020; 102:15-21. [PMID: 32453107 DOI: 10.2106/jbjs.20.00080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The relationship between femoroacetabular impingement (FAI) and inflammatory medical comorbidities has not been established in the pediatric population. The purpose of this study was to investigate the prevalence of inflammatory conditions in pediatric patients with FAI and the morphology of the associated deformity. METHODS We performed a retrospective cohort study of 90 patients who were diagnosed with FAI in our institution's adolescent hip clinic from January 2016 to March 2018. Patients with an inflammatory comorbidity were identified. Standard quantitative radiographic FAI measurements as well as qualitative femoral head-neck junction morphology were analyzed. RESULTS Eight patients (8.9%) with 11 symptomatic hips were found to have an inflammatory condition. These 8 patients all had cam deformities. Nine of the symptomatic hips in this subset of patients had a negative femoral offset, where the cam deformity extended beyond the anterior margin of the femoral head. Qualitative assessment revealed a unique head-neck morphology with a prominent and "sharp-edged" bump at the head-neck junction, which resembled an inflammatory beak. In comparing patients with and without inflammatory comorbidities, a marked difference was found for alpha angles (difference, 26.6°; 95% confidence interval [CI], 18.2° to 35.0°) but not for age at diagnosis (difference, 0.5 years; 95% CI, -0.8 to 1.6 years) or the lateral center-edge angle (difference, 1.9°; 95% CI, -3.9° to 7.7°). CONCLUSIONS At our institution, 8.9% of pediatric patients with FAI were found to have an inflammatory comorbidity. These patients presented with a characteristic prominent "sharp-edged" head-neck morphology that standard radiographic measurements captured as a negative femoral offset and a larger alpha angle than was seen in patients without systemic inflammatory disease. Awareness of the characteristic cam deformity that was found in these patients may help to identify patients with undiagnosed inflammatory conditions. This unique deformity also raises questions regarding the possible role of physeal inflammation in the development of cam deformities and indicates a need for additional studies to investigate the relationship between systemic inflammatory diseases and FAI. LEVEL OF EVIDENCE Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Akshay Seth
- Division of Orthopaedic Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Yi-Meng Yen
- Department of Orthopaedic Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Diego Tourn
- Division of Orthopaedic Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Kevin Smit
- Division of Orthopaedic Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Sasha Carsen
- Division of Orthopaedic Surgery, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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Ladha S, Fox D, Bone JN, Amed S. An Analysis of Self-Reported Barriers to Type 1 Diabetes Care in a Pediatric Population in British Columbia, Canada. Can J Diabetes 2020; 45:383-389. [PMID: 33358268 DOI: 10.1016/j.jcjd.2020.10.015] [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: 07/02/2020] [Revised: 09/22/2020] [Accepted: 10/24/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Our aim in this study was to identify patient-level barriers to attending pediatric type 1 diabetes mellitus (T1DM) clinic and to better understand the demographic and clinical characteristics of these reporting barriers. METHODS Patients were recruited from pediatric T1DM clinics throughout British Columbia. Barriers to attending clinic were identified through a survey. Demographic and clinical characteristics of patients who reported difficulty attending clinic appointments were compared with those who did not. RESULTS Of the 197 study participants, 31% reported difficulty attending appointments. Commonly reported barriers were distance to clinic and missing work. Younger child age and residing in northern regions increased the odds of reporting a barrier, whereas residing on Vancouver Island decreased odds of reporting a barrier. There were no differences in glycated hemoglobin levels between the 2 groups. CONCLUSIONS Approximately 1 in 3 patients identified challenges in attending T1DM appointments in British Columbia. Further research is needed to determine whether similar challenges exist in other provinces.
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Affiliation(s)
- Safia Ladha
- Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Danya Fox
- Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Jeffrey N Bone
- Department of Obstetrics and Gynecology, University of British Columbia, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Shazhan Amed
- Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada.
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Rami‐Merhar B, Hofer SE, Fröhlich‐Reiterer E, Waldhoer T, Fritsch M. Time trends in incidence of diabetes mellitus in Austrian children and adolescents <15 years (1989-2017). Pediatr Diabetes 2020; 21:720-726. [PMID: 32410357 PMCID: PMC7383999 DOI: 10.1111/pedi.13038] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 04/24/2020] [Accepted: 05/06/2020] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To analyze the time trends of nationwide diabetes incidence <15 years of age from 1989 until 2017 in Austria. METHODS The Austrian Diabetes Incidence Study Group registers all newly diagnosed patients with diabetes mellitus <15 years of age in a prospective population-based study. The diabetes type was classified on the basis of clinical and laboratory findings according to American Diabetes Association criteria. Time trends were estimated by Joinpoint analysis. RESULTS 1311 patients were diagnosed with type 1 diabetes (T1D) between 1989 and 1999 and 4624 patients with any type of diabetes (1999-2017). T1D accounted for the majority of cases (94.2%), 1.8% were classified as type 2 (T2D) and 4.0% as other specific types of diabetes (1999-2017). In the total cohort (age 0 to <15 years), a constant increase until 2012 (annual percent change [APC] 4.5, 95% confidence interval [CI]: 3.94, 5.06) was observed, followed by a leveling off with a corresponding drop (APC 0.28, 95%CI: -3.94, 4.69). This observation was mainly driven by the dynamic in the youngest age group (0-4 years) with a steep increase until 2007 (APC 7.1, 95%CI: 5.05, 9.19) and a decrease from 2007 to 2017 (APC -0.86, 95%CI: 4.41, 2.82). No significant increase of T2D <15 years was detected. Over the observed time period (APC = 3.7, 95%CI: -0.30, 7.78). CONCLUSIONS The incidence of T1D is declining in young children aged 0 to 4 years, but is still rising in children 5 to 14 years in Austria. Incidence of T2D did not increase significantly and other specific types of diabetes occur twice as often compared to T2D.
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Affiliation(s)
- Birgit Rami‐Merhar
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for PediatricsMedical University of ViennaViennaAustria
| | - Sabine E. Hofer
- Department of PediatricsMedical University of InnsbruckInnsbruckAustria
| | | | - Thomas Waldhoer
- Department of Epidemiology, Center of Public HealthMedical University of ViennaViennaAustria
| | - Maria Fritsch
- Department of Pediatrics and Adolescent Medicine, Comprehensive Center for PediatricsMedical University of ViennaViennaAustria,Department of Pediatrics and Adolescent MedicineMedical University of GrazGrazAustria
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Gad H, Al-Jarrah B, Saraswathi S, Petropoulos IN, Ponirakis G, Khan A, Singh P, Al Khodor S, Elawad M, Almasri W, Abdelrahman H, Elawwa A, Khalifa A, Shamekh A, Al-Khalaf F, Petrovski G, Al Zyoud M, Al Maadheed M, Hendaus MA, Hussain K, Akobeng AK, Malik RA. Corneal nerve loss in children with type 1 diabetes mellitus without retinopathy or microalbuminuria. J Diabetes Investig 2020; 11:1594-1601. [PMID: 32491258 PMCID: PMC7610109 DOI: 10.1111/jdi.13313] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/18/2020] [Accepted: 05/28/2020] [Indexed: 12/12/2022] Open
Abstract
Aims/Introduction Corneal confocal microscopy is a rapid, non‐invasive ophthalmic technique to identify subclinical neuropathy. The aim of this study was to quantify corneal nerve morphology in children with type 1 diabetes mellitus compared with age‐matched healthy controls using corneal confocal microscopy. Materials and Methods A total of 20 participants with type 1 diabetes mellitus (age 14 ± 2 years, diabetes duration 4.08 ± 2.91 years, glycated hemoglobin 9.3 ± 2.1%) without retinopathy or microalbuminuria and 20 healthy controls were recruited from outpatient clinics. Corneal confocal microscopy was undertaken, and corneal nerve fiber density (n/mm2), corneal nerve branch density (n/mm2), corneal nerve fiber length (mm/mm2), corneal nerve fiber tortuosity and inferior whorl length (mm/mm2) were quantified manually. Results Corneal nerve fiber density (22.73 ± 8.84 vs 32.92 ± 8.59; P < 0.001), corneal nerve branch density (26.19 ± 14.64 vs 47.34 ± 20.01; P < 0.001), corneal nerve fiber length (13.26 ± 4.06 vs 19.52 ± 4.54; P < 0.001) and inferior whorl length (15.50 ± 5.48 vs 23.42 ± 3.94; P < 0.0001) were significantly lower, whereas corneal nerve fiber tortuosity (14.88 ± 5.28 vs 13.52 ± 3.01; P = 0.323) did not differ between children with type 1 diabetes mellitus and controls. Glycated hemoglobin correlated with corneal nerve fiber tortuosity (P < 0.006) and aspartate aminotransferase correlated with corneal nerve fiber density (P = 0.039), corneal nerve branch density (P = 0.003) and corneal nerve fiber length (P = 0.037). Conclusion Corneal confocal microscopy identifies significant subclinical corneal nerve loss, especially in the inferior whorl of children with type 1 diabetes mellitus without retinopathy or microalbuminuria.
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Affiliation(s)
- Hoda Gad
- Medicine Department, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Bara Al-Jarrah
- Gastroenterology Department, Sidra Medicine, Doha, Qatar
| | | | | | | | - Adnan Khan
- Medicine Department, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Parul Singh
- Research Department, Sidra Medicine, Doha, Qatar
| | | | - Mamoun Elawad
- Gastroenterology Department, Sidra Medicine, Doha, Qatar
| | - Wesam Almasri
- Gastroenterology Department, Sidra Medicine, Doha, Qatar
| | | | - Ahmed Elawwa
- Endocrinology Department, Sidra Medicine, Doha, Qatar
| | - Amel Khalifa
- Endocrinology Department, Sidra Medicine, Doha, Qatar
| | - Ahmed Shamekh
- Endocrinology Department, Sidra Medicine, Doha, Qatar
| | | | | | | | | | | | | | | | - Rayaz A Malik
- Medicine Department, Weill Cornell Medicine-Qatar, Doha, Qatar.,Institute of Cardiovascular Medicine, University of Manchester, Manchester, UK
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Kao KT, Islam N, Fox DA, Amed S. Incidence Trends of Diabetic Ketoacidosis in Children and Adolescents with Type 1 Diabetes in British Columbia, Canada. J Pediatr 2020; 221:165-173.e2. [PMID: 32446476 DOI: 10.1016/j.jpeds.2020.02.069] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 02/20/2020] [Accepted: 02/24/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To estimate the 11-year incidence trend of diabetic ketoacidosis (DKA) at and after the diagnosis of type 1 diabetes. STUDY DESIGN A retrospective cohort study using a population-based administrative cohort diagnosed with type 1 diabetes at <20 years of age from 2002 to 2012 in British Columbia, Canada. DKA at (1 episode per individual) and DKA after (multiple episodes per individual) the diagnosis of diabetes were defined as DKA occurring ≤14 days or >14 days, respectively, from diagnosis, identified using International Classification of Diseases,9th and 10theditions codes. Incidence rate ratios were estimated using Poisson regression and DKA trends using Joinpoint regression analyses. RESULTS There were 1519 individuals (mean age at first-DKA, 12.6 ± 5.9 years; 50% male) with ≥1 DKA episode identified. Of 2615 incident cases of type 1 diabetes, there were 847 (32.4%; mean age, 9.9 ± 4.8 years; 52% male) episodes of DKA at the diagnosis of diabetes. Among prevalent cases of type 1 diabetes (1790 cases in 2002 increasing to 2264 in 2012), there were 1886 episodes of DKA after the diagnosis of diabetes (mean age at first DKA, 15.7 ± 5.2 years). The rates per 100 person-years of DKA at diabetes diagnosis (ranging from 24.1 in 2008 to 37.3 in 2006) and DKA after diabetes diagnosis (ranging from 4.9 in 2002 to 7.7 in 2008) remained stable. Females showed a 67% higher rate of incidence of DKA after the diagnosis of diabetes compared with their male counterparts (incidence rate ratio, 1.67; 95% CI, 1.50-1.86; P < .001), adjusted for the temporal trend by fiscal year. Younger age at diagnosis (<5 years) was associated with a greater risk of DKA at the time of diabetes diagnosis and older children (≥10 years) had a greater risk of DKA after the diagnosis of diabetes. CONCLUSIONS The risk of DKA at the time of diagnosis of diabetes was greater with younger age and the risk of DKA after the diagnosis of diabetes was higher in females and older children and youth.
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Affiliation(s)
- Kung-Ting Kao
- Divisions of Diabetes and Endocrinology, British Columbia Children's Hospital and Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Nazrul Islam
- MRC Epidemiology Unit, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Danya A Fox
- Divisions of Diabetes and Endocrinology, British Columbia Children's Hospital and Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Shazhan Amed
- Divisions of Diabetes and Endocrinology, British Columbia Children's Hospital and Department of Pediatrics, University of British Columbia, Vancouver, Canada.
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Weisman A, Tu K, Young J, Kumar M, Austin PC, Jaakkimainen L, Lipscombe L, Aronson R, Booth GL. Validation of a type 1 diabetes algorithm using electronic medical records and administrative healthcare data to study the population incidence and prevalence of type 1 diabetes in Ontario, Canada. BMJ Open Diabetes Res Care 2020; 8:8/1/e001224. [PMID: 32565422 PMCID: PMC7307536 DOI: 10.1136/bmjdrc-2020-001224] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 05/12/2020] [Accepted: 05/19/2020] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION We aimed to develop algorithms distinguishing type 1 diabetes (T1D) from type 2 diabetes in adults ≥18 years old using primary care electronic medical record (EMRPC) and administrative healthcare data from Ontario, Canada, and to estimate T1D prevalence and incidence. RESEARCH DESIGN AND METHODS The reference population was a random sample of patients with diabetes in EMRPC whose charts were manually abstracted (n=5402). Algorithms were developed using classification trees, random forests, and rule-based methods, using electronic medical record (EMR) data, administrative data, or both. Algorithm performance was assessed in EMRPC. Administrative data algorithms were additionally evaluated using a diabetes clinic registry with endocrinologist-assigned diabetes type (n=29 371). Three algorithms were applied to the Ontario population to evaluate the minimum, moderate and maximum estimates of T1D prevalence and incidence rates between 2010 and 2017, and trends were analyzed using negative binomial regressions. RESULTS Of 5402 individuals with diabetes in EMRPC, 195 had T1D. Sensitivity, specificity, positive predictive value and negative predictive value for the best performing algorithms were 80.6% (75.9-87.2), 99.8% (99.7-100), 94.9% (92.3-98.7), and 99.3% (99.1-99.5) for EMR, 51.3% (44.0-58.5), 99.5% (99.3-99.7), 79.4% (71.2-86.1), and 98.2% (97.8-98.5) for administrative data, and 87.2% (81.7-91.5), 99.9% (99.7-100), 96.6% (92.7-98.7) and 99.5% (99.3-99.7) for combined EMR and administrative data. Administrative data algorithms had similar sensitivity and specificity in the diabetes clinic registry. Of 11 499 711 adults in Ontario in 2017, there were 24 789 (0.22%, minimum estimate) to 102 140 (0.89%, maximum estimate) with T1D. Between 2010 and 2017, the age-standardized and sex-standardized prevalence rates per 1000 person-years increased (minimum estimate 1.7 to 2.56, maximum estimate 7.48 to 9.86, p<0.0001). In contrast, incidence rates decreased (minimum estimate 0.1 to 0.04, maximum estimate 0.47 to 0.09, p<0.0001). CONCLUSIONS Primary care EMR and administrative data algorithms performed well in identifying T1D and demonstrated increasing T1D prevalence in Ontario. These algorithms may permit the development of large, population-based cohort studies of T1D.
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Affiliation(s)
- Alanna Weisman
- ICES, Toronto, Ontario, Canada
- Division of Endocrinology & Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Karen Tu
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Toronto Western Hospital Family Health Team, University Health Network, Toronto, Ontario, Canada
- North York General Hospital, Toronto, Ontario, Canada
| | | | | | - Peter C Austin
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Liisa Jaakkimainen
- ICES, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- North York General Hospital, Toronto, Ontario, Canada
| | - Lorraine Lipscombe
- ICES, Toronto, Ontario, Canada
- Division of Endocrinology & Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | | | - Gillian L Booth
- ICES, Toronto, Ontario, Canada
- Division of Endocrinology & Metabolism, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
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Evans-Atkinson T, Fung A, Antunes Silvestre A, Crozier T, Hursh B. Evaluation of a Province-Wide Type 1 Diabetes Care Plan for Children in the School Setting. Can J Diabetes 2020; 45:15-21. [PMID: 32800762 DOI: 10.1016/j.jcjd.2020.04.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 03/11/2020] [Accepted: 04/02/2020] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The aim of this study was to identify perceptions of safety and effectiveness of a provincial type 1 diabetes school care plan, and to best inform future improvements in school care to accommodate the shifting needs of families, best clinical practices and new medical technologies. METHODS A cross-sectional satisfaction and feedback questionnaire to inform quality improvement was offered to both families of children with type 1 diabetes who receive care at school through a Delegated Diabetes Care Plan and to their program coordinators during the 2017‒2018 school year. RESULTS The response rate was 29.8% (160 of 537) for families and 68.2% (45 of 66) for coordinators. The majority of parents and coordinators reported that the care plan is meeting both safety and diabetes management needs. On a 7-point Likert scale, the safety score, expressed as mean (standard deviation), was 6.0 (1.2) by families and 5.7 (1.3) by coordinators, with higher scores reflecting greater satisfaction. Diabetes management was rated 5.6 (1.2) out of 7 by families, and 5.4 (0.8) out of 7 by coordinators. Families and coordinators expressed the need for individualization of care, and suggested modifications to how information is presented. There was near-unanimous support for future integration of continuous glucose-monitoring devices into the school setting. CONCLUSIONS British Columbia's provision of diabetes care in the school setting is overall perceived to be safe and is generally well received by families and coordinators. In this study, we provide valuable information to improve the care of children with type 1 diabetes in schools, including support for further individualization of care and future integration of diabetes technology into the school setting.
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Affiliation(s)
- Tara Evans-Atkinson
- Endocrinology and Diabetes Unit, Department of Pediatrics, Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Alex Fung
- Endocrinology and Diabetes Unit, Department of Pediatrics, Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Tamara Crozier
- Sunny Hill Health Centre for Children, Vancouver, British Columbia, Canada
| | - Brenden Hursh
- Endocrinology and Diabetes Unit, Department of Pediatrics, Children's Hospital and University of British Columbia, Vancouver, British Columbia, Canada.
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Elten M, Donelle J, Lima I, Burnett RT, Weichenthal S, Stieb DM, Hystad P, van Donkelaar A, Chen H, Paul LA, Crighton E, Martin RV, Decou ML, Luo W, Lavigne É. Ambient air pollution and incidence of early-onset paediatric type 1 diabetes: A retrospective population-based cohort study. ENVIRONMENTAL RESEARCH 2020; 184:109291. [PMID: 32120123 DOI: 10.1016/j.envres.2020.109291] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 02/17/2020] [Accepted: 02/21/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Studies have reported increasing incidence rates of paediatric diabetes, especially among those aged 0-5 years. Epidemiological evidence linking ambient air pollution to paediatric diabetes remains mixed. OBJECTIVE This study investigated the association between maternal and early-life exposures to common air pollutants (NO2, PM2.5, O3, and oxidant capacity [Ox; the redox-weighted average of O3 and NO2]) and the incidence of paediatric diabetes in children up to 6 years of age. METHODS All registered singleton births in Ontario, Ca nada occurring between April 1st, 2006 and March 31st, 2012 were included through linkage from health administrative data. Monthly exposures to NO2, PM2.5, O3, and Ox were estimated across trimesters, the entire pregnancy period and during childhood. Random effects Cox proportional hazards models were used to assess the relationships with paediatric diabetes incidence while controlling for important covariates. We also modelled the shape of concentration-response (CR) relationships. RESULTS There were 1094 children out of a cohort of 754,698 diagnosed with diabetes before the age of six. O3 exposures during the first trimester of pregnancy were associated with paediatric diabetes incidence (hazard ratio (HR) per interquartile (IQR) increase = 2.00, 95% CI: 1.04-3.86). The CR relationship between O3 during the first trimester and paediatric diabetes incidence appeared to have a risk threshold, in which there was little-to-no risk below 25 ppb of O3, while above this level risk increased sigmoidally. No other associations were observed. CONCLUSION O3 exposures during a critical period of development were associated with an increased risk of paediatric diabetes incidence.
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Affiliation(s)
- Michael Elten
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario Canada; Air Health Science Division, Health Canada, Ottawa, Ontario, Canada
| | | | - Isac Lima
- ICES UOttawa, Ottawa, Ontario, Canada
| | - Richard T Burnett
- Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada
| | - Scott Weichenthal
- Air Health Science Division, Health Canada, Ottawa, Ontario, Canada; Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - David M Stieb
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario Canada; Environmental Health Science and Research Bureau, Health Canada, Vancouver, British Columbia, Canada
| | - Perry Hystad
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Aaron van Donkelaar
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Energy, Environmental and Chemical Engineering, Washington University in St. Louis, USA
| | - Hong Chen
- ICES UOttawa, Ottawa, Ontario, Canada; Environmental Health Science and Research Bureau, Health Canada, Ottawa, Ontario, Canada; Public Health Ontario, Toronto Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Eric Crighton
- ICES UOttawa, Ottawa, Ontario, Canada; Department of Geography, Environment and Geomatics, University of Ottawa, Ottawa, Ontario, Canada
| | - Randall V Martin
- Department of Physics and Atmospheric Science, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Energy, Environmental and Chemical Engineering, Washington University in St. Louis, USA
| | - Mary Lou Decou
- Maternal & Infant Health Section, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Wei Luo
- Maternal & Infant Health Section, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Éric Lavigne
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario Canada; Air Health Science Division, Health Canada, Ottawa, Ontario, Canada.
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30
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Esen I, Okdemir D. Trend of type 1 diabetes incidence in children between 2009 and 2019 in Elazig, Turkey. Pediatr Diabetes 2020; 21:460-465. [PMID: 31951309 DOI: 10.1111/pedi.12984] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/09/2019] [Accepted: 01/13/2020] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To assess the incidence of T1D in children aged <15 years in Elazig, Turkey. METHOD The data of children who have been registered as child with T1D in the database of pediatric diabetes clinic was analyzed. Childhood census data were acquired from the Turkish Statistical Institute. The incidence rates of T1D were calculated for the whole group as well as separately for age group, gender, year of diagnosis, and place of residence, viz. either urban or rural per 100 000 persons per year. The change of incidence during the 10 year observation period was analyzed. RESULTS The overall mean incidence of T1D in study period was 16.7/100 000 [95% confidence interval (CI): 14.6-19.0] persons per year. The incidence rates of T1D varied from 10.2 to 24.1/100 000 persons per year, representing 2.4-fold variation between 2009 and 2019. The lowest incidence rate was in children aged 0 to 4 years (9.6/100 000 persons per year; CI: 6.9-12.9). There was no difference in incidence rate between genders, incidence rates was significant higher in urban residents. A significant increasing trend of T1D was detected in the total 10-year observation period; the average annual percent change was 7.8%. Subgroup analysis showed that there was significant increasing trend in boys, urban residents, and children aged 5 to 9 years groups. CONCLUSION This study demonstrated increase in T1D incidence of in children in Elazig and highest regional incidence rate of T1D until now in Turkey compared to previous limited data.
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Affiliation(s)
- Ihsan Esen
- Department of Paediatric Endocrinology, Firat University Hospital, Elazig, Turkey
| | - Deniz Okdemir
- Department of Paediatric Endocrinology, Firat University Hospital, Elazig, Turkey
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31
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Koebnick C, Imperatore G, Jensen ET, Stafford JM, Shah AS, Mottl AK, Bell RA, Dabelea D, Liese AD, Marcovina SM, D'Agostino RB, Urbina EM, Lawrence JM. Progression to hypertension in youth and young adults with type 1 or type 2 diabetes: The SEARCH for Diabetes in Youth Study. J Clin Hypertens (Greenwich) 2020; 22:888-896. [PMID: 32297456 PMCID: PMC7383720 DOI: 10.1111/jch.13849] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/10/2020] [Accepted: 02/29/2020] [Indexed: 12/12/2022]
Abstract
Central obesity may contribute to the development of hypertension in youths with diabetes. The SEARCH for Diabetes in Youth Study followed 1518 youths with type 1 diabetes (T1D) and 177 with type 2 diabetes (T2D) diagnosed when <20 years of age for incident hypertension. Incident hypertension was defined as blood pressure ≥95th percentile (or ≥130/80 mm Hg) or reporting antihypertensive therapy among those without hypertension at baseline. Poisson regression models were stratified by diabetes type and included demographic and clinical factors, clinical site, and waist‐to‐height ratio (WHtR). Youths with T2D were more likely to develop hypertension than those with T1D (35.6% vs 14.8%, P < .0001). For each 0.01 unit of annual increase in WHtR, adjusted relative risk for hypertension was 1.53 (95% CI 1.36‐1.73) and 1.20 (95% CI 1.00‐1.43) for youths with T1D and T2D, respectively. Effective strategies targeted toward reducing central obesity may reduce hypertension among youths with diabetes.
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Affiliation(s)
- Corinna Koebnick
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Giuseppina Imperatore
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Elizabeth T Jensen
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jeanette M Stafford
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Amy S Shah
- Department of Pediatrics, Cincinnati Children's Hospital and University of Cincinnati, Cincinnati, OH, USA
| | - Amy K Mottl
- Division of Nephrology and Hypertension, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Ronny A Bell
- Department of Public Health, East Carolina University, Greenville, NC, USA
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO, USA
| | - Angela D Liese
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA
| | - Santica M Marcovina
- Northwest Lipid Metabolism and Diabetes Research Laboratories, University of Washington, Seattle, WA, USA
| | - Ralph B D'Agostino
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Elaine M Urbina
- The Heart Institute, Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH, USA
| | - Jean M Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
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32
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Zhang X, Li G, Wu D, Yu Y, Hu N, Wang H, Li X, Wu Y. Emerging strategies for the activity assay and inhibitor screening of alpha-glucosidase. Food Funct 2020; 11:66-82. [DOI: 10.1039/c9fo01590f] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The high incidence of diabetes mellitus has caused widespread concern around the world, and has quickly become one of the most prevalent and costly chronic diseases.
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Affiliation(s)
- Xianlong Zhang
- School of Food and Biological Engineering
- Shaanxi University of Science and Technology
- Xi'an 710021
- China
| | - Guoliang Li
- School of Food and Biological Engineering
- Shaanxi University of Science and Technology
- Xi'an 710021
- China
- Key Laboratory of Life-Organic Analysis of Shandong Province
| | - Di Wu
- Yangtze Delta Region Institute of Tsinghua University
- China
| | - Yanxin Yu
- School of Food and Biological Engineering
- Shaanxi University of Science and Technology
- Xi'an 710021
- China
| | - Na Hu
- Key Laboratory of Tibetan Medicine Research & Qinghai Provincial Key Laboratory of Tibetan Medicine Research
- Northwest Institute of Plateau Biology
- Chinese Academy of Sciences
- Xining 810001
- China
| | - Honglun Wang
- Key Laboratory of Tibetan Medicine Research & Qinghai Provincial Key Laboratory of Tibetan Medicine Research
- Northwest Institute of Plateau Biology
- Chinese Academy of Sciences
- Xining 810001
- China
| | - Xiuting Li
- Beijing Advanced Innovation Center for Food Nutrition and Human Health
- Beijing Technology and Business University
- Beijing 100048
- China
| | - Yongning Wu
- Key Laboratories of Chemical Safety and Health
- China National Center for Food Safety Risk Assessment
- Beijing 100050
- China
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33
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Keshawarz A, Pyle L, Alman A, Sassano C, Westfeldt E, Sippl R, Snell-Bergeon J. Type 1 Diabetes Accelerates Progression of Coronary Artery Calcium Over the Menopausal Transition: The CACTI Study. Diabetes Care 2019; 42:2315-2321. [PMID: 31558547 PMCID: PMC6868458 DOI: 10.2337/dc19-1126] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 09/07/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Type 1 diabetes is associated with a higher risk of cardiovascular disease (CVD) in women. Although menopause increases risk of CVD, it is uncertain how menopause affects risk of CVD in women with type 1 diabetes. We examined whether risk of CVD changes differentially in women with and those without type 1 diabetes over the transition through menopause. RESEARCH DESIGN AND METHODS Premenopausal women with type 1 diabetes (n = 311) and premenopausal women without diabetes (n = 325) enrolled in the Coronary Artery Calcification in Type 1 Diabetes (CACTI) study and attended up to four study visits over 18 years. Coronary artery calcium (CAC) volume was measured from computed tomography scans obtained at each visit. Longitudinal repeated-measures modeling estimated the effect of diabetes on CAC volume over time and the effect of menopause on the diabetes-CAC relationship. RESULTS CAC volume was higher at baseline and increased more over time in women with type 1 diabetes than in women without diabetes. A significant diabetes-by-menopause interaction was found (P < 0.0001): postmenopausal women with type 1 diabetes had significantly higher CAC volumes than premenopausal women (5.14 ± 0.30 vs. 2.91 ± 0.18 mm3), while there was no difference in women without diabetes (1.78 ± 0.26 vs. 1.78 ± 0.17 mm3). This interaction remained significant after adjusting for CVD risk factors. CONCLUSIONS Type 1 diabetes was associated with higher CAC volume and accelerated progression of CAC over time. Menopause increased CAC progression more in women with diabetes than in women without diabetes independent of age and other CVD risk factors known to worsen with menopause.
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Affiliation(s)
- Amena Keshawarz
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO .,Barbara Davis Center for Diabetes, Aurora, CO
| | - Laura Pyle
- Barbara Davis Center for Diabetes, Aurora, CO.,Department of Biostatistics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Amy Alman
- Department of Epidemiology & Biostatistics, University of South Florida, Tampa, FL
| | | | | | | | - Janet Snell-Bergeon
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO.,Barbara Davis Center for Diabetes, Aurora, CO
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Ibanez-Bruron MC, Solebo AL, Cumberland PM, Rahi JS. Vulnerabilities in diabetic eye screening for children and young people in England. Pediatr Diabetes 2019; 20:932-940. [PMID: 31270908 DOI: 10.1111/pedi.12887] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/25/2019] [Accepted: 06/21/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Children and young people (CYP) living with diabetes require integrated child-centered care. We hypothesized that suboptimal uptake to diabetic retinopathy screening in CYP may be partly related to the degree of services integration. We investigated the structure of the current pediatric diabetic eye care pathway and associations between service-level characteristics and screening uptake. METHODS A quality improvement project between January and May 2017 comprising a survey of practice of all 158 pediatric diabetes services (pediatric diabetes units, PDUs) across England and secondary data analysis of routinely collected service data. Generalized linear models for proportional responses were fitted to investigate associations between reported PDU characteristics and screening uptake. RESULTS 124 PDUs (78%) responded. In 67% (n = 83), patients could be referred directly to screening programs; the remainder relied on primary care for onward referral. 97% (n = 120) considered eye screening results useful for counseling patients but only 65% (n = 81) reported it was "easy" to obtain them. Factors independently associated with higher screening uptake were a higher proportion of patients referred from primary care (OR = 1.005; 95%CI = 1.004-1.007 per 1% of increase), absence of "out-of-catchment area" patients (OR = 1.13; 95%CI = 1.04-1.22), and easy access to eye screening results (OR = 1.45; 95%CI = 1.34-1.56). CONCLUSIONS There is limited direct communication between the services involved in diabetic eye care for CYP in England. This risks reducing the effectiveness of diabetic retinopathy screening. Similar vulnerabilities are likely to exist in other countries where retinopathy screening for CYP has been "bolted on" to provision for adults.
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Affiliation(s)
- Maria C Ibanez-Bruron
- Great Ormond Street Institute of Child Health, University College London, London, UK.,Ulverscroft Vision Research Group, University College London Institute of Child Health, London, UK.,Department of Ophthalmology, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Ameenat L Solebo
- Great Ormond Street Institute of Child Health, University College London, London, UK.,Ulverscroft Vision Research Group, University College London Institute of Child Health, London, UK.,National Institute for Health Research Biomedical Research Centre, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Institute of Ophthalmology, University College London, London, UK
| | - Phillippa M Cumberland
- Great Ormond Street Institute of Child Health, University College London, London, UK.,Ulverscroft Vision Research Group, University College London Institute of Child Health, London, UK
| | - Jugnoo S Rahi
- Great Ormond Street Institute of Child Health, University College London, London, UK.,Ulverscroft Vision Research Group, University College London Institute of Child Health, London, UK.,National Institute for Health Research Biomedical Research Centre, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,National Institute for Health Research Biomedical Research Centre, Moorfields Eye Hospital NHS Foundation Trust, London, UK.,Institute of Ophthalmology, University College London, London, UK
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Wang Y, Xing L, Yu H, Zhao L. Prevalence of dental caries in children and adolescents with type 1 diabetes: a systematic review and meta-analysis. BMC Oral Health 2019; 19:213. [PMID: 31521152 PMCID: PMC6744653 DOI: 10.1186/s12903-019-0903-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 08/30/2019] [Indexed: 01/11/2023] Open
Abstract
Background Dental caries and type 1 diabetes are responsible for a large burden of global disease; however, the exact prevalence of dental caries among children and adolescents with type 1 diabetes remains controversial, and no quantitative meta-analysis exists. Thus, we performed a meta-analysis to evaluate the prevalence of dental caries among children and adolescents with type 1 diabetes. Methods We performed a systematic search strategy using PubMed, EMBASE and China National Knowledge Infrastructure for relevant studies investigating the prevalence of dental caries in children and adolescents with type 1 diabetes from July 1971 until December 2018. The pooled prevalence with 95% confidence intervals (95%CIs) and subgroup analyses were calculated using a random effects model. Results After screening 358 non-duplicated articles, a total of 10 articles involving 538 individuals were included. The overall prevalence of dental caries among children and adolescents with type 1 diabetes was 67% (95% CI: 0.56–0.77%; I2 = 83%). The prevalence was highest in South America (84%) and lowest in diabetic patients with good metabolic control (47%). Conclusions The prevalence of dental caries was high among children and adolescents with type 1 diabetes. Screening and preventive treatment should be included in dental clinical routines for diabetic children and adolescents, especially in those with poor metabolic control. Electronic supplementary material The online version of this article (10.1186/s12903-019-0903-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yan Wang
- Yan Tai Stomatological Hospital, No. 142 Beida Street Zhifu District, Yantai, 264008, Shandong, China
| | - Lin Xing
- Yan Tai Stomatological Hospital, No. 142 Beida Street Zhifu District, Yantai, 264008, Shandong, China.
| | - Hui Yu
- Yan Tai Stomatological Hospital, No. 142 Beida Street Zhifu District, Yantai, 264008, Shandong, China
| | - LiJuan Zhao
- Yan Tai Stomatological Hospital, No. 142 Beida Street Zhifu District, Yantai, 264008, Shandong, China
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Nakhla M, Rahme E, Simard M, Larocque I, Legault L, Li P. Risk of ketoacidosis in children at the time of diabetes mellitus diagnosis by primary caregiver status: a population-based retrospective cohort study. CMAJ 2019; 190:E416-E421. [PMID: 29632036 DOI: 10.1503/cmaj.170676] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Diabetic ketoacidosis is the leading cause of death among children with type 1 diabetes mellitus, and is an avoidable complication at first-time diagnosis of diabetes. Because having a usual provider of primary care is important in improving health outcomes for children, we tested the association between having a usual provider of care and risk of diabetic ketoacidosis at onset of diabetes. METHODS Using linked health administrative data for the province of Quebec, we conducted a population-based retrospective cohort study of children aged 1-17 years in whom diabetes was diagnosed from 2006 to 2015. We estimated adjusted risk ratios (RRs) for an episode of diabetic ketoacidosis at the time of diabetes diagnosis in relation to usual provider of care (family physician, pediatrician or none) using Poisson regression models with robust error variance. RESULTS We identified 3704 new cases of diabetes in Quebec children from 2006 to 2015. Of these, 996 (26.9%) presented with diabetic ketoacidosis. A decreased risk of this complication was associated with having a usual provider of care; the association was stronger with increasing age, reaching statistical significance among those aged 12-17 years. Within this age group, those who had a family physician or a pediatrician were 31% less likely (adjusted RR 0.69, 95% confidence interval [CI] 0.56-0.85) or 38% less likely (adjusted RR 0.62, 95% CI 0.45-0.86), respectively, to present with diabetic ketoacidosis, relative to those without a usual provider of care. INTERPRETATION For children with newly diagnosed diabetes, having a usual provider of care appears to be important in decreasing the risk of diabetic ketoacidosis at the time of diabetes diagnosis. Our results provide further evidence concerning the need for initiatives that promote access to primary care for children.
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Affiliation(s)
- Meranda Nakhla
- Department of Pediatrics (Nakhla, Legault, Li), The Montreal Children's Hospital, McGill University; Research Institute of the McGill University Health Centre (Nakhla, Rahme, Legault, Li), Montréal, Que.; Institut national de santé publique du Québec (Simard, Larocque), Québec, Que.
| | - Elham Rahme
- Department of Pediatrics (Nakhla, Legault, Li), The Montreal Children's Hospital, McGill University; Research Institute of the McGill University Health Centre (Nakhla, Rahme, Legault, Li), Montréal, Que.; Institut national de santé publique du Québec (Simard, Larocque), Québec, Que
| | - Marc Simard
- Department of Pediatrics (Nakhla, Legault, Li), The Montreal Children's Hospital, McGill University; Research Institute of the McGill University Health Centre (Nakhla, Rahme, Legault, Li), Montréal, Que.; Institut national de santé publique du Québec (Simard, Larocque), Québec, Que
| | - Isabelle Larocque
- Department of Pediatrics (Nakhla, Legault, Li), The Montreal Children's Hospital, McGill University; Research Institute of the McGill University Health Centre (Nakhla, Rahme, Legault, Li), Montréal, Que.; Institut national de santé publique du Québec (Simard, Larocque), Québec, Que
| | - Laurent Legault
- Department of Pediatrics (Nakhla, Legault, Li), The Montreal Children's Hospital, McGill University; Research Institute of the McGill University Health Centre (Nakhla, Rahme, Legault, Li), Montréal, Que.; Institut national de santé publique du Québec (Simard, Larocque), Québec, Que
| | - Patricia Li
- Department of Pediatrics (Nakhla, Legault, Li), The Montreal Children's Hospital, McGill University; Research Institute of the McGill University Health Centre (Nakhla, Rahme, Legault, Li), Montréal, Que.; Institut national de santé publique du Québec (Simard, Larocque), Québec, Que
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Wang J, Wang S, Wang W, Chen J, Zhang Z, Zheng Q, Liu Q, Cai L. Protection against diabetic cardiomyopathy is achieved using a combination of sulforaphane and zinc in type 1 diabetic OVE26 mice. J Cell Mol Med 2019; 23:6319-6330. [PMID: 31270951 PMCID: PMC6714218 DOI: 10.1111/jcmm.14520] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/20/2019] [Accepted: 06/15/2019] [Indexed: 12/17/2022] Open
Abstract
Sulforaphane (SFN) can effectively induce nuclear factor E2–related factor 2 (Nrf2), and zinc (Zn) can effectively induce metallothionein (MT), both of which have been shown to protect against diabetic cardiomyopathy (DCM). However, it is unclear whether combined treatment with SFN and Zn offers better cardiac protection than either one alone. Here, we treated 5‐week‐old OVE mice that spontaneously develop type 1 diabetes with SFN and/or Zn for 18 weeks. Cardiac dysfunction, by echocardiography, and pathological alterations and remodelling, shown by cardiac hypertrophy, fibrosis, inflammation and oxidative damage, examined by histopathology, Western blotting and real‐time PCR, were observed in OVE mice. All these dysfunction and pathological abnormalities seen in OVE mice were attenuated in OVE mice with treatment of either SFN, Zn or SFN/Zn, and the combined treatment with SFN/Zn was better than single treatments at ameliorating DCM. In addition, combined SFN and Zn treatment increased Nrf2 function and MT expression in the heart of OVE mice to a greater extent than SFN or Zn alone. This indicates that the dual activation of Nrf2 and MT by combined treatment with SFN and Zn may be more effective than monotherapy at preventing the development of DCM via complementary, additive mechanisms.
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Affiliation(s)
- Jiqun Wang
- The Center of Cardiovascular Diseases, The First Hospital of Jilin University, Changchun, China.,Pediatric Research Institute, Department of Pediatrics, University of Louisville, Louisville, Kentucky, USA
| | - Shudong Wang
- The Center of Cardiovascular Diseases, The First Hospital of Jilin University, Changchun, China
| | - Wanning Wang
- Pediatric Research Institute, Department of Pediatrics, University of Louisville, Louisville, Kentucky, USA.,Department of Nephrology, The First Hospital of Jilin University, Changchun, China
| | - Jing Chen
- Department of Otolaryngology, Stanford University, Palo Alto, California, USA
| | - Zhiguo Zhang
- The Center of Cardiovascular Diseases, The First Hospital of Jilin University, Changchun, China
| | - Qi Zheng
- Department of Bioinformatics and Biostatistics, University of Louisville, Louisville, Kentucky, USA
| | - Quan Liu
- The Center of Cardiovascular Diseases, The First Hospital of Jilin University, Changchun, China
| | - Lu Cai
- Pediatric Research Institute, Department of Pediatrics, University of Louisville, Louisville, Kentucky, USA.,Departments of Radiation Oncology, Pharmacology and Toxicology, University of Louisville, Louisville, Kentucky, USA
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Hamm NC, Pelletier L, Ellison J, Tennenhouse L, Reimer K, Paterson JM, Puchtinger R, Bartholomew S, Phillips KAM, Lix LM. Trends in chronic disease incidence rates from the Canadian Chronic Disease Surveillance System. Health Promot Chronic Dis Prev Can 2019; 39:216-224. [PMID: 31210047 PMCID: PMC6699608 DOI: 10.24095/hpcdp.39.6/7.02] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
INTRODUCTION The Public Health Agency of Canada's Canadian Chronic Disease Surveillance System (CCDSS) produces population-based estimates of chronic disease prevalence and incidence using administrative health data. Our aim was to assess trends in incidence rates over time, trends are essential to understand changes in population risk and to inform policy development. METHODS Incident cases of diagnosed asthma, chronic obstructive pulmonary disease (COPD), diabetes, hypertension, ischemic heart disease (IHD), and stroke were obtained from the CCDSS online infobase for 1999 to 2012. Trends in national and regional incidence estimates were tested using a negative binomial regression model with year as a linear predictor. Subsequently, models with year as a restricted cubic spline were used to test for departures from linearity using the likelihood ratio test. Age and sex were covariates in all models. RESULTS Based on the models with year as a linear predictor, national incidence rates were estimated to have decreased over time for all diseases, except diabetes; regional incidence rates for most diseases and regions were also estimated to have decreased. However, likelihood ratio tests revealed statistically significant departures from a linear year effect for many diseases and regions, particularly for hypertension. CONCLUSION Chronic disease incidence estimates based on CCDSS data are decreasing over time, but not at a constant rate. Further investigations are needed to assess if this decrease is associated with changes in health status, data quality, or physician practices. As well, population characteristics that may influence changing incidence trends also require exploration.
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Affiliation(s)
- Naomi C Hamm
- University of Manitoba, Winnipeg, Manitoba, Canada
| | | | | | | | - Kim Reimer
- British Columbia Ministry of Health, Victoria, British Columbia, Canada
| | | | - Rolf Puchtinger
- Ministry of Health, Government of Saskatchewan, Regina, Saskatchewan, Canada
| | | | - Karen A M Phillips
- Chief Public Health Office, Prince Edward Island Department of Health and Wellness, Charlottetown, Prince Edward Island, Canada
| | - Lisa M Lix
- University of Manitoba, Winnipeg, Manitoba, Canada
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Boucher SE, Gray AR, de Bock M, Wiltshire EJ, Galland BC, Tomlinson PA, Rayns J, MacKenzie KE, Wheeler BJ. Effect of 6 months' flash glucose monitoring in adolescents and young adults with type 1 diabetes and suboptimal glycaemic control: managing diabetes in a 'flash' randomised controlled trial protocol. BMC Endocr Disord 2019; 19:50. [PMID: 31109342 PMCID: PMC6528266 DOI: 10.1186/s12902-019-0378-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 05/09/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Teenagers and young adults with type 1 diabetes (T1D) experience significant burden managing this serious chronic condition and glycaemic control is at its unhealthiest during this life stage. Flash glucose monitoring (FGM) is a new technology that reduces the burden of glucose monitoring by easily and discreetly displaying glucose information when an interstitial glucose sensor worn on the upper arm is scanned with a handheld reader, as opposed to traditional capillary glucose sampling by finger prick (otherwise known as self-monitored blood glucose, SMBG). The effectiveness of this technology and impacts of its long-term use in youth with pre-existing suboptimal glycaemic control are unknown. This study therefore aims to investigate the effectiveness of FGM in addition to standard care in young people with T1D. METHODS This is a two phase study programme including a multi-centre randomised, parallel-group study consisting of a 6-month comparison between SMBG and FGM, with an additional 6-month continuation phase. We will enrol adolescents with T1D aged 13-20 years (inclusive), with suboptimal glycaemic control (mean glycated haemoglobin (HbA1c) in past 6 months ≥75 mmol/mol [≥9%]). Participants will be randomly allocated (1:1) to FGM (FreeStyle Libre; intervention group) or to continue SMBG with capillary blood glucose testing (usual care group). All participants will continue other aspects of standard care with the study only providing the FreeStyle Libre. At 6 months, the control group will cross over to the intervention. The primary outcome is the between group difference in changes in HbA1c at 6 months. Additional outcomes include a range of psychosocial and health economic measures as well as FGM acceptability. DISCUSSION >If improvements are found, this will further encourage steps towards integrating FGM into regular diabetes care for youth with unhealthy glycaemic control, with the expectation it will reduce daily diabetes management burden and improve short- and long-term health outcomes in this high-risk group. TRIAL REGISTRATION This trial was registered with the Australian New Zealand Clinical Trials Registry on 5 March 2018 ( ACTRN12618000320257p ) and the World Health Organization International Clinical Trials Registry Platform (Universal Trial Number U1111-1205-5784).
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Affiliation(s)
- Sara E. Boucher
- Department of Women’s and Children’s Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Andrew R. Gray
- Centre for Biostatistics, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Martin de Bock
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
- Paediatric Department, Canterbury District Health Board, Christchurch, New Zealand
| | - Esko J. Wiltshire
- Department of Paediatrics and Child Health, University of Otago Wellington, Wellington, New Zealand
- Paediatric Department, Capital and Coast District Health Board, Wellington, New Zealand
| | - Barbara C. Galland
- Department of Women’s and Children’s Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Paul A. Tomlinson
- Paediatric Department, Southern District Health Board, Invercargill, New Zealand
| | - Jenny Rayns
- Endocrinology Department, Southern District Health Board, Dunedin, New Zealand
| | - Karen E. MacKenzie
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
- Paediatric Department, Canterbury District Health Board, Christchurch, New Zealand
| | - Benjamin J. Wheeler
- Department of Women’s and Children’s Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Paediatric Department, Southern District Health Board, Dunedin, New Zealand
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Robinson ME, Li P, Rahme E, Simard M, Larocque I, Nakhla MM. Increasing prevalence of diabetic ketoacidosis at diabetes diagnosis among children in Quebec: a population-based retrospective cohort study. CMAJ Open 2019; 7:E300-E305. [PMID: 31088804 PMCID: PMC6517121 DOI: 10.9778/cmajo.20190047] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Diabetic ketoacidosis at type 1 diabetes diagnosis is a preventable life-threatening complication. Canadian data on the temporal trends of the prevalence of diabetic ketoacidosis at the onset of type 1 diabetes in children are unknown. We aimed to determine the temporal changes in diabetic ketoacidosis prevalence at diabetes diagnosis in Quebec. METHODS We conducted a population-based cohort study of children (aged 1-17 yr) living in Quebec who were diagnosed with diabetes between 2001 and 2014, using multiple health administrative linked databases available at the Institut national de santé publique du Québec through the Quebec Integrated Chronic Surveillance System. We used multivariate Poisson regression analysis with robust error variance to determine trends in the prevalence of diabetic ketoacidosis. RESULTS We found that 25.6% (1471/5741) of children presented with diabetic ketoacidosis at diabetes diagnosis. The incidence of diabetes was stable at 30 cases per 100 000 children per year during the study period. The age- and sex-standardized rates of diabetic ketoacidosis increased from 22% (95% confidence interval [CI] 17%-26%) in 2001 to 30% (95% CI 24%-36%) in 2014. The relative increase of diabetic ketoacidosis prevalence at diabetes diagnosis over the study period was 2.0% per year (rate ratio 1.02; 95% CI 1.01-1.03). INTERPRETATION Despite a stable incidence of type 1 diabetes, we found that the prevalence of diabetic ketoacidosis at diabetes onset increased between 2001 and 2014. Our findings are concerning and demonstrate a need to continue to campaign to recognize type 1 diabetes before diabetic ketoacidosis supervenes.
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Affiliation(s)
- Marie-Eve Robinson
- Divisions of Endocrinology (Robinson, Nakhla) and General Pediatrics (Li), Department of Pediatrics, McGill University Health Centre; Research Institute of the McGill University Health Centre (Li, Rahme, Nakhla), Montréal, Que.; Institut national de santé publique du Québec (Simard, Larocque), Québec, Que
| | - Patricia Li
- Divisions of Endocrinology (Robinson, Nakhla) and General Pediatrics (Li), Department of Pediatrics, McGill University Health Centre; Research Institute of the McGill University Health Centre (Li, Rahme, Nakhla), Montréal, Que.; Institut national de santé publique du Québec (Simard, Larocque), Québec, Que
| | - Elham Rahme
- Divisions of Endocrinology (Robinson, Nakhla) and General Pediatrics (Li), Department of Pediatrics, McGill University Health Centre; Research Institute of the McGill University Health Centre (Li, Rahme, Nakhla), Montréal, Que.; Institut national de santé publique du Québec (Simard, Larocque), Québec, Que
| | - Marc Simard
- Divisions of Endocrinology (Robinson, Nakhla) and General Pediatrics (Li), Department of Pediatrics, McGill University Health Centre; Research Institute of the McGill University Health Centre (Li, Rahme, Nakhla), Montréal, Que.; Institut national de santé publique du Québec (Simard, Larocque), Québec, Que
| | - Isabelle Larocque
- Divisions of Endocrinology (Robinson, Nakhla) and General Pediatrics (Li), Department of Pediatrics, McGill University Health Centre; Research Institute of the McGill University Health Centre (Li, Rahme, Nakhla), Montréal, Que.; Institut national de santé publique du Québec (Simard, Larocque), Québec, Que
| | - Meranda M Nakhla
- Divisions of Endocrinology (Robinson, Nakhla) and General Pediatrics (Li), Department of Pediatrics, McGill University Health Centre; Research Institute of the McGill University Health Centre (Li, Rahme, Nakhla), Montréal, Que.; Institut national de santé publique du Québec (Simard, Larocque), Québec, Que.
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Lawrence JM, Mayer-Davis EJ. What do we know about the trends in incidence of childhood-onset type 1 diabetes? Diabetologia 2019; 62:370-372. [PMID: 30569271 PMCID: PMC7341898 DOI: 10.1007/s00125-018-4791-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 11/16/2018] [Indexed: 01/14/2023]
Affiliation(s)
- Jean M Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 South Los Robles Avenue, 2nd floor, Pasadena, CA, 91101, USA.
| | - Elizabeth J Mayer-Davis
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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42
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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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Turtinen M, Härkönen T, Parkkola A, Ilonen J, Knip M. Sex as a determinant of type 1 diabetes at diagnosis. Pediatr Diabetes 2018; 19:1221-1228. [PMID: 29862628 DOI: 10.1111/pedi.12697] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 05/02/2018] [Accepted: 05/23/2018] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE The present study tested the hypothesis that girls have a more aggressive disease process than boys at the diagnosis of type 1 diabetes (T1D). METHODS Demographic and clinical characteristics, the humoral autoantibody profile, and the genetic risk assessed by the presence of human leukocyte antigen DR-DQ haplotypes were analyzed in terms of sex in 4993 children and adolescents diagnosed with T1D between January 2003 and December 2016. RESULTS A clear male preponderance (56.6%) was observed in our cohort and boys were significantly older than girls at clinical diagnosis (mean 8.3 vs 7.7 years, P < .001). Age-adjusted analyses showed a poorer metabolic decompensation in girls than boys at diagnosis. Boys tested more often positive for autoantibodies against insulin autoantibodies (P = .008), islet antigen-2 autoantibodies (P = .033), and zinc transporter 8 autoantibodies (P = .027), whereas girls had a higher frequency of glutamic acid decarboxylase autoantibodies (GADA) (P < .001) and higher GADA (P < .001) and islet cell antibody titers (P = .001). We did not find any significant differences in the genetic risk profile between girls and boys. CONCLUSIONS Our data show that the metabolic derangement is more severe in girls already at diagnosis of T1D and this finding is independent of age. The immunologic aggressiveness of the disease is more variable as the predominance of different autoantibodies varies between sexes with a higher frequency of GADA in girls, while the 3 other biochemical autoantibodies were more common in boys.
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Affiliation(s)
- Maaret Turtinen
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - Taina Härkönen
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - Anna Parkkola
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland
| | - Jorma Ilonen
- Immunogenetics Laboratory, Institute of Biomedicine, University of Turku, Turku, Finland.,Department of Clinical Microbiology, Turku University Hospital, Turku, Finland
| | - Mikael Knip
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.,Research Programs Unit, Diabetes and Obesity, University of Helsinki, Helsinki, Finland.,Folkhälsan Research Center, Helsinki, Finland.,Tampere Center for Child Health Research, Tampere University Hospital, Tampere, Finland
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