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Alazwari A, Tafakori L, Johnstone A, Abdollahian M. Modeling the number of new cases of childhood type 1 diabetes using Poisson regression and machine learning methods; a case study in Saudi Arabia. PLoS One 2025; 20:e0321480. [PMID: 40279367 PMCID: PMC12027261 DOI: 10.1371/journal.pone.0321480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 03/06/2025] [Indexed: 04/27/2025] Open
Abstract
Diabetes mellitus stands out as one of the most prevalent chronic conditions affecting pediatric populations. The escalating incidence of childhood type 1 diabetes (T1D) globally is a matter of increasing concern. Developing an effective model that leverages Key Performance Indicators (KPIs) to understand the incidence of T1D in children would significantly assist medical practitioners in devising targeted monitoring strategies. This study models the number of monthly new cases of T1D and its associated KPIs among children aged 0 to 14 in Saudi Arabia. The study involved collecting de-identified data (n=377) from diagnoses made between 2010 and 2020, sourced from pediatric diabetes centers in three cities across Saudi Arabia. Poisson regression (PR), and various machine learning (ML) techniques, including random forest (RF), support vector machine (SVM), and K-nearest neighbor (KNN), were employed to model the monthly number of new T1D cases using the local data. The performance of these models was assessed using both numbers of KPIs and metrics such as the coefficient of determination ([Formula: see text]), root mean squared error (RMSE), and mean absolute error (MAE). Among various Poisson and ML models, both model considering birth weight over 3.5 kg, maternal age over 25 years at the child's birth, family history of T1D, and nutrition history, specifically early introduction to cow milk and model taking into account birth weight over 3.5 kg, maternal age over 25 years at the child's birth, and nutrition history (early introduction to cow milk) emerged as the best-reduced models. They achieved [Formula: see text] of (0.89,0.88), RMSE (0.82, 0.95) and MAE(0.62,0.67). Additionally, models with fewer KPIs, like model that considers maternal age over 25 years and early introduction to cow milk, achieved consistently high [Formula: see text] values ranging from 0.80 to 0.83 across all models. Notably, this model demonstrated smaller values of RMSE (0.92) and MAE (0.67) in the KNN model. Simplified models facilitate the efficient creation and monitoring of KPIs profiles. The findings can assist healthcare providers in collecting and monitoring influential KPIs, enabling the development of targeted strategies to potentially reduce, or reverse, the increasing incidence rate of childhood T1D in Saudi Arabia.
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Affiliation(s)
- Ahood Alazwari
- School of Science, RMIT University, Melbourne, Victoria, Australia
- School of Science, Al-Baha University, Al-Baha, Saudi Arabia
| | - Laleh Tafakori
- School of Science, RMIT University, Melbourne, Victoria, Australia
| | - Alice Johnstone
- School of Science, RMIT University, Melbourne, Victoria, Australia
| | - Mali Abdollahian
- School of Science, RMIT University, Melbourne, Victoria, Australia
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Szabłowski M, Klimas P, Wiktorzak N, Okruszko M, Peczyńska J, Jamiołkowska-Sztabkowska M, Borysewicz-Sańczyk H, Polkowska A, Zasim A, Noiszewska K, Bossowski A, Głowińska-Olszewska B. Epidemiology of type 1 diabetes in Podlasie region, Poland, in years 2010-2022 - 13-years-single-center study, including COVID-19 pandemic perspective. Pediatr Endocrinol Diabetes Metab 2025; 31:9-16. [PMID: 40353383 PMCID: PMC12051105 DOI: 10.5114/pedm.2025.149201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2025] [Accepted: 03/10/2025] [Indexed: 05/14/2025]
Abstract
INTRODUCTION Diabetes is undeniably a pandemic of the 21st century. Although type 1 diabetes mellitus (T1DM) only represents 10% of all diabetes cases, it dominates the pediatric population. The number of T1DM cases is accelerating, and Poland is one of the countries with the fastest increase in incidence. AIM OF THE STUDY To evaluate the epidemiological situation in T1DM in Podlaskie region, Poland. MATERIAL AND METHODS The study included 777 patients (369 girls and 408 boys) under 18. Incidence rates were calculated and standardized to an age-matched population (general population of Poland 2010). RESULTS We showed an upward trend in the number of cases during the analyzed period (R2 = 0.6, p = 0.001). The average incidence rate grew during the study period from 19.22/100,000 in 2010 to 34.11/100,000 in 2022, a 1.77-fold increase over the study period. The youngest age group (0-4 years old) showed the most prominent, nearly 2.3-fold rise, from 9.86/100,000 in 2010 to 22.56/100,000 in 2022. We have also demonstrated the possible impact of the COVID pandemic - after a decrease in 2020 we observed an increase of the incidence rate in 2021 up to 38.05/100,000 and in 2022 to 34/100,000. CONCLUSIONS The incidence of type 1 diabetes in Podlaskie Voivodeship, Poland, continues its upward trend. Various factors may influence this, but the potential impact of the COVID-19 pandemic is worth considering.
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Affiliation(s)
- Maciej Szabłowski
- Clinical Research Centre, Medical University of Bialystok, Poland
- Department of Endocrinology, Diabetology and Internal Medicine, Medical University of Bialystok, Poland
- Department of Pediatrics, Endocrinology, Diabetology with Cardiology Division, Medical University of Bialystok, Poland
| | - Paweł Klimas
- Department of Pediatrics, Endocrinology, Diabetology with Cardiology Division, Medical University of Bialystok, Poland
| | - Natalia Wiktorzak
- Department of Pediatrics, Endocrinology, Diabetology with Cardiology Division, Medical University of Bialystok, Poland
| | - Michał Okruszko
- Department of Pediatrics, Endocrinology, Diabetology with Cardiology Division, Medical University of Bialystok, Poland
| | - Joanna Peczyńska
- Department of Pediatrics, Endocrinology, Diabetology with Cardiology Division, Medical University of Bialystok, Poland
| | | | - Hanna Borysewicz-Sańczyk
- Department of Pediatrics, Endocrinology, Diabetology with Cardiology Division, Medical University of Bialystok, Poland
| | - Agnieszka Polkowska
- Department of Pediatrics, Endocrinology, Diabetology with Cardiology Division, Medical University of Bialystok, Poland
| | - Aneta Zasim
- Department of Pediatrics, Endocrinology, Diabetology with Cardiology Division, Medical University of Bialystok, Poland
| | - Klaudyna Noiszewska
- Department of Pediatrics, Endocrinology, Diabetology with Cardiology Division, Medical University of Bialystok, Poland
| | - Artur Bossowski
- Department of Pediatrics, Endocrinology, Diabetology with Cardiology Division, Medical University of Bialystok, Poland
| | - Barbara Głowińska-Olszewska
- Department of Pediatrics, Endocrinology, Diabetology with Cardiology Division, Medical University of Bialystok, Poland
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Brzuszek M, Kochman M, Mazur A. Psychodiabetology: The Challenge of the Future? J Clin Med 2024; 13:2236. [PMID: 38673509 PMCID: PMC11051208 DOI: 10.3390/jcm13082236] [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: 03/13/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
The number of people suffering from diabetes, including type 1, is constantly increasing both in Poland and worldwide. Type 1 diabetes is a chronic disease characterized by uncertain prognosis and relapses, as well as permanent, irreversible, and progressive changes in health status. The ongoing disease results in dysfunction or disability, and the patient requires specialized supervision, care, and rehabilitation. However, the success of therapy does not depend solely on the perfection of treatment, but also on the patient's readiness to change their lifestyle and cooperate with the therapeutic team. The patient's constant alertness in making therapeutic decisions does not always lead to expected treatment results, and the risk of hypoglycemia associated with intensive insulin treatment depletes the patient's motivation for treatment, leading over time to the development of 'therapeutic burnout' and psychiatric disorders. This narrative review is an attempt to summarize the knowledge and possible future solutions in diabetes type 1 in Poland as well as highlight the importance of comprehensive care, including psychological care, which appears fundamental in a chronic disease such as type 1 diabetes. Therefore, the aim of the study was to present generational changes and psychosocial problems of patients with type 1 diabetes and to identify urgent challenges in diabetic care. Attention should be paid to the deteriorating mental condition of the young generations, who, in the course of diabetes, are exposed to additional psychological and psychiatric health problems. The next generation of patients will require more psychological care, which is why the challenge of the future is to create psychodiabetology centers.
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Affiliation(s)
- Marta Brzuszek
- Institute of Health Sciences, College of Medical Sciences, University of Rzeszów, ul. Warzywna 1a, 35-310 Rzeszów, Poland
| | - Maciej Kochman
- Department of Physiotherapy, Institute of Health Sciences, College of Medical Sciences, University of Rzeszów, ul. Marszałkowska 24, 35-215 Rzeszów, Poland
| | - Artur Mazur
- Institute of Medical Science, College of Medical Sciences, University of Rzeszów, ul. Warzywna 1a, 35-215 Rzeszów, Poland
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Zhang S, Mittinty M, Davis EA, Cameron E, Haynes A. Childhood-onset type 1 diabetes in Western Australia: An update on incidence and temporal trends from 2001 to 2022. Diabet Med 2023; 40:e15148. [PMID: 37191883 DOI: 10.1111/dme.15148] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/21/2023] [Accepted: 05/12/2023] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To determine the incidence and incidence trends over 2001-2022 of childhood-onset type 1 diabetes (T1D) in Western Australia and assess the impact of the COVID-19 pandemic. METHODS Children newly diagnosed with T1D aged 0-14 years in Western Australia from 1 January 2001 to 31 December 2022 were identified from the population-based Western Australian Children's Diabetes Database. Annual age- and sex-specific incidence was calculated, and Poisson regression was used to analyse trends by calendar year, month, sex and age group at diagnosis. Pandemic era impacts were also examined using the regression model adjusted for sex and age group. RESULTS Between 2001 and 2022, 2311 children (1214 boys, 1097 girls) were newly diagnosed with T1D aged 0-14 years, giving an overall mean annual incidence of 22.9 per 100,000 person-years (95% CI: 22.0, 23.9), with no significant difference observed between boys and girls. A significant linear increasing trend was only observed in 10-14 year olds with boys and girls combined (1.2% per year [IRR 1.012 (95% CI: 1.002, 1.022)]). No significant difference in the incidence was observed between the pre- and post-pandemic period. CONCLUSIONS The incidence of type 1 diabetes in 0-14 year old Western Australian children continues to increase in the oldest age group. Longer term monitoring of the incidence during the COVID-19 pandemic is needed to determine its impact on this globally unique population which experienced a delayed start to the pandemic with severe containment measures remaining in place until January 2022.
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Affiliation(s)
- Song Zhang
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- School of Public Health, The University of Adelaide, Adelaide, Southern Australia, Australia
| | - Murthy Mittinty
- College of Medicine and Public Health, Flinders University, Adelaide, Southern Australia, Australia
| | - Elizabeth A Davis
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Perth, Western Australia, Australia
- Division of Paediatrics, Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Ewan Cameron
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- Faculty of Health Sciences, Curtin University, Bentley, Western Australia, Australia
| | - Aveni Haynes
- Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
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Li Y, Qian K, Wu D, Wang X, Cui H, Yuan G, Yuan J, Yang L, Wei L, Cao B, Su C, Liang X, Liu M, Li W, Qin M, Chen J, Meng X, Wang R, Su S, Chen X, Chen H, Gong C. Incidence of Childhood Type 1 Diabetes in Beijing During 2011-2020 and Predicted Incidence for 2025-2035: A Multicenter, Hospitalization-Based Study. Diabetes Ther 2023; 14:519-529. [PMID: 36701106 PMCID: PMC9879256 DOI: 10.1007/s13300-023-01367-8] [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: 10/13/2022] [Accepted: 01/09/2023] [Indexed: 01/27/2023] Open
Abstract
INTRODUCTION China has a low incidence of type 1 diabetes mellitus (T1DM); however, based on the large population, the absolute numbers are high. Our aim was to assess the incidence of childhood T1DM in Beijing during 2011-2020, predicted incidence for 2025-2035, and to determine the incidence of diabetic ketosis or diabetic ketoacidosis (DK/DKA) in this population. METHODS Data on patients aged less than 15 years of age with newly diagnosed T1DM between January 1, 2011 and December 31, 2020 was obtained from five tertiary hospitals in Beijing and retrospectively analyzed. RESULTS In all, 636 children aged less than 15 years were diagnosed with T1DM during 2011-2020. The incidence of T1DM was 3.11-5.46 per 100,000 per year, with an average increase of 5.10% per year. The age-specific incidence for ages 0-4 years, 5-9 years, and 10-14 years was 2.97, 4.69, and 4.68 per 100,000 per year, respectively. The highest average annual increase (7.07%) in incidence was for the youngest age group. DK or DKA was present at the time of diagnosis of T1DM in 84.6% of patients. The age-specific incidence of T1DM among children aged less than 15 years was predicted to be 7.32, 11.4, and 11.52 per 100,000 in 2035 for ages 0-4 years, 5-9 years, and 10-14 years, respectively. CONCLUSIONS The was a gentle increase in the incidence of childhood T1DM during 2011-2020 in Beijing. This increase is expected to continue for the next 15 years.
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Affiliation(s)
- Yuchuan Li
- Outpatient Department, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Kun Qian
- Department of Endocrinology, Capital Institute of Pediatrics, No. 2 Yaobao Road Chaoyang District, Beijing, 100020, China
| | - Di Wu
- Department of Endocrinology, Genetics and Metabolism, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Xinli Wang
- Department of Pediatrics, Third Hospital Peking University, Beijing, 100191, China
| | - Hong Cui
- Department of Pediatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Geheng Yuan
- Department of Endocrinology, Peking University First Hospital, Beijing, 100034, China
| | - Jinfang Yuan
- Department of Pediatrics, Third Hospital Peking University, Beijing, 100191, China
| | - Lijun Yang
- Department of Pediatrics, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Liya Wei
- Department of Endocrinology, Genetics and Metabolism, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Bingyan Cao
- Department of Endocrinology, Genetics and Metabolism, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Chang Su
- Department of Endocrinology, Genetics and Metabolism, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Xuejun Liang
- Department of Endocrinology, Genetics and Metabolism, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Min Liu
- Department of Endocrinology, Genetics and Metabolism, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Wenjing Li
- Department of Endocrinology, Genetics and Metabolism, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Miao Qin
- Department of Endocrinology, Genetics and Metabolism, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Jiajia Chen
- Department of Endocrinology, Genetics and Metabolism, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Xi Meng
- Department of Endocrinology, Genetics and Metabolism, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Rui Wang
- Department of Endocrinology, Genetics and Metabolism, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Shan Su
- Department of Endocrinology, Genetics and Metabolism, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Xiaobo Chen
- Department of Endocrinology, Capital Institute of Pediatrics, No. 2 Yaobao Road Chaoyang District, Beijing, 100020, China.
| | - Hui Chen
- School of Biomedical Engineering, Capital Medical University, No. 10 Youanmenwai Xitoutiao, Fengtai District, Beijing, 100069, China.
| | - Chunxiu Gong
- Department of Endocrinology, Genetics and Metabolism, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No. 56 Nanlishi Road, Xicheng District, Beijing, 100045, China.
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Kącka A, Charemska A, Jarocka-Cyrta E, Głowińska-Olszewska B. Comparison of novel markers of metabolic complications and cardiovascular risk factors between obese non-diabetic and obese type 1 diabetic children and young adults. Front Endocrinol (Lausanne) 2022; 13:1036109. [PMID: 36578961 PMCID: PMC9791985 DOI: 10.3389/fendo.2022.1036109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 11/03/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction For the past years, the prevalence of obesity is growing in the general population of children, as well as among diabetic patients, resulting in increased risk of cardiovascular complications. Type 1 diabetes mellitus (T1DM) is one of the most common chronic diseases in children and young adults, leading to decreased life quality and lifespan, with obesity being recognized recently as a major contributing factor to these health problems. The objective of this study was to analyze and compare the selected novel markers for metabolic complications of obesity and vascular risk factors between obese non-diabetic and obese T1DM children and young adults. Methods One hundred four subjects, aged between 10 and 24 years (31 with T1DM and excessive body weight, 41 with obesity without diabetes, and 32 with T1DM and normal weight), and 32 matched lean controls were included in the study. Clinical characteristics, blood pressure measurements, daily requirement for insulin, HbA1c%, plasma lipids, fetuin-A, E-selectin, and osteoprotegerin levels were compared with respect to body mass index (BMI), body mass index standard deviation score (BMI-SDS), and carotid intima-media thickness (cIMT) of common carotid arteries. Results Patients with T1DM and excessive body weight compared to non-diabetic obese subjects had similar values of systolic blood pressure (125.6 ± 8.2 vs. 127.3 ± 12.9 mmHg, p = 0.515), diastolic blood pressure (78.19 ± 7.03 vs. 78.02 ± 8.01 mmHg, p = 0.918), cholesterol (175.26 ± 34.1 vs. 163.51 ± 26.08 mg/dl, p = 0.102), LDL (108.03 ± 32.55 vs. 112.22 ± 26.36 mg/dl, p = 0.548), and triglyceride levels (118.19 ± 71.20 vs. 117 ± 55.80 mg/dl, p = 0.937); all values were found to be higher compared to non-obese T1DM and healthy controls. HbA1c level and insulin resistance indices were significantly worse in T1DM obese vs. T1DM non-obese patients. Fetuin-A levels were higher among obese non-diabetic patients (p = 0.01), and E-selectin and osteoprotegerin levels were similar in both groups with obesity, but higher than in the reference group. There were no statistical differences in cIMT with T1DM with normal weight, excessive weight, and non-diabetic obese children; however, the cIMT value was higher compared to the reference group. Discussion Novel markers of metabolic complications of obesity are similar between obese T1DM and non-diabetic subjects. Obesity in patients with T1DM results in worse metabolic control, insulin resistance, and increased risk for vascular complications.
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Affiliation(s)
- Anna Kącka
- Department of Clinical Pediatrics, Faculty of Medical Sciences, University of Warmia and Mazury in Olsztyn, Provincial Specialist Children’s Hospital, Olsztyn, Poland
| | - Anna Charemska
- Department of Clinical Pediatrics, Faculty of Medical Sciences, University of Warmia and Mazury in Olsztyn, Provincial Specialist Children’s Hospital, Olsztyn, Poland
| | - Elżbieta Jarocka-Cyrta
- Department of Clinical Pediatrics, Faculty of Medical Sciences, University of Warmia and Mazury in Olsztyn, Provincial Specialist Children’s Hospital, Olsztyn, Poland
| | - Barbara Głowińska-Olszewska
- Department of Pediatrics, Endocrinology, Diabetology with Cardiology Division, Medical University of Białystok, Białystok, Poland
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Flotyńska J, Jaz K, Cieluch A, Grzelka-Woźniak A, Kaczmarek A, Pypeć A, Ciepłucha W, Nowicka A, Zozulińska-Ziółkiewicz D, Uruska A. Association between physical activity before diagnosis and the presence of clinical remission in type 1 diabetes - InlipoDiab1 study. Diabetes Metab Res Rev 2022; 38:e3510. [PMID: 34729892 DOI: 10.1002/dmrr.3510] [Citation(s) in RCA: 3] [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: 07/14/2021] [Accepted: 10/25/2021] [Indexed: 11/11/2022]
Abstract
AIM To investigate whether physical activity is associated with the occurrence of remission in adults with type 1 diabetes. METHODS Ninety nine adult participants with newly diagnosed type 1 diabetes were enroled into a prospective, observational study. The participants were advised to exercise 2-3 times a week with moderate intensity for a one-year period. Physical activity was assessed by a self-administrated questionnaire on every fourth visit. We counted the months in which participants fulfiled a partial-remission criteria: HbA1c < 6.5%, C-peptide > 0.5 ng/ml, and daily dose of insulin <0.3 U/kg/day. We assigned the participants to two groups: MORE EFFORT and LESS EFFORT, depending on the median value of physical activity in the studied population. RESULTS The occurrence of the remission achieved statistical significance at 6th month with a greater prevalence in MORE EFFORT group (55% vs. 35% p = 0.047). In multivariate logistic regression analysis for the occurrence of remission at 12th month, physical activity before the diagnosis was the only variable that influences the occurrence of the remission (adjusted odds ratios = 3.32 [95% confidence intervals 1.25-8.80]; p = 0.02). CONCLUSION In adults with newly diagnosed type 1 diabetes physical activity before the diagnosis is associated with higher occurrence of remission.
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Affiliation(s)
- Justyna Flotyńska
- Department of Internal Medicine and Diabetology, Raszeja Hospital, Poznan, Poland
| | - Kamila Jaz
- Department of Internal Medicine and Diabetology, Raszeja Hospital, Poznan, Poland
| | - Aleksandra Cieluch
- Department of Internal Medicine and Diabetology, Raszeja Hospital, Poznan, Poland
| | | | - Anita Kaczmarek
- Department of Internal Medicine and Diabetology, Raszeja Hospital, Poznan, Poland
| | - Aleksandra Pypeć
- Department of Internal Medicine and Diabetology, Raszeja Hospital, Poznan, Poland
| | - Wiktoria Ciepłucha
- Department of Internal Medicine and Diabetology, Raszeja Hospital, Poznan, Poland
| | - Aleksandra Nowicka
- Department of Internal Medicine and Diabetology, Raszeja Hospital, Poznan, Poland
| | | | - Aleksandra Uruska
- Department of Internal Medicine and Diabetology, Raszeja Hospital, Poznan, Poland
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8
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Zubkiewicz-Kucharska A, Noczyńska A, Sobieszczańska M, Poręba M, Chrzanowska J, Poręba R, Seifert M, Janocha A, Laszki-Szcząchor K. Disturbances in the intraventricular conduction system in teenagers with type 1 diabetes. A pilot study. J Diabetes Complications 2021; 35:108043. [PMID: 34538554 DOI: 10.1016/j.jdiacomp.2021.108043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 07/01/2021] [Accepted: 08/29/2021] [Indexed: 11/28/2022]
Abstract
UNLABELLED Body Surface Potential Mapping (BSPM) is a multi-electrode synchronous method for examining electrocardiographic records on the patients' body surface that allows the assessment of changes in the heart conduction system. The aim of the study was to visualize and evaluate changes in the intraventricular system in adolescents with T1D. PATIENTS AND METHODS Inclusion criteria: age > 12 years, T1D duration >3 years, HbA1c >8%. EXCLUSION CRITERIA diagnosis of autonomic neuropathy, heart structural defects, heart failure. BSPM data were processed into map plotting to illustrate differences in ventricular activation time (VAT, isochron lines). RESULTS 33 teenagers (20 boys), mean age 15.0 ± 2.1 years, T1D from 6.8 ± 4.1 years were included. Mean HbA1c was 9.6 ± 2.0%. In the standard ECG recording abnormalities were not present. The distribution of isolines on the group-mean map plotted for T1D patients only initially resembles the course of isolines on the group-map for normal subjects (N = 30), in whom the electrical impulse stimulating the heart ventricles passes through the atrio-ventricular node, then symmetrically excites the branches of His bundle and finally the Purkinje fibers. In T1D patients, after proper onset of intraventricular stimulation, the isolines reflecting the both ventricles reach higher time values, which indicates problems in the propagation of the ventricular depolarization.
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Affiliation(s)
- Agnieszka Zubkiewicz-Kucharska
- Department of Pediatric Endocrinology and Diabetology, Wrocław Medical University, Chałubińskiego Str. 2a, 50-368 Wrocław, Poland.
| | - Anna Noczyńska
- Department of Pediatric Endocrinology and Diabetology, Wrocław Medical University, Chałubińskiego Str. 2a, 50-368 Wrocław, Poland
| | - Małgorzata Sobieszczańska
- Department and Clinic of Geriatrics, Wrocław Medical University, Skłodowskiej-Curie Str. 66, 50-369 Wrocław, Poland
| | - Małgorzata Poręba
- Department of Pathophysiology, Wrocław Medical University, Marcinkowskiego Str. 1, 50-368 Wrocław, Poland
| | - Joanna Chrzanowska
- Department of Pediatric Endocrinology and Diabetology, Wrocław Medical University, Chałubińskiego Str. 2a, 50-368 Wrocław, Poland
| | - Rafał Poręba
- Department and Clinic of Internal and Occupational Diseases and Hypertension, Wrocław Medical University, Borowska Str. 213, 50-556 Wrocław, Poland
| | - Monika Seifert
- Department of Pediatric Endocrinology and Diabetology, Wrocław Medical University, Chałubińskiego Str. 2a, 50-368 Wrocław, Poland
| | - Anna Janocha
- Department of Pathophysiology, Wrocław Medical University, Marcinkowskiego Str. 1, 50-368 Wrocław, Poland
| | - Krystyna Laszki-Szcząchor
- Department of Pathophysiology, Wrocław Medical University, Marcinkowskiego Str. 1, 50-368 Wrocław, Poland
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Hohendorff J, Gumprecht J, Mysliwiec M, Zozulinska-Ziolkiewicz D, Malecki MT. Intermittently Scanned Continuous Glucose Monitoring Data of Polish Patients from Real-Life Conditions: More Scanning and Better Glycemic Control Compared to Worldwide Data. Diabetes Technol Ther 2021; 23:577-585. [PMID: 33794101 PMCID: PMC8377514 DOI: 10.1089/dia.2021.0034] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Background: Randomized trials and observational studies have shown that the use of FreeStyle Libre® intermittently scanned continuous glucose monitoring system (isCGMS) is associated with improved glycemic indices and quality of life. Materials and Methods: In this retrospective, real-world data analysis, we described country-specific glucometrics among isCGMS users from Poland and compared them with international data. The analyzed time period for the Polish data ranged between August 2016 and August 2020, and the analyzed time period for the international data ranged from September 2014 to August 2020. Results: Data from the Polish population were collected from 10,679 readers and 92,627 sensors with 113 million automatically recorded glucose readings. The worldwide database included information from 981,876 readers and 11,179,229 sensors with 13.1 billion glucose readings. On average, the users of isCGMS from Poland performed substantially more scans/day (21.2 ± 14.2 vs. 13.2 ± 10.7), achieved lower eHbA1c (7.0% ± 1.2% vs. 7.5% ± 1.5%), and spent more time-in-range (TIR) (64.2% ± 17.3% vs. 58.1% ± 20.3%) and less time-above-range (TAR) (29.7% ± 18.0% vs. 36.6% ± 21.3%) (P < 0.0001 for all comparisons). Moreover, they were more likely to achieve TIR >70% (36.3% vs. 28.8%), but spent more time-below-range (TBR) (4.7% vs. 3.6%). Our results confirmed that analyzed glucometrics improve as the scan rate frequency increases. However, at a similar scanning frequency to the comparative group, users from Poland achieved lower eHbA1c, higher TIR, and lower TAR, but higher TBR. Conclusions: We report more scanning and better glycemic control in isCGMS users in Poland than worldwide. The cause of this observation remains unknown. Our data also show that in real-life practice, a large number of patients may be willing to perform scanning more frequently than it is usually assumed.
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Affiliation(s)
- Jerzy Hohendorff
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
| | - Janusz Gumprecht
- Department of Internal Medicine, Diabetology and Nephrology, Medical University of Silesia, Katowice, Poland
| | - Malgorzata Mysliwiec
- Department of Pediatrics, Diabetology and Endocrinology, Medical University of Gdansk, Poland
| | | | - Maciej Tadeusz Malecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland
- Address correspondence to: Maciej Tadeusz Malecki, MD, PhD, Department of Metabolic Diseases, Jagiellonian University Medical College, 2 Jakubowskiego Street, Krakow 30-688, Poland
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Mameli C, Ghezzi M, Mari A, Cammi G, Macedoni M, Redaelli FC, Calcaterra V, Zuccotti G, D’Auria E. The Diabetic Lung: Insights into Pulmonary Changes in Children and Adolescents with Type 1 Diabetes. Metabolites 2021; 11:69. [PMID: 33530418 PMCID: PMC7912250 DOI: 10.3390/metabo11020069] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 12/13/2022] Open
Abstract
Historically, the lung was not listed and recognized as a major target organ of diabetic injury. The first evidence of diabetic lung involvement was published fifty years ago, with a study conducted in a population of young adults affected by type 1 diabetes (T1D). In recent years, there has been mounting evidence showing that the lung is a target organ of diabetic injury since the beginning of the disease-at the pediatric age. The deeply branched vascularization of the lungs and the abundance of connective tissue, indeed, make them vulnerable to the effects of hyperglycemia, in a way similar to other organs affected by microvascular complications. In this review, we focus on pulmonary function impairment in children and adolescents affected by T1D. We also cover controversial aspects regarding available studies and future perspectives in this field.
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Affiliation(s)
- Chiara Mameli
- Department of Pediatrics, V. Buzzi Children’s Hospital, 20154 Milan, Italy; (M.G.); (A.M.); (G.C.); (M.M.); (F.C.R.); (V.C.); (G.Z.); (E.D.)
- Department of Biomedical and Clinical Science “L. Sacco”, Università di Milano, 20157 Milan, Italy
| | - Michele Ghezzi
- Department of Pediatrics, V. Buzzi Children’s Hospital, 20154 Milan, Italy; (M.G.); (A.M.); (G.C.); (M.M.); (F.C.R.); (V.C.); (G.Z.); (E.D.)
- Allergology and Pneumology Unit, V. Buzzi Children’s Hospital, 20154 Milan, Italy
| | - Alessandra Mari
- Department of Pediatrics, V. Buzzi Children’s Hospital, 20154 Milan, Italy; (M.G.); (A.M.); (G.C.); (M.M.); (F.C.R.); (V.C.); (G.Z.); (E.D.)
| | - Giulia Cammi
- Department of Pediatrics, V. Buzzi Children’s Hospital, 20154 Milan, Italy; (M.G.); (A.M.); (G.C.); (M.M.); (F.C.R.); (V.C.); (G.Z.); (E.D.)
| | - Maddalena Macedoni
- Department of Pediatrics, V. Buzzi Children’s Hospital, 20154 Milan, Italy; (M.G.); (A.M.); (G.C.); (M.M.); (F.C.R.); (V.C.); (G.Z.); (E.D.)
| | - Francesca Chiara Redaelli
- Department of Pediatrics, V. Buzzi Children’s Hospital, 20154 Milan, Italy; (M.G.); (A.M.); (G.C.); (M.M.); (F.C.R.); (V.C.); (G.Z.); (E.D.)
| | - Valeria Calcaterra
- Department of Pediatrics, V. Buzzi Children’s Hospital, 20154 Milan, Italy; (M.G.); (A.M.); (G.C.); (M.M.); (F.C.R.); (V.C.); (G.Z.); (E.D.)
- Pediatric and Adolescent Unit, Department of Internal Medicine, University of Pavia, 27100 Pavia, Italy
| | - Gianvincenzo Zuccotti
- Department of Pediatrics, V. Buzzi Children’s Hospital, 20154 Milan, Italy; (M.G.); (A.M.); (G.C.); (M.M.); (F.C.R.); (V.C.); (G.Z.); (E.D.)
- Department of Biomedical and Clinical Science “L. Sacco”, Università di Milano, 20157 Milan, Italy
| | - Enza D’Auria
- Department of Pediatrics, V. Buzzi Children’s Hospital, 20154 Milan, Italy; (M.G.); (A.M.); (G.C.); (M.M.); (F.C.R.); (V.C.); (G.Z.); (E.D.)
- Allergology and Pneumology Unit, V. Buzzi Children’s Hospital, 20154 Milan, Italy
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11
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Butalia S, McGuire KA, Dyjur D, Mercer J, Pacaud D. Youth with diabetes and their parents' perspectives on transition care from pediatric to adult diabetes care services: A qualitative study. Health Sci Rep 2020; 3:e181. [PMID: 32782975 PMCID: PMC7410016 DOI: 10.1002/hsr2.181] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/28/2020] [Accepted: 07/09/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND AIMS When youth with diabetes transition from pediatric to adult diabetes care, they are at high risk for loss to follow up and worsening glucose control. We aimed to gain insight on how to improve the transition of youth with type 1 diabetes from pediatric to adult diabetes care from the patients' and parents' perspective. METHODS We conducted focus groups in youth with type 1 diabetes in transition from pediatric to adult diabetes care and their parents, in Calgary, Alberta, between June and August 2014. Eligibility criteria included: (a) type 1 diabetes; (b) aged 15 to 25 years; (c) have or had received care at the pediatric hospital; and, (d) either pre or post-transfer; or, (e) parents of recently transferred youth. Purposive sampling was used, and the theoretical framework used was the Integrated Behaviour Model. Participants were asked about positive, negative, or challenging experiences related to diabetes and transition, solutions to challenges, and tools and strategies to improve and better support transition. Thematic analysis was conducted after focus groups were recorded and transcribed. RESULTS Three focus groups were conducted: pre-transfer youth with diabetes (4 females and 3 males; median age 17.5 years, IQR 1.3 years); post-transfer young adults with diabetes (2 females and 2 males; median age 23.5 years, IQR 1.2 years); and parents of recently transferred young adults with diabetes (n = 3). Main themes were: (a) communication technology; (b) the need for more transition and diabetes education and preparation during transition; and, (c) the importance and need for social and peer support. CONCLUSION This study describes specific areas that may improve diabetes transfer and transition from pediatric to adult diabetes care. This information can help inform clinical care delivery for transition and the development of programs, strategies, and interventions to improve transition care.
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Affiliation(s)
- Sonia Butalia
- Division of Endocrinology and Metabolism, Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Department of Community Health Sciences, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- O'Brien Institute for Public Health, Cumming School of Medicine, CalgaryUniversity of CalgaryCalgaryAlbertaCanada
- Libin Cardiovascular Institute, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - K. Ashlee McGuire
- Provincial Primary Health CareAlberta Health ServicesCalgaryAlbertaCanada
- Department of Family Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - David Dyjur
- Diabetes Centre CalgaryAlberta Health ServicesCalgaryAlbertaCanada
| | - Julia Mercer
- Alberta Children's Hospital, Diabetes ClinicAlberta Health ServicesCalgaryAlbertaCanada
| | - Daniele Pacaud
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Alberta Children's Hospital Research Institute, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
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12
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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: 2.8] [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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13
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Mobasseri M, Shirmohammadi M, Amiri T, Vahed N, Hosseini Fard H, Ghojazadeh M. Prevalence and incidence of type 1 diabetes in the world: a systematic review and meta-analysis. Health Promot Perspect 2020; 10:98-115. [PMID: 32296622 PMCID: PMC7146037 DOI: 10.34172/hpp.2020.18] [Citation(s) in RCA: 389] [Impact Index Per Article: 77.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 10/26/2019] [Indexed: 12/13/2022] Open
Abstract
Background: Diabetes is referred to a group of diseases characterized by high glucose levels in blood. It is caused by a deficiency in the production or function of insulin or both, which can occur because of different reasons, resulting in protein and lipid metabolic disorders. The aim of this study was to systematically review the prevalence and incidence of type 1 diabetes in the world. Methods: A systematic search of resources was conducted to investigate the prevalence and incidence of type 1 diabetes in the world. The databases of Medline (via PubMed and Ovid),ProQuest, Scopus, and Web of Science from January 1980 to September 2019 were searched to locate English articles. The located articles were screened in multiple levels of title, abstract,and full-text and final studies that met the inclusion criteria were retrieved and included in the study. Results: From 1202 located articles, 193 studies were included in this systematic review. The results of meta-analysis showed that the incidence of type 1 diabetes was 15 per 100,000 people and the prevalence was 9.5% (95% CI: 0.07 to 0.12) in the world, which was statistically significant. Conclusion: According to the results, the incidence and prevalence of type 1 diabetes are increasing in the world. As a result, insulin will be difficult to access and afford, especially in underdeveloped and developing countries.
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Affiliation(s)
- Majid Mobasseri
- Endocrine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masoud Shirmohammadi
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Tarlan Amiri
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nafiseh Vahed
- Emergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, Iran
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A Joanna Briggs Institute Affiliated Group, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Hosseini Fard
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A Joanna Briggs Institute Affiliated Group, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Morteza Ghojazadeh
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A Joanna Briggs Institute Affiliated Group, Tabriz University of Medical Sciences, Tabriz, Iran
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14
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Butalia S, Kaplan GG, Khokhar B, Haubrich S, Rabi DM. The Challenges of Identifying Environmental Determinants of Type 1 Diabetes: In Search of the Holy Grail. Diabetes Metab Syndr Obes 2020; 13:4885-4895. [PMID: 33328748 PMCID: PMC7734044 DOI: 10.2147/dmso.s275080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 10/15/2020] [Indexed: 12/21/2022] Open
Abstract
Type 1 diabetes is the result of autoimmune-mediated destruction and inflammation of the insulin-producing β-cells of the pancreas. The excess morbidity and mortality from its complications coupled with its increasing incidence emphasize the importance to better understand the etiology of this condition. It has a strong genetic component, but a genetic predisposition is not the sole contributor to disease development as only 30% to 50% of identical twins both develop the disease. In addition, there are multiple lines of evidence to support that environmental factors contribute to the pathogenesis of type 1 diabetes. Environmental risk factors that have been proposed include infections, dietary factors, air pollution, vaccines, location of residence, childhood obesity, family environment and stress. Researchers have conducted many observational studies to identify and characterize these potential environmental factors, but findings have been inconsistent or inconclusive. Many studies have had inherent methodological issues in recruitment, participation, defining cases and exposures, and/or data analysis which may limit the interpretability of findings. Identifying and addressing these limitations may allow for greatly needed advances in our understanding of type 1 diabetes. As such, the purpose of this article is to review and discuss the limitations of observational studies that aim to determine environmental risk factors for type 1 diabetes and propose recommendations to overcome them.
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Affiliation(s)
- Sonia Butalia
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Correspondence: Sonia ButaliaDivision of Endocrinology and Metabolism, Richmond Road Diagnostic and Treatment Centre, 1820 Richmond Road SW, Calgary, AlbertaT2T 5C7, CanadaTel +1 403-955-8327Fax +1 403-955-8249 Email
| | - Gilaad G Kaplan
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Bushra Khokhar
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sydney Haubrich
- Ward of the 21st Century, University of Calgary, Calgary, Alberta, Canada
| | - Doreen M Rabi
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Cardiac Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
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15
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Gomez-Lopera N, Pineda-Trujillo N, Diaz-Valencia PA. Correlating the global increase in type 1 diabetes incidence across age groups with national economic prosperity: A systematic review. World J Diabetes 2019; 10:560-580. [PMID: 31915518 PMCID: PMC6944530 DOI: 10.4239/wjd.v10.i12.560] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 10/17/2019] [Accepted: 10/29/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The global epidemiology of type 1 diabetes (T1D) is not yet well known, as no precise data are available from many countries. T1D is, however, characterized by an important variation in incidences among countries and a dramatic increase of these incidences during the last decades, predominantly in younger children. In the United States and Europe, the increase has been associated with the gross domestic product (GDP) per capita. In our previous systematic review, geographical variation of incidence was correlated with socio-economic factors.
AIM To investigate variation in the incidence of T1D in age categories and search to what extent these variations correlated with the GDP per capita.
METHODS A systematic review was performed to retrieve information about the global incidence of T1D among those younger than 14 years of age. The study was carried out according to the PRISMA recommendations. For the analysis, the incidence was organized in the periods: 1975-1999 and 2000-2017. We searched the incidence of T1D in the age-groups 0-4, 5-9 and 10-14. We compared the incidences in countries for which information was available for the two periods. We obtained the GDP from the World Bank. We analysed the relationship between the incidence of T1D with the GDP in countries reporting data at the national level.
RESULTS We retrieved information for 84 out of 194 countries around the world. We found a wide geographic variation in the incidence of T1D and a worldwide increase during the two periods. The largest contribution to this increase was observed in the youngest group of children with T1D, with a relative increase of almost double when comparing the two periods (P value = 2.5 × e-5). Twenty-six countries had information on the incidence of T1D at the national level for the two periods. There was a positive correlation between GDP and the incidence of T1D in both periods (Spearman correlation = 0.52 from 1975-1999 and Spearman correlation = 0.53 from 2000-2017).
CONCLUSION The incidence increase was higher in the youngest group (0-4 years of age), and the highest incidences of T1D were found in wealthier countries.
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Affiliation(s)
- Natalia Gomez-Lopera
- Grupo Mapeo Genetico, Departamento de Pediatría, Facultad de Medicina, Universidad de Antioquia, Medellín 050010470, Colombia
| | - Nicolas Pineda-Trujillo
- Grupo Mapeo Genetico, Departamento de Pediatría, Facultad de Medicina, Universidad de Antioquia, Medellín 050010470, Colombia
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16
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Topor-Madry R, Wojtyniak B, Strojek K, Rutkowski D, Bogusławski S, Ignaszewska-Wyrzykowska A, Jarosz-Chobot P, Czech M, Kozierkiewicz A, Chlebus K, Jędrzejczyk T, Mysliwiec M, Polanska J, Wysocki MJ, Zdrojewski T. Prevalence of diabetes in Poland: a combined analysis of national databases. Diabet Med 2019; 36:1209-1216. [PMID: 30889281 DOI: 10.1111/dme.13949] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/15/2019] [Indexed: 12/15/2022]
Abstract
AIMS To assess the number of people with diabetes in Poland using combined national sources and to evaluate the usefulness of data from an insurance system for epidemiological purposes. METHODS The data were collected from four sources: 1) 2013 all-billing records of the national insurance system comprising people of all age groups undergoing procedures or receiving services in primary healthcare, specialist practices and hospitals and also those receiving drugs; 2) an epidemiological study, NATPOL, that involved the assessment of people with undiagnosed diabetes; 3) the RECEPTOmetr Sequence study on prescriptions; and 4) regional child diabetes registries. RESULTS In 2013, 1.76 million people (0.98 million women and 0.79 million men) had medical consultations (coded E10-E14) and 2.13 million people (1.19 million women and 0.94 million men) purchased drugs or strip tests for diabetes. A total of 0.04 million people who used medical services did not buy drugs. In total, the number of people with diabetes in the insurance system was 2.16 million (1.21 million women and 0.95 million men), which corresponds to 6.1% (95% CI 6.11-6.14) of women and 5.1% (95% CI 5.12-5.14) of men. Including undiagnosed cases, the total number of people with diabetes in Poland was 2.68 million in 2013. CONCLUSION The estimated prevalence of diabetes (diagnosed and undiagnosed cases) in Poland is 6.97%. Data from the national insurance system with full coverage of the population can be treated as a reliable source of information on diseases with well-defined diagnosis and treatment methods, combined with an assessment of the number of undiagnosed individuals.
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Affiliation(s)
- R Topor-Madry
- Institute of Public Health, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow
| | - B Wojtyniak
- National Institute of Public Health - National Institute of Hygiene, Warsaw
| | - K Strojek
- Department of Internal Diseases, Diabetology and Cardiometabolic Diseases, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice
| | | | | | | | - P Jarosz-Chobot
- Department of Children's Diabetology, Medical University of Silesia, Katowice
| | - M Czech
- Medical University in Warsaw, Warsaw
| | | | - K Chlebus
- Department of Cardiology, Clinical Center of Cardiology, Medical University of Gdansk, Gdansk
| | - T Jędrzejczyk
- Department of Preventive Medicine and Medical Education, Medical University of Gdansk, Gdansk
| | - M Mysliwiec
- Chair of Pediatrics, Diabetology and Endocrinology, Medical University of Gdansk, Gdansk, Gdansk
| | - J Polanska
- Data Mining Group, Silesian University of Technology, Gliwice, Poland
| | - M J Wysocki
- National Institute of Public Health - National Institute of Hygiene, Warsaw
| | - T Zdrojewski
- Department of Preventive Medicine and Medical Education, Medical University of Gdansk, Gdansk
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17
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Uruska A, Gandecka A, Araszkiewicz A, Zozulinska-Ziolkiewicz D. Accumulation of advanced glycation end products in the skin is accelerated in relation to insulin resistance in people with Type 1 diabetes mellitus. Diabet Med 2019; 36:620-625. [PMID: 30706538 DOI: 10.1111/dme.13921] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/30/2019] [Indexed: 01/16/2023]
Abstract
AIM To evaluate the association between skin advanced glycation end products and insulin resistance in Type 1 diabetes. METHODS The study group consisted of 476 people with Type 1 diabetes (247 men) with a median (interquartile range) age of 42 (33-53) years, disease duration of 24 (19-32) years and HbA1c concentration of 63 (55-74) mmol/mol [7.9 (7.2-8.9)%]. Insulin resistance was assessed according to estimated glucose disposal rate. Advanced glycation product accumulation in the skin was measured by autofluorescence using an AGE Reader. The group was divided into three subgroups based on estimated glucose disposal rate tertiles (<5.5, 5.5-9.5 and >9.5 mg/kg/min, respectively). The higher the estimated glucose disposal rate, the lower the insulin resistance. RESULTS Skin autofluoresence level decreased with increasing estimated glucose disposal rate; comparing people below the lower tertile, with those between the first and third tertiles, and with those above the third tertile, the median autofluoresences were, respectively: 2.5 (2.2-2.9) vs 2.3 (2.0-2.7) vs 2.1 (1.9-2.5) AU (P<0.0001). A negative correlation was observed between skin autofluorescence and estimated glucose disposal rate (Spearman's correlation coefficient=-0.31, P <0.001). Multiple logistic regression showed a significant, two-way association of insulin resistance with skin autofluorescence. CONCLUSION The results of this study offer strong evidence for a two-way relationship between insulin resistance and advanced glycation product accumulation in the skin in people with Type 1 diabetes.
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Affiliation(s)
- A Uruska
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poznan, Poland
| | - A Gandecka
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poznan, Poland
| | - A Araszkiewicz
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poznan, Poland
| | - D Zozulinska-Ziolkiewicz
- Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, Poznan, Poland
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18
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Martins KAKF, Mascarenhas LPG, Morandini M, Cat MNL, Pereira RM, Carvalho JRD, Lacerda Filho LD, França SN. Health-related quality of life in a cohort of youths with type 1 diabetes. Rev Assoc Med Bras (1992) 2018; 64:1038-1044. [DOI: 10.1590/1806-9282.64.11.1038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 03/24/2018] [Indexed: 12/17/2022] Open
Abstract
SUMMARY Health-related quality of life (HRQOL) in type 1 diabetes mellitus (T1DM) has been widely studied. The objectives of this study were to evaluate and identify the factors influencing the HRQOL of children and adolescents with T1DM. MATERIAL AND METHODS: In total, 59 patients (9–16 years, T1DM for ≥1 year) responded to a version of the Diabetes Quality of Life Instrument for Youth (DQOLY) adapted to adapted to Brazilian patients, the Instrumento de Qualidade de Vida para Jovens com Diabetes (IQVJD). This instrument comprises 50 items (domains satisfaction, impact, and concerns, with the lowest scores corresponding to better HRQOL) and a questionnaire gathering social, demographic, and clinical parameters. RESULTS: The mean age of the patients was 13.6 years, and 57.6% were girls. The median age at diagnosis was 7.16 years, 63% presented diabetic ketoacidosis (DKA) at diagnosis and 29% during follow-up. Mean glycated hemoglobin (HbA1c) in the previous year was 10%. All patients administered multiple insulin doses (mean 4.2 applications/day), 74.5% used rapid-acting and intermediate-acting insulin analogs, and 67.8% used pens for insulin application. The results of the DQOLY were within the cutoff limit for better HRQOL. An isolated analysis of each domain and the questionnaire results showed that the following factors were associated with better HRQOL: height Z-score, lower HbA1c, practice of physical activity, use of pen, fewer hospitalizations, and residence in a rural area. There was a high DKA rate at diagnosis, and the metabolic control was inappropriate in most patients. Despite coming from low-income households, most patients had access to the recommended treatment. CONCLUSION: Among T1DM patients, 71% had IQVJD scores compatible with better HRQOL.
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Mayer-Davis EJ, Kahkoska AR, Jefferies C, Dabelea D, Balde N, Gong CX, Aschner P, Craig ME. ISPAD Clinical Practice Consensus Guidelines 2018: Definition, epidemiology, and classification of diabetes in children and adolescents. Pediatr Diabetes 2018; 19 Suppl 27:7-19. [PMID: 30226024 PMCID: PMC7521365 DOI: 10.1111/pedi.12773] [Citation(s) in RCA: 363] [Impact Index Per Article: 51.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 07/27/2018] [Indexed: 12/16/2022] Open
Affiliation(s)
- Elizabeth J. Mayer-Davis
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Anna R. Kahkoska
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina,Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Craig Jefferies
- Starship Children’s Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, Colorado
| | - Naby Balde
- Department of Endocrinology, University Hospital, Conakry, Guinea
| | - Chun X. Gong
- Beijing Children’s Hospital, Capital Medical University, Beijing, China
| | | | - Maria E. Craig
- The Children’s Hospital at Westmead, University of Sydney, Sydney, New South Wales, Australia,School of Women’s and Children’s Health, University of NSW, Sydney, New South Wales, Australia
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20
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Szypowska A, Dżygało K, Wysocka-Mincewicz M, Mazur A, Lisowicz L, Ben-Skowronek I, Sieniawska J, Klonowska B, Charemska D, Nawrotek J, Jałowiec I, Bossowski A, Jamiołkowska M, Pyrżak B, Rogozińska I, Szalecki M. High incidence of diabetic ketoacidosis at diagnosis of type 1 diabetes among Polish children aged 10-12 and under 5 years of age: A multicenter study. Pediatr Diabetes 2017; 18:722-728. [PMID: 27726262 DOI: 10.1111/pedi.12446] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 08/06/2016] [Accepted: 08/11/2016] [Indexed: 11/28/2022] Open
Abstract
AIM Despite its characteristic symptoms, type 1 diabetes (T1D) is still diagnosed late causing the development of diabetic ketoacidosis (DKA). The aim of this study was to estimate the incidence of DKA and factors associated with the development of acidosis at T1D recognition in Polish children aged 0-17. METHODS The study population consisted of 2100 children with newly diagnosed T1D in the years 2010-2014 in 7 hospitals in eastern and central Poland. The population living in these areas accounts for 35% of the Polish population. DKA was defined as a capillary pH < 7.3, blood glucose > 11 mmol/L. The analyzed data included age, sex, diabetes recognition, pH, glycated hemoglobin (HbA1c), fasting C-peptide, and body mass index standard deviation score (BMI-SDS). RESULTS We observed DKA in 28.6% of children. There were 2 peaks in DKA occurrence: in children <5 years of age (33.9%) and aged 10-12 (34%). The highest incidence of DKA was noted in children aged 0-2 (48.4%). In the group with DKA, moderate and severe DKA occurred in 46.7% of children. Girls and children <2 years of age were more prone to severe DKA. The multiple logistic regression analysis showed the following factors associated with DKA: age (P = .002), fasting C-peptide (P = .0001), HbA1c (P = .0001), no family history of T1D (P = .0001), and BMI-SDS (P = .0001). CONCLUSIONS The incidence of DKA is high and remained unchanged over the last 5 years. Increasing the awareness of symptoms of DKA is recommended among children <5 years of age (especially <2 years of age) and aged 10-12. Children <2 years of age and girls were at the highest risk of severe DKA.
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Affiliation(s)
| | - Katarzyna Dżygało
- Department of Pediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Marta Wysocka-Mincewicz
- Department of Endocrinology and Diabetology, Children's Memorial Health Institute, Warsaw, Poland
| | - Artur Mazur
- II Department of Pediatrics, Pediatric Endocrinology and Diabetes, Medical Faculty University of Rzeszow, Rzeszow, Poland
| | - Lucyna Lisowicz
- II Department of Pediatrics, Pediatric Endocrinology and Diabetes, Medical Faculty University of Rzeszow, Rzeszow, Poland
| | - Iwona Ben-Skowronek
- Department of Pediatric Endocrinology and Diabetology, Medical University of Lublin, Lublin, Poland
| | - Joanna Sieniawska
- Department of Pediatric Endocrinology and Diabetology, Medical University of Lublin, Lublin, Poland
| | - Bożenna Klonowska
- Department of Clinical Pediatrics, Faculty of Medical Sciences, University of Warmia and Mazury in Olsztyn, Provincial Specialist Children's Hospital, Olsztyn, Poland
| | - Dorota Charemska
- Department of Clinical Pediatrics, Faculty of Medical Sciences, University of Warmia and Mazury in Olsztyn, Provincial Specialist Children's Hospital, Olsztyn, Poland
| | - Jolanta Nawrotek
- Endocrinology and Diabetology Ward, General District Hospital, Kielce, Poland
| | - Irena Jałowiec
- Endocrinology and Diabetology Ward, General District Hospital, Kielce, Poland
| | - Artur Bossowski
- Department of Pediatrics, Endocrinology, Diabetology with a Cardiology Division, Medical University of Białystok, Białystok, Poland
| | - Milena Jamiołkowska
- Department of Pediatrics, Endocrinology, Diabetology with a Cardiology Division, Medical University of Białystok, Białystok, Poland
| | - Beata Pyrżak
- Department of Pediatric and Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | - Izabela Rogozińska
- Department of Pediatric and Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | - Mieczysław Szalecki
- Department of Endocrinology and Diabetology, Children's Memorial Health Institute, Warsaw, Poland.,Faculty of Medicine and Health Sciences, UJK, Kielce, Poland
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21
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Wan H, Merriman C, Atkinson MA, Wasserfall CH, Mcgrail KM, Liang Y, Fu D, Dai H. Proteoliposome-based full-length ZnT8 self-antigen for type 1 diabetes diagnosis on a plasmonic platform. Proc Natl Acad Sci U S A 2017; 114:10196-10201. [PMID: 28874568 PMCID: PMC5617307 DOI: 10.1073/pnas.1711169114] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Identified as a major biomarker for type 1 diabetes (T1D) diagnosis, zinc transporter 8 autoantibody (ZnT8A) has shown promise for staging disease risk and disease diagnosis. However, existing assays for ZnT8 autoantibody (ZnT8A) are limited to detection by soluble domains of ZnT8, owing to difficulties in maintaining proper folding of a full-length ZnT8 protein outside its native membrane environment. Through a combined bioengineering and nanotechnology approach, we have developed a proteoliposome-based full-length ZnT8 self-antigen (full-length ZnT8 proteoliposomes; PLR-ZnT8) for efficient detection of ZnT8A on a plasmonic gold chip (pGOLD). The protective lipid matrix of proteoliposomes improved the proper folding and structural stability of full-length ZnT8, helping PLR-ZnT8 immobilized on pGOLD (PLR-ZnT8/pGOLD) achieve high-affinity capture of ZnT8A from T1D sera. Our PLR-ZnT8/pGOLD exhibited efficient ZnT8A detection for T1D diagnosis with ∼76% sensitivity and ∼97% specificity (n = 307), superior to assays based on detergent-solubilized full-length ZnT8 and the C-terminal domain of ZnT8. Multiplexed assays using pGOLD were also developed for simultaneous detection of ZnT8A, islet antigen 2 autoantibody, and glutamic acid decarboxylase autoantibody for diagnosing T1D.
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Affiliation(s)
- Hao Wan
- Department of Chemistry, Bio-X, and the Biophysics Program, Stanford University, Stanford, CA 94305
- Department of Materials Science and Engineering, South University of Science and Technology of China, Shenzhen 518055, China
| | - Chengfeng Merriman
- Department of Physiology, Johns Hopkins School of Medicine, Baltimore, MD 21205
| | - Mark A Atkinson
- Department of Pathology, College of Medicine, University of Florida, Gainesville, FL 32610-0275
- Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL 32610-0275
| | - Clive H Wasserfall
- Department of Pathology, College of Medicine, University of Florida, Gainesville, FL 32610-0275
- Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL 32610-0275
| | - Kieran M Mcgrail
- Department of Pathology, College of Medicine, University of Florida, Gainesville, FL 32610-0275
- Department of Pediatrics, College of Medicine, University of Florida, Gainesville, FL 32610-0275
| | - Yongye Liang
- Department of Materials Science and Engineering, South University of Science and Technology of China, Shenzhen 518055, China
| | - Dax Fu
- Department of Physiology, Johns Hopkins School of Medicine, Baltimore, MD 21205;
| | - Hongjie Dai
- Department of Chemistry, Bio-X, and the Biophysics Program, Stanford University, Stanford, CA 94305;
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22
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Chobot A, Polanska J, Brandt A, Deja G, Glowinska-Olszewska B, Pilecki O, Szadkowska A, Mysliwiec M, Jarosz-Chobot P. Updated 24-year trend of Type 1 diabetes incidence in children in Poland reveals a sinusoidal pattern and sustained increase. Diabet Med 2017; 34:1252-1258. [PMID: 28257151 DOI: 10.1111/dme.13345] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/27/2017] [Indexed: 12/11/2022]
Abstract
AIMS To present the incidence trend for Type 1 diabetes in Polish children aged 0-14 years, updated using data collected during 2005-2012, and assess the reliability of the predictive model constructed previously using the 1989-2004 database. METHODS Children aged < 15 years with newly diagnosed Type 1 diabetes are recorded prospectively (EURODIAB criteria) in several regional registers in Poland. Age- and gender-standardized incidence rates for Type 1 diabetes were calculated per 100 000 persons/year. Incidence rates were analysed in terms of the dependency on age, gender, geographical region and population density. Incidence rate trends over time were modelled using generalized linear models. RESULTS The mean standardized incidence for 1989-2012 was 12.72 per 100 000 persons/year [95% confidence interval (CI), 11.35 to 14.21]. Over the 24-year observation period, the incidence increased from 5.36 to 22.74 per 100 000 persons/year. The lowest incidence rate was in children aged 0-4 years (8.35, 95% CI 7.27 to 9.57 per 100 000 persons/year). There was no difference between genders, or urban and rural regions. Incidence rates were higher in northern compared with southern Poland [14.04 (95% CI 12.59 to 15.63) vs. 11.94 (95% CI 10.62 to 13.39) per 100 000 persons/year]. The new data corrected the earlier predictive model by changing the estimates of some factors related to patient age, gender and their interactions with the remaining factors. The incidence rate shows periodic 5.33-year fluctuations. The periodicity component allows for a more accurate prediction of the incidence rate over time. CONCLUSIONS This cohort study reveals a sustained increase in Type 1 diabetes incidence in Polish children aged 0-14 years with regular, sinusoidal fluctuations and a slight levelling off in past few years. It is of concern that are the highest increases in incidence are found in children aged 0-4 years.
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Affiliation(s)
| | - J Polanska
- Silesian University of Technology, Gliwice
| | - A Brandt
- Medical University of Gdansk, Gdansk
| | - G Deja
- Medical University of Silesia, Katowice
| | | | - O Pilecki
- Provincial Children's Hospital, Bydgoszcz
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23
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Marek-Trzonkowska N, Myśliwiec M, Iwaszkiewicz-Grześ D, Gliwiński M, Derkowska I, Żalińska M, Zieliński M, Grabowska M, Zielińska H, Piekarska K, Jaźwińska-Curyłło A, Owczuk R, Szadkowska A, Wyka K, Witkowski P, Młynarski W, Jarosz-Chobot P, Bossowski A, Siebert J, Trzonkowski P. Factors affecting long-term efficacy of T regulatory cell-based therapy in type 1 diabetes. J Transl Med 2016; 14:332. [PMID: 27903296 PMCID: PMC5131539 DOI: 10.1186/s12967-016-1090-7] [Citation(s) in RCA: 78] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 11/22/2016] [Indexed: 01/10/2023] Open
Abstract
Background Recent studies suggest that immunotherapy using T regulatory cells (Tregs) prolongs remission in type 1 diabetes (T1DM). Here, we report factors that possibly affect the efficacy of this treatment. Methods The metabolic and immune background of 12 children with recently diagnosed T1DM, as well as that of untreated subjects, during a 2-year follow-up is presented. Patients were treated with up to 30 × 106/kg b.w. of autologous expanded CD3+CD4+CD25highCD127− Tregs. Results The disease progressed and all patients were insulin-dependent 2 years after inclusion. The β-cell function measured by c-peptide levels and the use of insulin were the best preserved in patients treated with two doses of Tregs (3/6 in remission), less so after one dose (1/6 in remission) and the worst in untreated controls (no remissions). Increased levels of Tregs could be seen in peripheral blood after their adoptive transfer together with the shift from naïve CD62L+CD45RA+ to memory CD62L+CD45RA− Tregs. Increasing serum levels of proinflammatory cytokines were found: IL6 increased in all subjects, while IL1 and TNFα increased only in untreated group. Therapeutic Tregs were dependent on IL2, and their survival could be improved by other lymphocytes. Conclusions The disease progression was associated with changing proportions of naïve and memory Tregs and slowly increasing proinflammatory activity, which was only partially controlled by the administered Tregs. The therapeutic cells were highly dependent on IL2. We conclude that the therapy should be administered at the earliest to protect the highest possible mass of islets and also to utilize the preserved content of Tregs in the earlier phases of T1DM. Trial registrationhttp://www.controlled-trials.com/ISRCTN06128462; registered retrospectively Electronic supplementary material The online version of this article (doi:10.1186/s12967-016-1090-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Natalia Marek-Trzonkowska
- Laboratory of Immunoregulation and Cellular Therapies, Department of Family Medicine, Medical University of Gdańsk, Debinki 2, 80-210, Gdańsk, Poland
| | - Małgorzata Myśliwiec
- Department of Pediatric Diabetology and Endocrinology, Medical University of Gdańsk, Debinki 7, 80-210, Gdańsk, Poland
| | - Dorota Iwaszkiewicz-Grześ
- Department of Clinical Immunology and Transplantology, Medical University of Gdańsk, Debinki 7, 80-210, Gdańsk, Poland
| | - Mateusz Gliwiński
- Department of Clinical Immunology and Transplantology, Medical University of Gdańsk, Debinki 7, 80-210, Gdańsk, Poland
| | - Ilona Derkowska
- Department of Pediatric Diabetology and Endocrinology, Medical University of Gdańsk, Debinki 7, 80-210, Gdańsk, Poland
| | - Magdalena Żalińska
- Department of Pediatric Diabetology and Endocrinology, Medical University of Gdańsk, Debinki 7, 80-210, Gdańsk, Poland
| | - Maciej Zieliński
- Department of Clinical Immunology and Transplantology, Medical University of Gdańsk, Debinki 7, 80-210, Gdańsk, Poland
| | - Marcelina Grabowska
- Department of Clinical Immunology and Transplantology, Medical University of Gdańsk, Debinki 7, 80-210, Gdańsk, Poland
| | - Hanna Zielińska
- Department of Clinical Immunology and Transplantology, Medical University of Gdańsk, Debinki 7, 80-210, Gdańsk, Poland
| | - Karolina Piekarska
- Laboratory of Immunoregulation and Cellular Therapies, Department of Family Medicine, Medical University of Gdańsk, Debinki 2, 80-210, Gdańsk, Poland
| | - Anna Jaźwińska-Curyłło
- Regional Center of Blood Donation and Treatment, Hoene-Wrońskiego 4, 80-210, Gdańsk, Poland
| | - Radosław Owczuk
- Department of Anaesthesiology and Critical Care, Medical University of Gdańsk, Debinki 7, 80-210, Gdańsk, Poland
| | - Agnieszka Szadkowska
- Department of Paediatrics, Oncology, Haematology and Diabetology, Medical University of Lodz, Sporna 36/50, 91-738, Lodz, Poland
| | - Krystyna Wyka
- Department of Paediatrics, Oncology, Haematology and Diabetology, Medical University of Lodz, Sporna 36/50, 91-738, Lodz, Poland
| | - Piotr Witkowski
- Section of Transplantation, Department of Surgery, The University of Chicago, 5841 S. Maryland Ave. MC5027, Chicago, IL, 60637, USA
| | - Wojciech Młynarski
- Department of Paediatrics, Oncology, Haematology and Diabetology, Medical University of Lodz, Sporna 36/50, 91-738, Lodz, Poland
| | - Przemysława Jarosz-Chobot
- Department of Paediatrics, Endocrinology and Diabetes, Medical University of Silesia, Poniatowskiego 15, 40-055, Katowice, Poland
| | - Artur Bossowski
- Department of Peadiatrics, Endocrinology, Diabetology with Cardiology Division, Medical University of Bialystok, Jana Kilińskiego 1, 15-089, Białystok, Poland
| | - Janusz Siebert
- Laboratory of Immunoregulation and Cellular Therapies, Department of Family Medicine, Medical University of Gdańsk, Debinki 2, 80-210, Gdańsk, Poland
| | - Piotr Trzonkowski
- Department of Clinical Immunology and Transplantology, Medical University of Gdańsk, Debinki 7, 80-210, Gdańsk, Poland.
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Butalia S, Kaplan GG, Khokhar B, Rabi DM. Environmental Risk Factors and Type 1 Diabetes: Past, Present, and Future. Can J Diabetes 2016; 40:586-593. [PMID: 27545597 DOI: 10.1016/j.jcjd.2016.05.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 03/08/2016] [Accepted: 05/03/2016] [Indexed: 02/06/2023]
Abstract
Type 1 diabetes is an autoimmune condition that results from the destruction of the insulin-producing beta cells of the pancreas. The excess morbidity and mortality resulting from its complications, coupled with its increasing incidence, emphasize the importance of better understanding the causes of this condition. Over the past several decades, a substantive amount of work has been done and, although many advances have occurred in identifying disease-susceptibility genes, there has been a lag in understanding the environmental triggers. Several putative environmental risk factors have been proposed, including infections, dietary factors, air pollution, vaccines, location of residence, family environment and stress. However, most of these factors have been inconclusive, thus supporting the need for further study into the causes of type 1 diabetes.
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Affiliation(s)
- Sonia Butalia
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | - Gilaad G Kaplan
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Bushra Khokhar
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Doreen M Rabi
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Cardiac Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
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25
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Effect of Associated Autoimmune Diseases on Type 1 Diabetes Mellitus Incidence and Metabolic Control in Children and Adolescents. BIOMED RESEARCH INTERNATIONAL 2016; 2016:6219730. [PMID: 27525273 PMCID: PMC4971288 DOI: 10.1155/2016/6219730] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Revised: 04/06/2016] [Accepted: 04/19/2016] [Indexed: 02/06/2023]
Abstract
Type 1 diabetes mellitus (T1DM) is one of the most common chronic diseases developing in childhood. The incidence of the disease in children increases for unknown reasons at a rate from 3 to 5% every year worldwide. The background of T1DM is associated with the autoimmune process of pancreatic beta cell destruction, which leads to absolute insulin deficiency and organ damage. Complex interactions between environmental and genetic factors contribute to the development of T1DM in genetically predisposed patients. The T1DM-inducing autoimmune process can also affect other organs, resulting in development of additional autoimmune diseases in the patient, thereby impeding diabetes control. The most common T1DM comorbidities include autoimmune thyroid diseases, celiac disease, and autoimmune gastritis; additionally, diabetes can be a component of PAS (Polyglandular Autoimmune Syndrome). The aim of this review is to assess the prevalence of T1DM-associated autoimmune diseases in children and adolescents and their impact on the course of T1DM. We also present suggestions concerning screening tests.
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Abstract
The incidence of type 1 diabetes has risen considerably in the past 30 years due to changes in the environment that have been only partially identified. In this Series paper, we critically discuss candidate triggers of islet autoimmunity and factors thought to promote progression from autoimmunity to overt type 1 diabetes. We revisit previously proposed hypotheses to explain the growth in the incidence of type 1 diabetes in light of current data. Finally, we suggest a unified model in which immune tolerance to β cells can be broken by several environmental exposures that induce generation of hybrid peptides acting as neoautoantigens.
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Affiliation(s)
- Marian Rewers
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO, USA
| | - Johnny Ludvigsson
- Division of Pediatrics, Department of Clinical and Experimental Medicine, Medical Faculty, Linköping University and Linköping University Hospital, Linköping, Sweden.
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27
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Rojnic Putarek N, Ille J, Spehar Uroic A, Skrabic V, Stipancic G, Krnic N, Radica A, Marjanac I, Severinski S, Svigir A, Bogdanic A, Dumic M. Incidence of type 1 diabetes mellitus in 0 to 14-yr-old children in Croatia--2004 to 2012 study. Pediatr Diabetes 2015; 16:448-53. [PMID: 25080870 DOI: 10.1111/pedi.12197] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Revised: 06/04/2014] [Accepted: 06/27/2014] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The incidence of type 1 diabetes mellitus (T1DM) among children and adolescents increased during the last 50 yr. The T1DM incidence in Croatia was 8.87/100.000/yr over 1995-2003, with an annual increase of 9%, which placed Croatia among countries with moderate risk for T1DM. AIM To investigate incidence rates and trends of T1DM from 2004 to 2012 in 0 to 14-yr-old Croatian children, and to compare the results with previous studies in Croatia and other European countries. METHODS T1DM crude incidence rates are estimated for the entire group and three subgroups: 0-4, 5-9, and 10-14 yr. Standardized incidence is calculated using the method of direct standardization according to World Health Organization (WHO) standard world population. The incidence rates by gender, age groups, seasonality, and calendar year, and their interactions were analyzed using Poisson regression model. RESULTS A total of 1066 cases were ascertained over 2004-2012. The standardized incidence was 17.23/100.000/yr (95% CI: 16.19-18.26), with no significant differences in incidence rates or trends between boys and girls. Statistically significant annual increase of 5.87% (p < 0.001) was found for the whole group, and for the subgroups 5-9 yr (6.82%; p < 0.001) and 10-14 yr (7.47%; p < 0.001). In the youngest subgroup (0-4 yr), annual increase was lower (2.43%; p = 0338) and not statistically significant. CONCLUSION The incidence of childhood T1DM is increasing in Croatia, thus placing Croatia among countries with high risk for T1DM. The annual increment of 5.87% is considerably lower than 9.0% reported earlier, but still higher than the European average (3.9%). The increase in incidence ceased in youngest children.
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Affiliation(s)
- Natasa Rojnic Putarek
- Department of Pediatric Endocrinology and Diabetes, University Hospital Zagreb, Zagreb, Croatia
| | - Jasenka Ille
- Department of Pediatric Endocrinology and Diabetes, University Hospital Zagreb, Zagreb, Croatia
| | - Anita Spehar Uroic
- Department of Pediatric Endocrinology and Diabetes, University Hospital Zagreb, Zagreb, Croatia
| | - Veselin Skrabic
- Department of Pediatrics, University Hospital Center Split, Split, Croatia
| | - Gordana Stipancic
- Department of Pediatrics, University Hospital 'Sestre milosrdnice', Zagreb, Croatia
| | - Nevena Krnic
- Department of Pediatric Endocrinology and Diabetes, University Hospital Zagreb, Zagreb, Croatia
| | - Ana Radica
- Department of Pediatric Endocrinology and Diabetes, University Hospital Zagreb, Zagreb, Croatia
| | - Igor Marjanac
- Department of Pediatrics, University Hospital Center Osijek, Osijek, Croatia
| | - Srecko Severinski
- Department of Pediatrics, University Hospital Center Rijeka-Kantrida, Rijeka, Croatia
| | - Alen Svigir
- Department of Pediatric Endocrinology and Diabetes, University Hospital Zagreb, Zagreb, Croatia
| | - Ana Bogdanic
- Department of Pediatric Endocrinology and Diabetes, University Hospital Zagreb, Zagreb, Croatia
| | - Miroslav Dumic
- Department of Pediatric Endocrinology and Diabetes, University Hospital Zagreb, Zagreb, Croatia
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Mianowska B, Fendler W, Tomasik B, Młynarski W, Szadkowska A. Effect of Insulin Dilution on Lowering Glycemic Variability in Pump-Treated Young Children with Inadequately Controlled Type 1 Diabetes. Diabetes Technol Ther 2015; 17:605-10. [PMID: 26270205 DOI: 10.1089/dia.2014.0392] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND We investigated whether in young children with inadequately controlled type 1 diabetes and technical problems with continuous subcutaneous infusion of insulin at 100 units/mL the switch to insulin diluted to 10 units/mL (U10) can limit technical problems and improve glycemic control. SUBJECTS AND METHODS Diluted U10 insulin was started in three children 3.8, 3.2, and 1.3 years old with a hemoglobin A1c (HbA1c) level (mean±SD) of 8.1±0.17% (65±1.7 mmol/mol) and insulin dose of 8.80±2.93 units/day. Patients were evaluated with continuous glucose monitoring (iPro™2; Medtronic Minimed, Northridge, CA) and a quality of life questionnaire (PedsQL™; www.pedsql.org/ ) and surveyed for pump-related problems at baseline and after 3 and 9 months of U10 insulin therapy. RESULTS Continuous glucose monitoring records showed that glycemic variability assessed by SD and M100 decreased significantly (P=0.0085 and P=0.0482, respectively). HbA1c levels dropped to 7.3±1.00% (56±11.0 mmol/mol) after 3 months and to 6.7±0.55% (50±6.1 mmol/mol) after 9 months (P=0.12). Technical difficulties were minimized. CONCLUSIONS These results suggest that the use of U10 insulin decreases glycemic variability and improves hampered pump therapy in young children with inadequately controlled type 1 diabetes.
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Affiliation(s)
- Beata Mianowska
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Łódź , Łódź, Poland
| | - Wojciech Fendler
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Łódź , Łódź, Poland
| | - Bartłomiej Tomasik
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Łódź , Łódź, Poland
| | - Wojciech Młynarski
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Łódź , Łódź, Poland
| | - Agnieszka Szadkowska
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Łódź , Łódź, Poland
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Łuczyński W, Grubczak K, Moniuszko M, Głowińska-Olszewska B, Bossowski A. Elevated levels of Th17 cells in children with central obesity. Scandinavian Journal of Clinical and Laboratory Investigation 2015. [PMID: 26216210 DOI: 10.3109/00365513.2015.1066845] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND It is believed that the recently discovered interleukin 17-producing Th17 cells play a role in the pathogenesis of chronic inflammation in the course of obesity and diabetes. OBJECTIVES The purpose of our study was to complete data on this subject in children. METHODS We assessed Th17 cell levels in the peripheral blood of children diagnosed with central obesity (n = 14) and compared the results with data obtained in patients with newly diagnosed (n = 11) and long-term type 1 diabetes mellitus (n = 18), and in a control group as well (n = 24). RESULTS (i) Children with central obesity were characterized by higher percentages of Th17 cells as compared to children from the control group; (ii) in the peripheral blood of patients with long-term type 1 diabetes the Th17 cell counts were higher compared to the control group; (iii) total plasma cholesterol concentration correlated positively with Th17/Treg cells ratio; and (iv) among patients with long-term diabetes, disease duration correlated positively with Th17 cell count and Th17/Th1 cell ratio. CONCLUSION The results of our study indicate that Th17 cells may be involved in chronic inflammation accompanying obesity and type 1 diabetes mellitus in children.
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Affiliation(s)
- Włodzimierz Łuczyński
- a Department of Pediatrics , Endocrinology, Diabetology with Cardiology Division, Medical University of Białystok , Białystok , Poland
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30
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Bergamin CS, Dib SA. Enterovirus and type 1 diabetes: What is the matter? World J Diabetes 2015; 6:828-839. [PMID: 26131324 PMCID: PMC4478578 DOI: 10.4239/wjd.v6.i6.828] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 01/30/2015] [Accepted: 04/09/2015] [Indexed: 02/05/2023] Open
Abstract
A complex interaction of genetic and environmental factors can trigger the immune-mediated mechanism responsible for type 1 diabetes mellitus (T1DM) establishment. Environmental factors may initiate and possibly sustain, accelerate, or retard damage to β-cells. The role of environmental factors in this process has been exhaustive studied and viruses are among the most probable ones, especially enteroviruses. Improvements in enterovirus detection methods and randomized studies with patient follow-up have confirmed the importance of human enterovirus in the pathogenesis of T1DM. The genetic risk of T1DM and particular innate and acquired immune responses to enterovirus infection contribute to a tolerance to T1DM-related autoantigens. However, the frequency, mechanisms, and pathways of virally induced autoimmunity and β-cell destruction in T1DM remain to be determined. It is difficult to investigate the role of enterovirus infection in T1DM because of several concomitant mechanisms by which the virus damages pancreatic β-cells, which, consequently, may lead to T1DM establishment. Advances in molecular and genomic studies may facilitate the identification of pathways at earlier stages of autoimmunity when preventive and therapeutic approaches may be more effective.
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Chobot A, Polanska J, Deja G, Jarosz-Chobot P. Incidence of type 1 diabetes among Polish children ages 0-14 years from 1989-2012. Acta Diabetol 2015; 52:483-8. [PMID: 25381194 DOI: 10.1007/s00592-014-0682-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Accepted: 10/27/2014] [Indexed: 12/17/2022]
Abstract
AIMS The incidence of pediatric type 1 diabetes mellitus (T1DM) in Poland is intermediate relative to the rest of the world. T1DM prevalence in the region of Silesia approximates national estimates for all of Poland. This epidemiologic study aimed to analyze the changes in incidence rates of T1DM among children ages 0-14 years from 1989 to 2012 in this region. METHODS Data collection methods for the registry followed EURODIAB criteria. To estimate overall population size, data from the Central and regional Statistical Office in Katowice were used. T1DM incidence rates/100,000 children ages 0-14 years/annum and their 95 % CI were calculated for all children and in age subgroups (0-4, 5-9, 10-14 years). For comparative analysis incidence rates were age and sex standardized to the population of Poland in 2005. For statistical analyses open source R Bioconductor software was used. RESULTS During this 24-year period, 2,215 new cases (1,146 boys) were diagnosed. The standardized incidence rate rose about 7 % annually. The mean standardized incidence rates estimated in four 6-year time periods (1989-1994, 1995-2000, 2001-2006, 2007-2012) separately showed significant increases from 5.80/100,000/year (1989-1994) through 10.44/100,000/year (1995-2000) and 15.05/100,000/year (2001-2006) to 18.94/100,000/year (2007-2012). From 1989 to 2012, the greatest relative rise in annual incidence (/100,000/year) was among the very young: 2.58-14.00 (0-4 years); 4.96-19.43 (5-9 years); 8.84-22.15 (10-14 years). The highest average annual increment of the incidence rate was in the middle age subgroup (5-9 years). No significant sex difference was observed. CONCLUSIONS The overall incidence rate increased 3.8 times, suggesting an epidemic of pediatric T1DM in Silesia, Poland. These temporal changes confirm that Poland currently has one of the highest incidence rates of pediatric T1DM in Europe.
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Affiliation(s)
- Agata Chobot
- Clinical Hospital No 1, 3-go Maja 13-15, Zabrze, Poland,
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Kobos E, Imiela J. Factors affecting the level of burden of caregivers of children with type 1 diabetes. Appl Nurs Res 2015; 28:142-9. [DOI: 10.1016/j.apnr.2014.09.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 09/11/2014] [Accepted: 09/19/2014] [Indexed: 11/26/2022]
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Malachowska B, Tomasik B, Szadkowska A, Baranowska-Jazwiecka A, Wegner O, Mlynarski W, Fendler W. Altered platelets' morphological parameters in children with type 1 diabetes – a case-control study. BMC Endocr Disord 2015; 15:17. [PMID: 25886514 PMCID: PMC4391729 DOI: 10.1186/s12902-015-0011-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 03/26/2015] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Platelet hyperreactivity is a factor which contributes towards increased risk of cardiovascular events in adults with type 2 diabetes (T2DM). However, little is known about platelets' disturbances among children with type 1 diabetes (T1DM). The aim of the study was to investigate whether platelets' morphology or function are altered in children with type 1 diabetes, potentially predisposing them to cardiovascular events in the future. METHODS The study group consisted of 389 children with T1DM during the 2008-2010 period. Patients with acute diabetes complications and ongoing infections were excluded from the study. An equinumerous (N = 389), age and sex-matched control group was assembled from children undergoing routine, minor surgical procedures in the same hospital. Platelet: count (PLT), mean volume (MPV), distribution width (PDW) and platelet large cell ratio (P-LCR) as well as HbA1c levels were measured. For statistical analysis we used Chi-square tests, the student's t-test, one-way analysis of variance (ANOVA), the Pearson's correlation coefficient and linear regression models in order to adjust for covariates. RESULTS MPV, PDW and P-LCR were significantly higher among children with diabetes in comparison with the control group (MPV 10.47+/-0.85 fL vs 10.23+/-0.94 fL, p = 0.0007; PDW 12.09+/-1.80% vs 11.66+/-1.90%, p = 0.0032; P-LCR 28.21+/-6.15% vs 26.29+/-6.38%, p < 0.0001). PLT however, were shown to be similar (263.55+/-60.04 vs 268.77+/-65.78 10(3)/μl; p = 0.5637). In both cases and controls age was inversely correlated with platelet count (for study group: r = -0.30, p < 0.0001; for control group: r = -0.34, p < 0.0001), positively correlated with MPVs (r = 0.20, p < 0.0001; r = 0.26, p < 0.0001), PDW (r = 0.25, p < 0.0001 and r = 0.24, p < 0.0001) and P-LCR (r = 0.26, p < 0.0001; r = 0.26, p < 0.0001). After adjustment for confounding factors, higher platelet counts were associated with poorer metabolic control (beta = 0.20; 0.0001). CONCLUSIONS Platelets of paediatric patients with T1DM show morphological evidence of hyperreactivity (higher MPV, PDW and P-LCR), while poorer metabolic control increases their number potentially predisposing the patients to future cardiovascular events.
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Affiliation(s)
- Beata Malachowska
- Department of Paediatrics, Oncology, Haematology and Diabetology, Medical University of Lodz, 36/50 Sporna St., 91-738, Lodz, Poland.
| | - Bartlomiej Tomasik
- Department of Paediatrics, Oncology, Haematology and Diabetology, Medical University of Lodz, 36/50 Sporna St., 91-738, Lodz, Poland.
| | - Agnieszka Szadkowska
- Department of Paediatrics, Oncology, Haematology and Diabetology, Medical University of Lodz, 36/50 Sporna St., 91-738, Lodz, Poland.
| | - Anna Baranowska-Jazwiecka
- Department of Paediatrics, Oncology, Haematology and Diabetology, Medical University of Lodz, 36/50 Sporna St., 91-738, Lodz, Poland.
| | - Olga Wegner
- Department of Paediatrics, Oncology, Haematology and Diabetology, Medical University of Lodz, 36/50 Sporna St., 91-738, Lodz, Poland.
| | - Wojciech Mlynarski
- Department of Paediatrics, Oncology, Haematology and Diabetology, Medical University of Lodz, 36/50 Sporna St., 91-738, Lodz, Poland.
| | - Wojciech Fendler
- Department of Paediatrics, Oncology, Haematology and Diabetology, Medical University of Lodz, 36/50 Sporna St., 91-738, Lodz, Poland.
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Gong C, Meng X, Jiang Y, Wang X, Cui H, Chen X. Trends in childhood type 1 diabetes mellitus incidence in Beijing from 1995 to 2010: a retrospective multicenter study based on hospitalization data. Diabetes Technol Ther 2015; 17:159-65. [PMID: 25545069 DOI: 10.1089/dia.2014.0205] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND The incidence of type 1 diabetes mellitus (T1DM) is increasing rapidly worldwide for children of every age group. MATERIALS AND METHODS A retrospective analysis of hospital registration data from five tertiary hospitals in Beijing, China, identified 485 patients (210 boys, 275 girls) younger than 15 years of age with newly diagnosed T1DM between 1995 and 2010. RESULTS From 1995 to 2010, the incidence of T1DM in patients <15 years of age ranged from 0.935-3.26 per 100,000 per year. During this period, the average age-standardized incidence rate was 1.7 per 100,000 per year, and the average annual increase in T1DM incidence was 4.36%. The highest rate increases occurred in boys and in patients <5 years of age. For both genders and all age groups, T1DM incidence increased at an accelerated rate after 2006. By 2020, the incidence of T1DM among children in Beijing is projected to increase by a factor of 1.69. CONCLUSIONS The incidence of T1DM among patients younger than 15 years of age in Beijing increased from 1995 to 2010, with rates growing at an accelerated pace since 2006. Based on recent trends, we project continued rapid growth in the number of new childhood T1DM cases in Beijing.
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Affiliation(s)
- Chunxiu Gong
- 1 Department of Endocrinology, Genetics and Metabolism, Beijing Children's Hospital, Capital Medical University , Beijing, China
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35
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Craig ME, Jefferies C, Dabelea D, Balde N, Seth A, Donaghue KC. ISPAD Clinical Practice Consensus Guidelines 2014. Definition, epidemiology, and classification of diabetes in children and adolescents. Pediatr Diabetes 2014; 15 Suppl 20:4-17. [PMID: 25182305 DOI: 10.1111/pedi.12186] [Citation(s) in RCA: 177] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 06/16/2014] [Indexed: 12/20/2022] Open
Affiliation(s)
- Maria E Craig
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead and University of Sydney, Sydney, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, Australia
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36
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Łuczyński W, Szypowska A, Głowińska-Olszewska B, Szadkowska A, Bossowski A. Disease associated clinical factors and FTO polymorphism: effect on body mass in children with type 1 diabetes mellitus. Pediatr Diabetes 2014; 15:363-71. [PMID: 25184161 DOI: 10.1111/pedi.12091] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND One of the consequences of excessive weight gain during insulin therapy in type 1 diabetes mellitus (T1DM) is an increased predisposition to cardiovascular diseases (CVD). Not only clinical but also genetic factors may play a role in the pathogenesis of this phenomenon. The aim of this study was to evaluate the prevalence of cardiovascular disease risk factors as well as the fat mass and obesity associated (FTO) gene rs9939609 variant in a large group of children with T1DM of the same ethnic-Polish origin. A total of 1237 children with T1DM and 1015 controls were recruited. RESULTS The proportions of patients with obesity, hypertension, and abnormal LDL-cholesterol levels among children with T1DM were significantly higher than those in the non-diabetic. There was a higher rate of overweight, central obesity, and abnormal LDL-cholesterol levels among girls in comparison to that in boys in the group of children with diabetes. Children with inadequate metabolic control were characterized by the presence of more CVD risk factors. Similar differences were observed in children treated with the use of pens versus those using insulin pumps. The FTO gene single nucleotide polymorphism (SNP) correlated with body mass index (BMI) in both control and diabetic children, but the effect was lesser in diabetics. In a regression model the current BMI-SDS value in diabetics was significantly affected by the baseline BMI, disease duration, metabolic control, and subject's sex, but not the FTO genotype. CONCLUSIONS Clinical rather than genetic factors have a greater impact on the development of overweight and obesity in insulin-treated children
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Affiliation(s)
- Włodzimierz Łuczyński
- Department of Pediatrics, Endocrinology, Diabetology with Cardiology Division; Medical University of Białystok; Białystok Poland
| | | | - Barbara Głowińska-Olszewska
- Department of Pediatrics, Endocrinology, Diabetology with Cardiology Division; Medical University of Białystok; Białystok Poland
| | - Agnieszka Szadkowska
- Department of Pediatrics, Oncology, Hematology and Diabetology; Medical University of Lodz; Lodz Poland
| | - Artur Bossowski
- Department of Pediatrics, Endocrinology, Diabetology with Cardiology Division; Medical University of Białystok; Białystok Poland
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Gong C, Meng X, Saenger P, Wu D, Cao B, Wu D, Wei L. Trends in the incidence of childhood type 1 diabetes mellitus in Beijing based on hospitalization data from 1995 to 2010. Horm Res Paediatr 2014; 80:328-34. [PMID: 24216776 DOI: 10.1159/000355388] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2012] [Accepted: 09/02/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To study the incidence trend of type 1 diabetes mellitus (T1DM) in children in Beijing from 1995 to 2010, to compare it with incidences reported worldwide and to predict the requirement of medical resources in the future. METHODS This study involved newly diagnosed T1DM cases younger than 15 years of age in the Beijing Children's Hospital from January 1995 to December 2010. We calculated the incidence of T1DM children in Beijing according to hospitalization data and Beijing's population. We defined it as the underestimated incidence rate (UE-IR). RESULTS The UE-IRs of T1DM ranged from around 0.88/100,000 to 2.37/100,000 for children in Beijing younger than 15 years of age from 1995 to 2010. The UE-IR increased faster in boys (1.47 times) and in the age group of 0-4 years (1.89 times) after 2003. The UE-IR was greatest in children aged 5-9 years (1.81/100,000) followed by the age of puberty (10-14 years, 1.76/100,000). The predicted number of new T1DM cases in Beijing will increase 1.97 times over the next 10 years. CONCLUSIONS The incidence trend of T1DM was increasing gradually in those younger than 15 years of age in Beijing. The incidence of younger children and boys grew faster. The 5- to 14-year-old children represented a high-risk population of T1DM. The number of predicted new T1DM cases will grow rapidly. This means that we should train more health care providers for pediatric diabetes patients, in order to achieve high-quality medical care and to be able to prevent or postpone chronic complications.
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Affiliation(s)
- Chunxiu Gong
- Beijing Children's Hospital, Capital Medical University, Beijing, China
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Fendler W, Małachowska B, Baranowska-Jazwiecka A, Borowiec M, Wyka K, Malecki MT, Jarosz-Chobot P, Mysliwiec M, Mlynarski W. Population-based estimates for double diabetes amongst people with glucokinase monogenic diabetes, GCK-MODY. Diabet Med 2014; 31:881-3. [PMID: 24660669 DOI: 10.1111/dme.12449] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 12/23/2013] [Accepted: 12/27/2013] [Indexed: 11/30/2022]
Affiliation(s)
- W Fendler
- Department of Paediatrics, Oncology, Haematology and Diabetology
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Cadario F, Cerutti F, Savastio S, Rabbone I, Tumini S, Bruno G. Increasing burden, younger age at onset and worst metabolic control in migrant than in Italian children with type 1 diabetes: an emerging problem in pediatric clinics. Acta Diabetol 2014; 51:263-7. [PMID: 24065151 DOI: 10.1007/s00592-013-0514-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 09/11/2013] [Indexed: 01/22/2023]
Abstract
To assess burden and clinical features of type 1 diabetes in migrant with respect to Italian children. Prevalent children with type 1 diabetes were identified through a multicenter study, including 46 pediatric outpatients diabetic clinics. A nested case-control study was also performed, comparing features at diabetes onset and after 1 year of insulin treatment in 84 migrants and 75 Italian children with onset in 2011, matched for age and sex. Out of 7,812 children cared for by pediatric diabetologists, 761 (10%) were migrant and 548 of them were born in Italy. Age at diagnosis was lower in migrants born in Italy (5.1 years, interquartile range (IQR) 2.2-7.7) than in those born in their original countries (7.8 years, IQR 5.3-10.3) and in Italians (9.8 years, IQR 5.9-13.0, p < 0.001). At diabetes onset, migrants had lower frequencies of positivities of markers of β-cell autoimmunity (96 vs. 99.5%, p < 0.01), higher values of weight loss (11 vs. 7%, p < 0.01), HbA1c (70 vs. 58 mmol/mol, p < 0.001), and insulin requirement (0.70 ± 0.03 vs. 0.63 ± 0.10 UI/kg/die, p = 0.05) and lower levels of 25-OH vitamin D3 (15.0 ± 2.8 vs. 20.8 ± 1.3, p = 0.03). Moreover, they experienced higher frequencies of hospitalizations during the first year of disease (19.2 vs. 2.7%, p < 0.001). Burden of type 1 diabetes in migrant children is increasing in Italy, with younger age at onset and different clinical features than in Italian children. Higher hospitalization rates and poorer glycemic control over the first year underline that approach to diabetes care in migrants needs to be improved.
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Affiliation(s)
- Francesco Cadario
- Division of Pediatrics, Department of Health Sciences, Università del "Piemonte Orientale Amedeo Avogadro", Novara, Italy
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Patterson C, Guariguata L, Dahlquist G, Soltész G, Ogle G, Silink M. Diabetes in the young - a global view and worldwide estimates of numbers of children with type 1 diabetes. Diabetes Res Clin Pract 2014; 103:161-75. [PMID: 24331235 DOI: 10.1016/j.diabres.2013.11.005] [Citation(s) in RCA: 271] [Impact Index Per Article: 24.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
This paper describes the methodology, results and limitations of the 2013 International Diabetes Federation (IDF) Atlas (6th edition) estimates of the worldwide numbers of prevalent cases of type 1 diabetes in children (<15 years). The majority of relevant information in the published literature is in the form of incidence rates derived from registers of newly diagnosed cases. Studies were graded on quality criteria and, if no information was available in the published literature, extrapolation was used to assign a country the rate from an adjacent country with similar characteristics. Prevalence rates were then derived from these incidence rates and applied to United Nations 2012 Revision population estimates for 2013 for each country to obtain estimates of the number of prevalent cases. Data availability was highest for the countries in Europe (76%) and lowest for the countries in sub-Saharan Africa (8%). The prevalence estimates indicate that there are almost 500,000 children aged under 15 years with type 1 diabetes worldwide, the largest numbers being in Europe (129,000) and North America (108,700). Countries with the highest estimated numbers of new cases annually were the United States (13,000), India (10,900) and Brazil (5000). Compared with the prevalence estimates made in previous editions of the IDF Diabetes Atlas, the numbers have increased in most of the IDF Regions, often reflecting the incidence rate increases that have been well-documented in many countries. Monogenic diabetes is increasingly being recognised among those with clinical features of type 1 or type 2 diabetes as genetic studies become available, but population-based data on incidence and prevalence show wide variation due to lack of standardisation in the studies. Similarly, studies on type 2 diabetes in childhood suggest increased incidence and prevalence in many countries, especially in Indigenous peoples and ethnic minorities, but detailed population-based studies remain limited.
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Affiliation(s)
- Chris Patterson
- Queen's University Belfast, Centre for Public Health, Belfast, United Kingdom
| | | | - Gisela Dahlquist
- University of Umeå, Department of Clinical Science, Umeå, Sweden
| | - Gyula Soltész
- Pécs University, Department of Pediatrics, Pécs, Hungary
| | - Graham Ogle
- International Diabetes Federation Life for a Child Program and Australian Diabetes Council, Sydney, Australia
| | - Martin Silink
- University of Sydney and the Children's Hospital at Westmead, Sydney, Australia
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Stankov K, Benc D, Draskovic D. Genetic and epigenetic factors in etiology of diabetes mellitus type 1. Pediatrics 2013; 132:1112-22. [PMID: 24190679 DOI: 10.1542/peds.2013-1652] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Diabetes mellitus type 1 (T1D) is a complex disease resulting from the interplay of genetic, epigenetic, and environmental factors. Recent progress in understanding the genetic basis of T1D has resulted in an increased recognition of childhood diabetes heterogeneity. After the initial success of family-based linkage analyses, which uncovered the strong linkage and association between HLA gene variants and T1D, genome-wide association studies performed with high-density single-nucleotide polymorphism genotyping platforms provided evidence for a number of novel loci, although fine mapping and characterization of these new regions remains to be performed. T1D is one of the most heritable common diseases, and among autoimmune diseases it has the largest range of concordance rates in monozygotic twins. This fact, coupled with evidence of various epigenetic modifications of gene expression, provides convincing proof of the complex interplay between genetic and environmental factors. In T1D, epigenetic phenomena, such as DNA methylation, histone modifications, and microRNA dysregulation, have been associated with altered gene expression. Increasing epidemiologic and experimental evidence supports the role of genetic and epigenetic alterations in the etiopathology of diabetes. We discuss recent results related to the role of genetic and epigenetic factors involved in development of T1D.
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Affiliation(s)
- Karmen Stankov
- Clinical Centre of Vojvodina, Medical Faculty, University of Novi Sad, Hajduk Veljkova 1, 21000 Novi Sad, Serbia.
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Zorena K, Raczyńska D, Raczyńska K. Biomarkers in diabetic retinopathy and the therapeutic implications. Mediators Inflamm 2013; 2013:193604. [PMID: 24311895 PMCID: PMC3839118 DOI: 10.1155/2013/193604] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 09/09/2013] [Indexed: 02/06/2023] Open
Abstract
The main problem both in type 1 (T1DM) and type 2 (T2DM) diabetes is the development of chronic vascular complications encompassing micro- as well as macrocirculation. Chronic complications lower the quality of life, lead to disability, and are the cause of premature death in DM patients. One of the chronic vascular complications is a diabetic retinopathy (DR) which leads to a complete loss of sight in DM patients. Recent trials show that the primary cause of diabetic retinopathy is retinal neovascularization caused by disequilibrium between pro- and antiangiogenic factors. Gaining knowledge of the mechanisms of action of factors influencing retinal neovascularization as well as the search for new, effective treatment methods, especially in advanced stages of DR, puts special importance on research concentrating on the implementation of biological drugs in DR therapy. At present, it is antivascular endothelial growth factor and antitumor necrosis factor that gain particular significance.
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Affiliation(s)
- Katarzyna Zorena
- Department of Clinical and Experimental Endocrinology, Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, Powstania Styczniowego 9b, 81-519 Gdynia, Poland
| | - Dorota Raczyńska
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Gdańsk, Poland
- Department and Clinic of Ophthalmology, Medical University of Gdańsk, Poland
| | - Krystyna Raczyńska
- Department and Clinic of Ophthalmology, Medical University of Gdańsk, Poland
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Relationship between serum transforming growth factor β 1 concentrations and the duration of type 1 diabetes mellitus in children and adolescents. Mediators Inflamm 2013; 2013:849457. [PMID: 24222720 PMCID: PMC3810184 DOI: 10.1155/2013/849457] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 09/02/2013] [Indexed: 12/13/2022] Open
Abstract
The aim of this study was to evaluate the relationship between serum transforming growth factor β 1 (TGF- β 1) concentrations and the duration of type 1 diabetes mellitus (T1DM) in children and adolescents. One hundred and sixteen patients with T1DM and 19 healthy controls were examined. Serum TGF- β 1 concentrations were measured using the cytometric bead array (CBA). A positive association between the time of diabetes duration and higher serum TGF- β 1 concentrations was observed. Similarly, the prevalence of microvascular complications, such as retinopathy and nephropathy, increased with the duration of diabetes. Logistic regression analysis showed that serum TGF- β 1 concentrations and the duration of the disease are independent risk factors of microangiopathy development. Higher serum TGF- β 1 concentrations were associated with a significant risk of microangiopathy development after 10 years of T1DM duration. In the successive years of the disease, the effect was even stronger. The results of our study indicate that serum TGF- β 1 concentrations are one of the factors that may have an impact on the progression of vascular complications in children and adolescents with T1DM.
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1H NMR-based metabolomics studies of urine reveal differences between type 1 diabetic patients with high and low HbAc1 values. J Pharm Biomed Anal 2013; 83:43-8. [DOI: 10.1016/j.jpba.2013.04.017] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2012] [Revised: 04/03/2013] [Accepted: 04/05/2013] [Indexed: 12/16/2022]
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Bruno G, Spadea T, Picariello R, Gruden G, Barutta F, Cerutti F, Cavallo-Perin P, Costa G, Gnavi R. Early life socioeconomic indicators and risk of type 1 diabetes in children and young adults. J Pediatr 2013; 162:600-605.e1. [PMID: 23084710 DOI: 10.1016/j.jpeds.2012.09.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2012] [Revised: 07/13/2012] [Accepted: 09/05/2012] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To examine the potential role of 2 early-life socioeconomic indicators, parental education, and crowding index, on risk of type 1 diabetes (T1DM) in patients up to age 29 years to test heterogeneity by age at onset according to the hygiene hypothesis. STUDY DESIGN The study base was 330 950 individuals born from 1967 to 2006 who resided in the city of Turin at any time between 1984 and 2007. Data on their early life socioeconomic position were derived from the Turin Longitudinal Study; 414 incident cases of T1DM up to age 29 years were derived from the Turin T1DM registry. RESULTS Socioeconomic indicators had opposing effects on risk of T1DM in different age at onset subgroups. In a Poisson regression model that included both socioeconomic indicators, there was a 3-fold greater risk of T1DM (relative risk 2.91, 95% CI 0.99-8.56) in children age 0-3 years at diagnosis living in crowded houses. In the 4- to 14-year subgroup, a low parental educational level had a protective effect (relative risk 0.50, 95% CI 0.29-0.84), and the effect of crowding nearly disappeared. In the 15- to 29-year subgroup, neither crowding nor parental educational level was clearly associated with the incidence of T1DM. CONCLUSIONS We provide evidence of heterogeneity by age at onset of the association between early-life socioeconomic indicators and the risk of T1DM. This finding is consistent with the hypothesis that infectious agents in the perinatal period may increase the risk, whereas in the following years they may become protective factors (hygiene hypothesis).
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Affiliation(s)
- Graziella Bruno
- Department of Medical Sciences, University of Turin, Turin, Italy.
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Compés ML, Feja C, Niño De Guzman E, Aguilar I, Conde S, Alonso JP, Rodrigo MP. Bayesian analysis of the geographical variation of type 1 diabetes mellitus in under 15 yr olds in northeast Spain, 1991-2009. Pediatr Diabetes 2013; 14:66-76. [PMID: 22816867 DOI: 10.1111/j.1399-5448.2012.00892.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 05/18/2012] [Accepted: 05/23/2012] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE High variability has been observed in type 1 diabetes mellitus (DM1) incidence rates (IRs) in childhood. The aim of this study was to characterize DM1 in Aragón and to identify variations in the geographical pattern by gender. METHODS A descriptive and ecological study was conducted to determine geographical variations in the DM1 incidence for the period 1991-2009. The source of information was the registry of DM1. To determine data completeness, a capture-recapture analysis was performed. Cases were georeferenced according to the Basic Healthcare Area (BHA) of residence. IRs for both genders, age group, 5 yr of diagnosis, and 95% confidence intervals (95% CIs) were calculated. Geographical pattern was studied applying Bayesian statistical model. The standardized incidence ratios (SIRs), smoothed SIR, and the posteriori risk probability (PRP) were represented cartographically for BHA stratified by gender. RESULTS The completeness was 93.5%. The global IR was 19.2 cases/10(5) person-years (95% CI: 17.6-20.8), boys 21.4 (95% CI: 19.0-23.8) and girls 16.8 (95% CI: 14.7-19.1). The age-specific rates were significantly lower in the 0-4 year age group with respect to the groups of 5-9 and 10-14 years. For boys, areas with a statistically significant excess of risk were found in the north [smoothed SIR: 118-167.9 and PRP of what the smoothed SIR would be greater than 100 (PRP) above 0.8] and below average risk in the south (smoothed SIR: 65.9-79.1 and PRP less than 0.2). CONCLUSIONS DM1 IR presented a north-south geographical pattern in boys. This pattern was not observed in girls or when both genders were considered together. Later studies should include gender as an essential variable.
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Affiliation(s)
- Maria Luisa Compés
- Group Health Services Research of Aragon, GRISSA, Government of Aragon, Zaragoza, Spain
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Korzeniowska K, Jarosz-Chobot P, Szypowska A, Ramotowska A, Fendler W, Kalina-Faska B, Szadkowska A, Mlynarski W, Mysliwiec M. L-thyroxine stabilizes autoimmune inflammatory process in euthyroid nongoitrous children with Hashimoto's thyroiditis and type 1 diabetes mellitus. J Clin Res Pediatr Endocrinol 2013; 5:240-4. [PMID: 24379033 PMCID: PMC3890223 DOI: 10.4274/jcrpe.1136] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 09/22/2013] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVE To investigate if L-thyroxine (T4) treatment may influence the clinical course of autoimmune thyroiditis (AIT) or prevent progression to subclinical or overt hypothyroidism in euthyroid nongoitrous pediatric patients with type 1 diabetes mellitus (T1DM) and AIT. METHODS The study was performed in four Polish pediatric diabetes centers. Of 330 children with T1DM and AIT followed between 2008 and 2012, 101 received L-T4 and 160 underwent clinical observation for 24 months. Thyroid stimulating hormone (TSH), free T4 (fT4), anti thyroid peroxidase antibody (anti-TPO), anti thyroglobulin antibody (anti-TG), glycosylated hemoglobin (HbA1c) levels, and lipid profile were assessed in all patients. Ultrasonographic evaluation was also performed in all children at each examination. RESULTS Patients treated with thyroid hormones had higher TSH levels (3.99; interquantile 3.5 to 4.52 vs. 2.09 mIU/L; interquantile 1.55 to 3.06; pp<0.0001). A fall in TSH level (0.87 mIU/L 95% CI 0.43-1.30; pp<0.0001) was documented after the first year of treatment. FT4 level did not differ between the groups at baseline (p=0.7434), but rose in the treatment group and fell in the control group [mean difference 0.78 95% CI-0.22-1.53 pmol/L (p=0.02) after 12 months and 0.98 95% CI 0.04-1.76 (p=0.005) after 24 months]. Higher levels of anti-TPO were initially found in the treated patients (pp<0.0001) and significantly decreased over the 24-month period (pp<0.0001). Children in the treatment group had higher anti-TG levels (pp<0.0001), which showed a borderline decrease (p=0.08) in time. In the control group, anti-TG levels rose marginally (p=0.06) during the study. CONCLUSIONS The data demonstrate that treatment with L-T4 in euthyroid pediatric patients with T1DM and AIT stabilizes autoimmune inflammation in the thyroid gland and is to be recommended as soon as the diagnosis is established.
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Affiliation(s)
- Katarzyna Korzeniowska
- Medical University of Gdansk, Department of Pediatrics, Diabetology and Endocrinology, Gdansk, Poland. E-mail:
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Cinek O, Kulich M, Sumnik Z. The incidence of type 1 diabetes in young Czech children stopped rising. Pediatr Diabetes 2012; 13:559-63. [PMID: 22487027 DOI: 10.1111/j.1399-5448.2012.00858.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Accepted: 01/24/2012] [Indexed: 12/01/2022] Open
Abstract
AIMS The aim was to assess trends in incidence of pediatric type 1 diabetes (T1D) using data recorded by the population-based Czech Childhood Diabetes Register over 1989-2009. METHODS New cases of childhood-onset T1D aged 0-14.9 yr were recorded using the EURODIAB protocol by two independent sources with the combined estimated completeness of 98.6%. The incidence was modeled by Poisson regression, and the effects of age and calendar time on incidence were assessed using piecewise linear functions. RESULTS A total of 5155 cases was ascertained over 1989-2009 from an average pediatric population of 1.76 million. Two points of change in the incidence trend were identified by the modeling: in 1995 the incidence accelerated, while in 2001 the growth in incidence significantly slowed down in all ages up to 10 yr. In the youngest age category, 0-4 yr at onset, the rapid average annual rise of 15% over 1996-2001 suddenly changed into stagnation over 2002-2009. CONCLUSIONS Our data contribute to the notion that long- and intermediate-term predictions from the past incidence developments of incidence are difficult, as abrupt changes in the trend can occur. Caution should be exercised against too far-reaching incidence predictions, even if the population has experienced a previous history of a very fast rise in T1D incidence.
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Affiliation(s)
- Ondrej Cinek
- Department of Paediatrics, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic.
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Usher-Smith JA, Thompson M, Ercole A, Walter FM. Variation between countries in the frequency of diabetic ketoacidosis at first presentation of type 1 diabetes in children: a systematic review. Diabetologia 2012; 55:2878-94. [PMID: 22933123 PMCID: PMC3464389 DOI: 10.1007/s00125-012-2690-2] [Citation(s) in RCA: 151] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Accepted: 07/12/2012] [Indexed: 01/02/2023]
Abstract
AIMS/HYPOTHESIS Type 1 diabetes is the most frequent endocrine disease in children, with 65,000 children diagnosed worldwide every year. Up to 80% of these children present with diabetic ketoacidosis (DKA), which is associated with both short-term risks and long-term consequences. This study aimed to characterise the worldwide variation in presentation of type 1 diabetes to inform future interventions to reduce this excess morbidity and mortality. METHODS This was a systematic review of studies indexed on PubMed, EMBASE, Web of Science, Scopus or CINAHL before March 2011 that included unselected groups of children presenting with new-onset type 1 diabetes, reported the proportion presenting with DKA and used a definition of DKA based on measurement of pH or bicarbonate. RESULTS Sixty-five studies of cohorts comprising over 29,000 children in 31 countries were included. The frequency of DKA at diagnosis ranged from 12.8% to 80%, with highest frequencies in the United Arab Emirates, Saudi Arabia and Romania, and the lowest in Sweden, the Slovak Republic and Canada. Multivariable modelling showed the frequency of DKA was inversely associated with gross domestic product, latitude and background incidence of type 1 diabetes. CONCLUSIONS/INTERPRETATION This is the first description of the variation in frequency of DKA at presentation of type 1 diabetes in children across countries. It demonstrates large variations that may, at least in part, be explained by different levels of disease awareness and healthcare provision and suggests ways to decrease the excess morbidity and mortality associated with DKA at diagnosis.
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Affiliation(s)
- J A Usher-Smith
- The Primary Care Unit, Department of Public Health and Primary Care, Strangeways Research Laboratory, University of Cambridge, Worts Causeway, Cambridge CB1 8RN, UK.
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Zorena K, Kula M, Malinowska E, Raczyńska D, Myśliwiec M, Raczyńska K. Threshold serum concentrations of tumour necrosis factor alpha (TNFα) as a potential marker of the presence of microangiopathy in children and adolescents with type 1 diabetes mellitus (T1DM). Hum Immunol 2012; 74:75-81. [PMID: 23073299 DOI: 10.1016/j.humimm.2012.10.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Revised: 09/12/2012] [Accepted: 10/03/2012] [Indexed: 11/18/2022]
Abstract
The aim of this study was to estimate the threshold serum concentrations of advanced glycation end products (AGEs) and their soluble receptors (sRAGE) as well as tumour necrosis factor alpha (TNFα), vascular endothelial growth factor(165) (VEGF(165)) and interleukin-12 (IL-12) in predicting the occurrence of microangiopathy in children and adolescents with type 1 diabetes mellitus (T1DM). We studied 88 children and adolescents (age range: 6-20 yrs) with T1DM and 32 control subjects (age range: 7-20 yrs). All study participants had their daily urinary albumin excretion, HbA1c and serum creatinine levels measured, and underwent an eye examination and 24-h blood pressure monitoring. Moreover, serum concentrations of AGEs, sRAGE, TNFα, VEGF(165) and IL-12 were measured. In order to calculate the threshold values of the studied parameters, the Receiver Operating Characteristic (ROC) curve analysis was used. The results of our study have shown that among all the studied parameters a discriminative ability was found for TNFα, VEGF(165), duration of the disease, serum AGEs concentrations and daily urinary albumin excretion. However, the highest value of the area under the ROC curve (AUC(ROC)) in predicting the occurrence of diabetic microangiopathy was found for serum TNFα concentrations with its threshold value of 1.7 pg/ml [AUC(ROC) = 0.88 (95% CI: 0.79-0.97)]. The sensitivity and specificity for this variable was at the level of 85.7% and 94.3%, respectively. In conclusion, according to our results serum TNFα concentrations over 1.7 pg/ml may point to the presence of diabetic microangiopathy in children and adolescents T1DM.
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Affiliation(s)
- Katarzyna Zorena
- Department of Clinical and Experimental Endocrinology, Institute of Maritime and Tropical Medicine, Medical University of Gdańsk, Poland.
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