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Kodama Y, Okabe T, Sasaki S, Yokomizo H, Sakamoto R, Niimi K, Ogawa Y. Anti-GAD antibody-negative, anti-IA2 antibody-positive slowly progressive insulin-dependent diabetes mellitus and Graves' disease preceded by childhood-onset minimal change nephrotic syndrome: a case report. Diabetol Int 2025; 16:421-426. [PMID: 40166451 PMCID: PMC11954764 DOI: 10.1007/s13340-024-00787-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Accepted: 12/18/2024] [Indexed: 04/02/2025]
Abstract
It is rare for a patient to have minimal change nephrotic syndrome, slowly progressive insulin-dependent diabetes mellitus, and Graves' disease in combination. In this case, a patient developed idiopathic nephrotic syndrome at the age of 11 years. She was diagnosed with frequently relapsing nephrotic syndrome and steroid-dependent nephrotic syndrome after repeated increases in urinary protein levels with prednisolone reduction. At the age of 14 years, steroid-induced diabetes was suspected because she was negative for anti-glutamic acid decarboxylase (GAD) antibody, and her glycemic control improved after medication. At the age of 16 years, her nephrotic syndrome was in remission, but even after discontinuation of cyclosporine, her glycemic control did not improve. Decreased insulin secretion and positive anti-insulinoma-associated protein-2 (IA2) antibody were found, and therefore she was diagnosed as having slowly progressive insulin-dependent diabetes mellitus (SPIDDM). Although her glycemic control was stable with insulin therapy, she was diagnosed with asymptomatic Graves' disease at the age of 28 years and started treatment. Human leukocyte antigen testing (HLA) was performed to evaluate the etiology of the disease, which revealed A*02:01, B*35:01, DQA1*03:01, DQB1*03:02, DQB1*04:01, DRB1*04:05, DRB1*08:02, and DPB1*05:01, suggesting genetic involvement of HLA for each disease susceptibility.
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Affiliation(s)
- Yoshimi Kodama
- Fukuoka Central Hospital, 6-11-2 Yakuin, Chuou-ku, Fukuoka, 810-0022 Japan
| | - Taijiro Okabe
- Fukuoka Central Hospital, 6-11-2 Yakuin, Chuou-ku, Fukuoka, 810-0022 Japan
- Fukuoka Sanno Hospital, 3-6-45 Momochihama, Sawara-ku, Fukuoka, 814-0001 Japan
| | - Shuji Sasaki
- Sasaki Diabetes Clinic, 5-15-13 Nishijin, Sawara-ku, Fukuoka, 814-0002 Japan
| | - Hisashi Yokomizo
- Department of Endocrinology and Diabetes, Fukuoka University School of Medicine, 7-45-1 Nanakuma, Jonan-ku, Fukuoka, 814-0180 Japan
| | - Ryuichi Sakamoto
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
| | - Kazuhiko Niimi
- Fukuoka Sanno Hospital, 3-6-45 Momochihama, Sawara-ku, Fukuoka, 814-0001 Japan
| | - Yoshihiro Ogawa
- Department of Medicine and Bioregulatory Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582 Japan
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Kamitani F, Nishioka Y, Koizumi M, Nakajima H, Kurematsu Y, Okada S, Kubo S, Myojin T, Noda T, Imamura T, Takahashi Y. Immune checkpoint inhibitor-related type 1 diabetes incidence, risk, and survival association. J Diabetes Investig 2025; 16:334-342. [PMID: 39569589 PMCID: PMC11786175 DOI: 10.1111/jdi.14362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2024] [Revised: 10/01/2024] [Accepted: 11/10/2024] [Indexed: 11/22/2024] Open
Abstract
AIM/INTRODUCTION Although immune checkpoint inhibitor-related type 1 diabetes mellitus (ICI-T1DM) is a rare condition, it is of significant concern globally. We aimed to elucidate the precise incidence, risk factors, and impact of ICI-T1DM on survival outcomes. MATERIALS AND METHODS The study is a large retrospective cohort study, performed using the DeSC Japanese administrative claims database comprising 11 million patients. The database population is reportedly similar to the entire population of Japan. Patients administered ICI between 2014 and 2022 were enrolled in the study, including 21,121 patients. The risk factors for ICI-T1DM development and their characteristics were evaluated by logistic regression analysis. Development of a new irAE after the day following the first administration of ICI was set as the study outcome. RESULTS ICI-T1DM was observed in 102 (0.48%) of the 21,121 patients after ICI initiation. PD-(L)1 and CTLA-4 combination therapy was associated with an increased risk of ICI-T1DM compared with PD-1 monotherapy (odds ratio [OR], 2.36; 95% confidence interval [CI], 1.21-4.58; P = 0.01). Patients with a prior diagnosis of diabetes mellitus (OR, 1.59; 95% CI, 1.03-2.46; P = 0.04) or hypothyroidism (OR, 2.48; 95% CI, 1.39-4.43; P < 0.01) also exhibited an increased risk of ICI-T1DM. The Kaplan-Meier analysis revealed that patients with ICI-T1DM showed higher survival rates than those without (log-lank test, P < 0.01). Multivariable Cox regression analysis demonstrated that ICI-T1DM development was associated with lower mortality (hazard ratio, 0.60; 95% CI, 0.37-0.99; P = 0.04). CONCLUSIONS Collectively, the results of this study demonstrate the precise incidence and risk factors of ICI-T1DM. The development of ICI-T1DM, like other irAEs, is associated with higher survival rates.
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Affiliation(s)
- Fumika Kamitani
- Department of Diabetes and EndocrinologyNara Medical UniversityKashiharaNaraJapan
| | - Yuichi Nishioka
- Department of Public Health, Health Management and PolicyNara Medical UniversityKashiharaNaraJapan
| | - Miyuki Koizumi
- Department of Diabetes and EndocrinologyNara Medical UniversityKashiharaNaraJapan
| | - Hiroki Nakajima
- Department of Diabetes and EndocrinologyNara Medical UniversityKashiharaNaraJapan
| | - Yukako Kurematsu
- Department of Diabetes and EndocrinologyNara Medical UniversityKashiharaNaraJapan
| | - Sadanori Okada
- Department of Diabetes and EndocrinologyNara Medical UniversityKashiharaNaraJapan
| | - Shinichiro Kubo
- Department of Public Health, Health Management and PolicyNara Medical UniversityKashiharaNaraJapan
| | - Tomoya Myojin
- Department of Public Health, Health Management and PolicyNara Medical UniversityKashiharaNaraJapan
| | - Tatsuya Noda
- Department of Public Health, Health Management and PolicyNara Medical UniversityKashiharaNaraJapan
| | - Tomoaki Imamura
- Department of Public Health, Health Management and PolicyNara Medical UniversityKashiharaNaraJapan
| | - Yutaka Takahashi
- Department of Diabetes and EndocrinologyNara Medical UniversityKashiharaNaraJapan
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Tagawa K, Maruo Y. Dolutegravir metabolism: impact of genetic variations on uridine diphosphate glucuronosyltransferase subfamilies. Xenobiotica 2025:1-8. [PMID: 39815789 DOI: 10.1080/00498254.2025.2453983] [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: 11/06/2024] [Revised: 01/09/2025] [Accepted: 01/12/2025] [Indexed: 01/18/2025]
Abstract
Dolutegravir (DTG) is a key drug used to treat human immunodeficiency virus type-1 (HIV-1) infections. Adverse events (AEs) of DTG treatment, including headache, anxiety, depression, insomnia, and abnormal dreams, are influenced by sex, body weight, age, and serum bilirubin levels. DTG is mainly metabolised by members of the uridine diphosphate glucuronosyltransferase 1A subfamilies (UGT1As), especially UGT1A1.Some studies suggest a relationship between UGT1A1 variants and AEs. The aim of this study was to identify UGT1A isoforms that exhibit DTG glucuronidation activity and determine the relationship between UGT1A variants and DTG glucuronidation in vitro.UGT1A1, UGT1A3, UGT1A9, and UGT1A10 exhibited DTG glucuronidation activity, of which UGT1A1 was the most active. Furthermore, variants of these isoforms showed decreased DTG glucuronidation activity. The different variants of UGT1As, such as UGT1A1.6, UGT1A1.7, UGT1A1.35, UGT1A1.63, UGT1A3.5, UGT1A9.2, UGT1A10M59I, and UGT1A10T202I, showed reduced glucuronidation activity towards DTG in comparison with the wild-type UGT1As.This study elucidates the relationship between UGT1A variants and the levels of glucuronidation associated with each variant.Checking for UGT1As may be helpful in predicting potential toxicities and adverse effects related to DTG treatment.
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Affiliation(s)
- Kouji Tagawa
- Department of Pediatrics, Shiga University of Medical Science, Shiga, Japan
- Department of Pediatrics, Sapporo Tokushukai Hospital, Hokkaido, Japan
| | - Yoshihiro Maruo
- Department of Pediatrics, Shiga University of Medical Science, Shiga, Japan
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Conway RB, Snell-Bergeon J, Honda-Kohmo K, Peddi AK, Isa SB, Sulong S, Sibomana L, Gerard Gonzalez A, Song J, Lomax KE, Lo CN, Kim W, Haynes A, de Bock M, Burckhardt MA, Schwab S, Hong K. Disparities in Diabetes Technology Uptake in Youth and Young Adults With Type 1 Diabetes: A Global Perspective. J Endocr Soc 2024; 9:bvae210. [PMID: 39703363 PMCID: PMC11655873 DOI: 10.1210/jendso/bvae210] [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: 05/23/2024] [Indexed: 12/21/2024] Open
Abstract
Globally, nearly 9 million people are living with type 1 diabetes (T1D). Although the incidence of T1D is not affected by socioeconomic status, the development of complications and limited access to modern therapy is overrepresented in vulnerable populations. Diabetes technology, specifically continuous glucose monitoring and automated insulin delivery systems, are considered the gold standard for management of T1D, yet access to these technologies varies widely across countries and regions, and varies widely even within high-income countries. This review focuses on disparities in diabetes technology use among adolescents and young adults with T1D, barriers to access and use, and summarizes common themes emerging across countries and regions. We conducted a survey among medical technology manufacturers and physicians in various countries across diverse geographical regions and performed extensive literature searches. Across all countries and regions, economic barriers stand out as the largest and most common barriers, either preventing market penetrance of technology into a country or limiting its access to the individual with diabetes due to high out of pocket costs. Other common barriers include structural or accessibility barriers, such as stringent eligibility requirements by insurance providers, regardless of whether the insurance was private or government-based, and provider/individual level barriers. Based on the evidence presented, we suggest the need for a joint effort involving governments, private health insurers, technology manufacturers, and healthcare providers to address the global disparities of diabetic technology utilization and ensure equitable access for all individuals living with T1D worldwide.
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Affiliation(s)
- Rebecca Baqiyyah Conway
- Department of Epidemiology, University of Colorado, Aurora, CO 80045, USA
- American Academy of Epidemiology, Inc., Tyler, TX 75701, USA
| | - Janet Snell-Bergeon
- Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado, Aurora, CO 80045, USA
| | - Kyoko Honda-Kohmo
- Division of Preventative Healthcare, National Cerebral and Cardiovascular Center, Suita, Osaka 564-8565, Japan
| | | | - Salbiah Binti Isa
- Universiti Sains Malaysia, Advanced Medical and Dental Institute, 130200 Pulau, Pinang, Malaysia
| | - Shakira Sulong
- Division of Medical Operations, Metro Sihat Sdn Bhd, 60000 Kuala Lumpur, Malaysia
| | - Laurien Sibomana
- Department of the Director, Pillar of Health, Pittsburgh, PA 15237, USA
| | - Andrea Gerard Gonzalez
- Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado, Aurora, CO 80045, USA
| | - Jooyoun Song
- Department of Psychiatry, Jooyoun's Psychiatry, 07938 Seoul, Korea
| | - Kate Elizabeth Lomax
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, WA 6909, Australia
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Nedlands, WA 6909, Australia
| | - Ching-Nien Lo
- GM Office, EPS BIO Technology Corp., Hsinchu 30076, Taiwan
| | - Wondong Kim
- Management (Including R&D Director), CareforU Co., Ltd., 14042 Anyang, Korea
| | - Aveni Haynes
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Nedlands, WA 6909, Australia
| | - Martin de Bock
- Department of Pediatrics, University of Otago, Christchurch 8140, New Zealand
| | - Marie-Anne Burckhardt
- University Children's Hospital Basel UKBB, Pediatric Endocrinology and Diabetology, 4056 Basel, Switzerland
| | - Savannah Schwab
- Department of Epidemiology, University of Colorado, Aurora, CO 80045, USA
| | - Kwanho Hong
- Management (Marketing & Development), CareforU Co., Ltd., 14042 Anyang, Korea
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Nóvoa-Medina Y, Marcelino-Rodriguez I, Suárez NM, Barreiro-Bautista M, Rivas-García E, Sánchez-Alonso S, González-Martínez G, Quinteiro-González S, Domínguez Á, Cabrera M, López S, Pavlovic S, Flores C, Wägner AM. Does HLA explain the high incidence of childhood-onset type 1 diabetes in the Canary Islands? The role of Asp57 DQB1 molecules. BMC Pediatr 2024; 24:569. [PMID: 39243072 PMCID: PMC11378579 DOI: 10.1186/s12887-024-04983-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 07/29/2024] [Indexed: 09/09/2024] Open
Abstract
The Canary Islands inhabitants, a recently admixed population with significant North African genetic influence, has the highest incidence of childhood-onset type 1 diabetes (T1D) in Spain and one of the highest in Europe. HLA accounts for half of the genetic risk of T1D. AIMS To characterize the classical HLA-DRB1 and HLA-DQB1 alleles in children from Gran Canaria with and without T1D. METHODS We analyzed classic HLA-DRB1 and HLA-DQB1 alleles in childhood-onset T1D patients (n = 309) and control children without T1D (n = 222) from the island of Gran Canaria. We also analyzed the presence or absence of aspartic acid at position 57 in the HLA-DQB1 gene and arginine at position 52 in the HLA-DQA1 gene. Genotyping of classical HLA-DQB1 and HLA-DRB1 alleles was performed at two-digit resolution using Luminex technology. The chi-square test (or Fisher's exact test) and odds ratio (OR) were computed to assess differences in allele and genotype frequencies between patients and controls. Logistic regression analysis was also used. RESULTS Mean age at diagnosis of T1D was 7.4 ± 3.6 years (46% female). Mean age of the controls was 7.6 ± 1.1 years (55% female). DRB1*03 (OR = 4.2; p = 2.13-13), DRB1*04 (OR = 6.6; p ≤ 2.00-16), DRB1* 07 (OR = 0.37; p = 9.73-06), DRB1*11 (OR = 0.17; p = 6.72-09), DRB1*12, DRB1*13 (OR = 0.38; p = 1.21-05), DRB1*14 (OR = 0.0; p = 0.0024), DRB1*15 (OR = 0.13; p = 7.78-07) and DRB1*16 (OR = 0.21; p = 0.003) exhibited significant differences in frequency between groups. Among the DQB1* alleles, DQB1*02 (OR: 2.3; p = 5.13-06), DQB1*03 (OR = 1.7; p = 1.89-03), DQB1*05 (OR = 0.64; p = 0.027) and DQB1*06 (OR = 0.19; p = 6.25-14) exhibited significant differences. A total of 58% of the studied HLA-DQB1 genes in our control population lacked aspartic acid at position 57. CONCLUSIONS In this population, the overall distributions of the HLA-DRB1 and HLA-DQB1 alleles are similar to those in other European populations. However, the frequency of the non-Asp-57 HLA-DQB1 molecules is greater than that in other populations with a lower incidence of T1D. Based on genetic, historical and epidemiological data, we propose that a common genetic background might help explain the elevated pediatric T1D incidence in the Canary Islands, North-Africa and middle eastern countries.
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Affiliation(s)
- Yeray Nóvoa-Medina
- Unidad de Endocrinología Pediátrica, Complejo Hospitalario Universitario Insular Materno Infantil de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
- Asociación Canaria para la Investigación Pediátrica (ACIP canarias), Las Palmas, Spain.
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias de la Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain.
| | - Itahisa Marcelino-Rodriguez
- Preventive Medicine and Public Health Area, University of La Laguna, Santa Cruz de Tenerife, Spain
- Institute of Biomedical Technologies, University of La Laguna, Santa Cruz de Tenerife, Spain
| | - Nicolás M Suárez
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias de la Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Marta Barreiro-Bautista
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias de la Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Eva Rivas-García
- Servicio de Inmunología, Complejo Hospitalario Universitario Insular Materno Infantil de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Santiago Sánchez-Alonso
- Servicio de Inmunología, Complejo Hospitalario Universitario Insular Materno Infantil de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Gema González-Martínez
- Servicio de Inmunología, Complejo Hospitalario Universitario Insular Materno Infantil de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Sofía Quinteiro-González
- Unidad de Endocrinología Pediátrica, Complejo Hospitalario Universitario Insular Materno Infantil de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Ángela Domínguez
- Unidad de Endocrinología Pediátrica, Complejo Hospitalario Universitario Insular Materno Infantil de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - María Cabrera
- Unidad de Endocrinología Pediátrica, Complejo Hospitalario Universitario Insular Materno Infantil de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Sara López
- Unidad de Endocrinología Pediátrica, Complejo Hospitalario Universitario Insular Materno Infantil de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Svetlana Pavlovic
- Servicio de Pediatría Complejo Hospitalario Universitario Insular Materno Infantil de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Carlos Flores
- Institute of Biomedical Technologies, University of La Laguna, Santa Cruz de Tenerife, Spain
- Genomics Division, Instituto Tecnológico y de Energías Renovables (ITER), Santa Cruz de Tenerife, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Facultad de Ciencias de la Salud, Universidad Fernando de Pessoa Canarias, Las Palmas de Gran Canaria, Spain
| | - Ana M Wägner
- Instituto Universitario de Investigaciones Biomédicas y Sanitarias de la Universidad de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
- Servicio de Endocrinología y Nutrición, Complejo Hospitalario Universitario Insular Materno Infantil de Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain
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6
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Tanaka S, Akagawa H, Azuma K, Higuchi S, Ujiie A, Hashimoto K, Iwasaki N. High prevalence of copy number variations in the Japanese participants with suspected MODY. Clin Genet 2024; 106:293-304. [PMID: 38733153 DOI: 10.1111/cge.14544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/27/2024] [Accepted: 04/29/2024] [Indexed: 05/13/2024]
Abstract
Maturity-Onset Diabetes of the Young (MODY) is a diabetes mellitus subtype caused by a single gene. The detection rate of the responsible gene is 27% in the United Kingdom, indicating that the causative gene remains unknown in the majority of clinically diagnosed MODY cases. To improve the detection rate, we applied comprehensive genetic testing using whole exome sequencing (WES) followed by Multiplex Ligation-dependent Probe Amplification (MLPA) and functional analyses. Twenty-one unrelated Japanese participants with MODY were enrolled in the study. To detect copy number variations (CNVs), WES was performed first, followed by MLPA analysis for participants who were negative on the basis of WES. Undetermined variants were analyzed according to their functional properties. WES identified 7 pathogenic and 3 novel likely pathogenic variants in the 21 participants. Functional analyses revealed that 1 in 3 variants was pathogenic. MLPA analysis applied to the remaining 13 undetermined samples identified 4 cases with pathogenic CNVs: 3 in HNF4A and 1 in HNF1B. Pathogenic variants were identified in 12 participants (12/21, 57.1%) - relatively high rate reported to date. Notably, one-third of the participants had CNVs in HNF4A or HNF1B, indicating a limitation of WES-only screening.
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Affiliation(s)
- Satoshi Tanaka
- Institute for Comprehensive Medical Sciences, Tokyo Women's Medical University, Tokyo, Japan
- Diabetes and Metabolism, School of Medicine, Tokyo Women's Medical University, Tokyo, Japan
| | - Hiroyuki Akagawa
- Institute for Comprehensive Medical Sciences, Tokyo Women's Medical University, Tokyo, Japan
- Department of Neurosurgery, Tokyo Women's Medical University Adachi Medical Center, Tokyo, Japan
| | - Kenkou Azuma
- Institute for Comprehensive Medical Sciences, Tokyo Women's Medical University, Tokyo, Japan
| | - Sayaka Higuchi
- Institute for Comprehensive Medical Sciences, Tokyo Women's Medical University, Tokyo, Japan
| | - Atsushi Ujiie
- Department of Diabetes, Endocrinology and Hematology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Koshi Hashimoto
- Department of Diabetes, Endocrinology and Hematology, Dokkyo Medical University Saitama Medical Center, Saitama, Japan
| | - Naoko Iwasaki
- Institute for Comprehensive Medical Sciences, Tokyo Women's Medical University, Tokyo, Japan
- Diabetes and Metabolism, School of Medicine, Tokyo Women's Medical University, Tokyo, Japan
- Division of Diabetes, Endocrinology and Metabolism, Tokyo Women's Medical University Yachiyo Medical Center, Chiba, Japan
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7
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Warncke K, Tamura R, Schatz DA, Veijola R, Steck AK, Akolkar B, Hagopian W, Krischer JP, Lernmark Å, Rewers MJ, Toppari J, McIndoe R, Ziegler AG, Vehik K, Haller MJ, Elding Larsson H. The Influence of Pubertal Development on Autoantibody Appearance and Progression to Type 1 Diabetes in the TEDDY Study. J Endocr Soc 2024; 8:bvae103. [PMID: 38867880 PMCID: PMC11167566 DOI: 10.1210/jendso/bvae103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Indexed: 06/14/2024] Open
Abstract
Context The 2 peaks of type 1 diabetes incidence occur during early childhood and puberty. Objective We sought to better understand the relationship between puberty, islet autoimmunity, and type 1 diabetes. Methods The relationships between puberty, islet autoimmunity, and progression to type 1 diabetes were investigated prospectively in children followed in The Environmental Determinants of Diabetes in the Young (TEDDY) study. Onset of puberty was determined by subject self-assessment of Tanner stages. Associations between speed of pubertal progression, pubertal growth, weight gain, homeostasis model assessment of insulin resistance (HOMA-IR), islet autoimmunity, and progression to type 1 diabetes were assessed. The influence of individual factors was analyzed using Cox proportional hazard ratios. Results Out of 5677 children who were still in the study at age 8 years, 95% reported at least 1 Tanner Stage score and were included in the study. Children at puberty (Tanner Stage ≥2) had a lower risk (HR 0.65, 95% CI 0.45-0.93; P = .019) for incident autoimmunity than prepubertal children (Tanner Stage 1). An increase of body mass index Z-score was associated with a higher risk (HR 2.88, 95% CI 1.61-5.15; P < .001) of incident insulin autoantibodies. In children with multiple autoantibodies, neither HOMA-IR nor rate of progression to Tanner Stage 4 were associated with progression to type 1 diabetes. Conclusion Rapid weight gain during puberty is associated with development of islet autoimmunity. Puberty itself had no significant influence on the appearance of autoantibodies or type 1 diabetes. Further studies are needed to better understand the underlying mechanisms.
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Affiliation(s)
- Katharina Warncke
- TUM School of Medicine, Department of Pediatrics, Technical University of Munich, 81675 Munich, Germany
- German Center for Environmental Health, Institute of Diabetes Research, Helmholtz Munich, 80939 Munich, Germany
| | - Roy Tamura
- Health Informatics Institute, University of South Florida, Tampa, FL 33612, USA
| | - Desmond A Schatz
- Diabetes Center of Excellence, University of Florida, Gainesville, FL 32610, USA
| | - Riitta Veijola
- Department of Pediatrics, Research Unit of Clinical Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, 90014 Oulu, Finland
| | - Andrea K Steck
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Beena Akolkar
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD 20892, USA
| | - William Hagopian
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Jeffrey P Krischer
- Health Informatics Institute, University of South Florida, Tampa, FL 33612, USA
| | - Åke Lernmark
- Department of Clinical Sciences, Lund University/Clinical Research Centre, Skane University Hospital, 21428 Malmö, Sweden
| | - Marian J Rewers
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Jorma Toppari
- Department of Pediatrics, University of Turku and Turku University Hospital, 20520 Turku, Finland
- Institute of Biomedicine, Research Centre for Integrative Physiology and Pharmacology, and Centre for Population Health Research, University of Turku, 20520 Turku, Finland
| | - Richard McIndoe
- Center for Biotechnology and Genomic Medicine, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA
| | - Anette-G Ziegler
- German Center for Environmental Health, Institute of Diabetes Research, Helmholtz Munich, 80939 Munich, Germany
- German Center for Diabetes Research (DZD), 85764 Munich-Neuherberg, Germany
- Forschergruppe Diabetes, School of Medicine, Klinikum rechts der Isar, Technical University Munich, 81675 Munich, Germany
- Forschergruppe Diabetes e.V. at Helmholtz Munich, German Research Center for Environmental Health, 80939 Munich, Germany
| | - Kendra Vehik
- Health Informatics Institute, University of South Florida, Tampa, FL 33612, USA
| | - Michael J Haller
- Department of Pediatrics, Diabetes Institute, College of Medicine, University of Florida, Gainesville, FL 32610, USA
| | - Helena Elding Larsson
- Unit for Pediatric Endocrinology, Department of Clinical Sciences Malmö, Lund University, 20502 Malmö, Sweden
- Department of Paediatrics, Skåne University Hospital, 20502 Malmö, Sweden
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8
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Sato J, Nakajima K, Mita T, Koshibu M, Sato A, Goto H, Ikeda F, Nishida Y, Aso K, Watada H. Protocol of a Prospective Observational Study on Lifestyle and Quality of Life in Adults with Type 1 Diabetes in Japan. Diabetes Ther 2024; 15:883-892. [PMID: 38363542 PMCID: PMC10951137 DOI: 10.1007/s13300-024-01539-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 01/25/2024] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION Recent studies have shown that the quality of life (QOL) of people living with type 1 diabetes (T1D) is poor and must be improved. However, the living situation and QOL of adults living with T1D in Japan have not been fully clarified. This study will examine their lifestyle, QOL, and clinical situation, as well as the relationships between them. METHODS This is a prospective, 5-year follow-up observational study. Between December 2019 and September 2021, we enrolled adults in Japan who were living with T1D and receiving insulin therapy, and are acquiring longitudinal clinical data and the responses to seven questionnaires regarding lifestyle and QOL. The primary study outcomes are (1) the relationship between Problem Areas in Diabetes (PAID) scores and various factors including demographic data, clinical characteristics, medical history, lifestyle habits, treatment history, biochemical data, and the scores of questionnaires; and (2) the relationship between Beck Depression Inventory (BDI)-II scores and various factors aforementioned. The secondary outcomes are the relationships between various factors aforementioned and each of the following: (1) blood glucose control, (2) blood lipid control, (3) dietary patterns, (4) fear of hypoglycemia, (5) sleep patterns, and (6) physical activity. PLANNED OUTCOME We registered 352 participants. The median age was 49 (41-63) years, and the median duration of T1D was 13 (8-20) years. All the results will be available in 2026. We expect to clarify the factors associated with decreased QOL, and that this knowledge will contribute to improving QOL in adults in Japan who are living with T1D and receiving insulin therapy. TRIAL REGISTRATION Clinical Trials.gov identifier, UMIN000044088.
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Affiliation(s)
- Junko Sato
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Kenichi Nakajima
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Tomoya Mita
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Mami Koshibu
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Ayako Sato
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Hiromasa Goto
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Fuki Ikeda
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Yuya Nishida
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Katsumi Aso
- Aso Clinic, 11-1 Tsutsui-cho, Numazu-shi, Shizuoka, 410-0041, Japan
| | - Hirotaka Watada
- Department of Metabolism and Endocrinology, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
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Ata F, Khan AA, Khamees I, AlKodmani S, Al-Sadi A, Yaseen KB, Muthanna B, Godwin A, Beer SF, Bashir M. Prevalence and prognosis of fulminant type 1 diabetes mellitus in The Middle East: a comparative analysis in a 5-year nationwide cohort. BMC Endocr Disord 2024; 24:33. [PMID: 38462602 PMCID: PMC10926611 DOI: 10.1186/s12902-024-01559-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 02/21/2024] [Indexed: 03/12/2024] Open
Abstract
PURPOSE To analyze the prevalence and progression of fulminant type 1 diabetes (FT1D) in Qatar. METHODS This retrospective study analyzed consecutive index- diabetic ketoacidosis (DKA) admissions (2015-2020) among patients with new-onset T1D (NT1D) in Qatar. RESULTS Of the 242 patients, 2.5% fulfilled the FT1D diagnostic criteria. FT1D patients were younger (median-age 4-years vs.15-years in classic-T1D). Gender distribution in FT1D was equal, whereas the classic-T1D group showed a female predominance at 57.6% (n = 136). FT1D patients had a mean C-peptide of 0.11 ± 0.09 ng/ml, compared to 0.53 ± 0.45 ng/ml in classic-T1D. FT1D patients had a median length of stay (LOS) of 1 day (1-2.2) and a DKA duration of 11.25 h (11-15). The median (length of stay) LOS and DKA duration in classic-T1D patients were 2.5 days (1-3.9) and 15.4 h (11-23), respectively. The FT1D subset primarily consisted of moderate (83.3%) and severe 916.7%) DKA, whereas classic T1D had 25.4% mild, 60.6% moderate, and 14% severe DKA cases. FT1D was associated with a higher median white cell count (22.3 × 103/uL) at admission compared to classic T1D (10.6 × 103/uL). ICU admission was needed for 66.6% of FT1D patients, compared to 38.1% of classic-T1D patients. None of the patients in the FT1D group had mortality, while two died in the classic-T1D group. CONCLUSION This is the first study establishing the existence of FT1D in ME, which presented distinctively from classic-T1D, exhibiting earlier age onset and higher critical care requirements. However, the clinical outcomes in patients with FT1D seem similar to classic T1D.
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Affiliation(s)
- Fateen Ata
- Department of Endocrinology, Hamad Medical Corporation, Doha, Qatar.
| | - Adeel Ahmad Khan
- Department of Endocrinology, Hamad Medical Corporation, Doha, Qatar
| | - Ibrahim Khamees
- Department of Internal Medicine, University of Missouri, Kansas City, MO, USA
| | - Sham AlKodmani
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Anas Al-Sadi
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | - Bassam Muthanna
- Department of Medicine, Louis A. Weiss Memorial Hospital, Chicago, USA
| | - Angela Godwin
- Department of Laboratory Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | - Mohammed Bashir
- Department of Endocrinology, Hamad Medical Corporation, Doha, Qatar
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10
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Hormazábal-Aguayo I, Ezzatvar Y, Huerta-Uribe N, Ramírez-Vélez R, Izquierdo M, García-Hermoso A. Incidence of type 1 diabetes mellitus in children and adolescents under 20 years of age across 55 countries from 2000 to 2022: A systematic review with meta-analysis. Diabetes Metab Res Rev 2024; 40:e3749. [PMID: 38037806 DOI: 10.1002/dmrr.3749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 10/03/2023] [Accepted: 11/11/2023] [Indexed: 12/01/2023]
Abstract
AIMS The aim of this study was to determine the global incidence of type 1 diabetes mellitus (T1DM) in children and adolescents under 20 years of age from 2000 to 2022. MATERIALS AND METHODS Two reviewers searched three electronic databases (PubMed, Web of Science, and CINAHL) for studies published between January 2000 and November 2022. Pooled estimates of T1DM incidence with a 95% confidence interval (CI) per 100,000 person-years were calculated by country/region, sex, age, and COVID-19 pandemic period (pre-COVID-19 and pandemic). RESULTS The study included 126 studies from 55 countries and 18 regions. The incidence rate (IR) of T1DM from 2000 to 2022 was 14.07 (95%CI, 12.15-16.29) per 100,000 person-years. Finland and high-income North America had the highest IR, with 56.81 (95%CI, 55.91-57.73) and 28.77 (95%CI, 26.59-31.13) per 100,000 person-years, respectively. The IR was 13.37 (95%CI, 10.60-16.88) per 100,000 person-years in boys and 13.87 (95%CI, 11.51-16.70) per 100,000 person-years in girls. There were statistically significant differences among different age ranges: 0-4 versus 5-9 and 10-14 years old (p < 0.001); 5-9 versus 15-19 (p < 0.001) and 10-14 versus 15-19 years old (p = 0.003). Finally, during the pandemic period (2020-2022), the IR was 24.84 (95%CI, 17.16-35.96) per 100,000 person-years, which was higher but not significant compared with the prepandemic period (2017-2019) of 13.56 (95%CI, 7.49-24.56) per 100,000 person-years (p = 0.090). CONCLUSIONS The IR of T1DM in children and adolescents under 20 years of age is substantial, especially during the pandemic period, although it varies across regions. More reliable data from additional countries are needed to determine the worldwide incidence of T1DM.
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Affiliation(s)
- Ignacio Hormazábal-Aguayo
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), Pamplona, Spain
| | - Yasmin Ezzatvar
- Department of Nursing, Universitat de València, Valencia, Spain
| | - Nidia Huerta-Uribe
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), Pamplona, Spain
| | - Robinson Ramírez-Vélez
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), Pamplona, Spain
| | - Mikel Izquierdo
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), Pamplona, Spain
| | - Antonio García-Hermoso
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), Pamplona, Spain
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11
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Shi H, Wu S, Ran Z, Tang H, Xiong Q. A New Mouse Model of Whole Pancreas Transplant With Graft Blood Through the Portal Vein. EXP CLIN TRANSPLANT 2024; 22:52-62. [PMID: 38284375 DOI: 10.6002/ect.2023.0305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2024]
Abstract
OBJECTIVES Pancreas transplant is currently the most effective method for maintaining physiological blood sugar levels and reversing small blood vessel injuries. Our team developed a model of whole pancreas transplant based on microsurgical techniques following the investigation of more than 300 mice. MATERIALS AND METHODS A mouse pancreatic transplant model is required to investigate the pathophysiological process of pancreas transplant and pancreatic preservation technologies. Recently, the segment-neck pancreas transplant has been the most utilized mouse pancreatic transplant model. The innovative mouse pancreatic transplant modelthat we developed in this study uses the whole pancreas and returns heart blood flow into the liver via the portal vein. RESULTS With our mouse pancreatic transplant model, the survivalrate of mice aftertransplant was >80%, and the success rate of pancreatic transplant was >90%. CONCLUSIONS The segment-neck and the whole pancreas model can guarantee that the transplanted pancreas functions effectively, and both have excellent postoperative outcomes, survivalrates and pancreatic active rates.
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Affiliation(s)
- Huizhong Shi
- From the Faculty of Hepato-Pancreato-Biliary Surgery, Chinese PLA General Hospital, Beijing, China
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12
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Wang D, Hou X, Huang J, Sun J, Kadowaki T, Lee MK, Jenkins AJ, Ji L. Incidence and trends of type 1 diabetes before and after 2000 in the Western Pacific Region: A systematic review and meta-analysis. Diabetes Res Clin Pract 2024; 207:111055. [PMID: 38104899 DOI: 10.1016/j.diabres.2023.111055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 12/09/2023] [Accepted: 12/13/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVES To undertake a systematic review of publications describing Type 1 diabetes (T1DM) incidence, trends over time and associated factors in the Western Pacific Region (WPR). METHODS As per the PROSPERO-registered (CRD42019122646) protocol English (MEDLINE, Embase, Global Health) and Chinese data-bases (China National Knowledge Infrastructure, VIP, Wanfang) from onset to 31/12/2019 were searched for T1DM incidence in the WPR. Country level data extracted included annual crude incidence rates by sex, number of new cases per annum (p.a.) and cumulatively, and the population at-risk. A meta-analysis for T1DM incidence was performed (by region and narrow age-bands, where possible) with subgroup analyses by time and by region. FINDINGS Forty-five population-based studies (21 from China), published 1973-2017, estimated T1DM incidence, mostly in youth, in 11 WPR countries. After 2000, mean annual T1DM incidence/100,000 person years aged 0-14 years ranged from 0.9 (95 % confidence intervals (CI), 0.6-1.3) in Fiji to 23.2 (95 % CI, 21.3-25.2) in Australia. The mean annual increase over time ranged from 2.8 % in Australia (1990-2002) to 14.2 % in Shanghai (1997-2011). T1DM incidence increased most in China (2.7-fold over 30-years) then Thailand (2-fold over 15-years). Most studies documented increasing incidence with age, though only two studies included people aged ≥ 20 years. Many, but not all studies reported significantly higher T1DM incidence in females vs. males. CONCLUSION T1DM incidence in the WPR is generally increasing, varying by age, sex, time and country. Results increase understanding of regional T1DM incidence and inform research and healthcare strategies.
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Affiliation(s)
- Du Wang
- The George Institute for Global Health, People's Republic of China
| | - Xiaoli Hou
- Department of Endocrinology and Metabolism, The Fifth Affiliated Hospital of Xinxiang Medical College, Xin Xiang 453100, People's Republic of China
| | - Juan Huang
- Department of Endocrinology and Metabolism, The First Hospital of Hunan University of Chinese Medicine, Changsha, Hunan, People's Republic of China
| | - Jianjing Sun
- Department of Endocrinology, Jining No.1 People's Hospital, Jining 272 011, Shandong, People's Republic of China
| | - Takashi Kadowaki
- Toranomon Hospital, The University of Tokyo, Minato-ku, Tokyo 105-8470, Japan
| | - Moon-Kyu Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu, Republic of Korea
| | | | - Linong Ji
- Department of Endocrinology and Metabolism, Peking University People's Hospital, No. 11, Xizhimen Nan Da Jie, Xicheng District, Beijing 100044, People's Republic of China.
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13
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Kuribayashi R, Hasebe S, Ishida D, Hirose S, Mimori S, Takizawa T, Yamasaki Y, Suzuki S, Kanzaki T. An age-stratified cross-sectional study of antidiabetic and non-antidiabetic drugs prescribed to Japanese outpatients with diabetes. Glob Health Med 2023; 5:294-300. [PMID: 37908508 PMCID: PMC10615024 DOI: 10.35772/ghm.2023.01059] [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: 05/16/2023] [Revised: 08/18/2023] [Accepted: 08/28/2023] [Indexed: 11/02/2023]
Abstract
Polypharmacy, common in patients with diabetes, may cause adverse drug reactions. The number of antidiabetic and non-antidiabetic drugs prescribed to patients in different age groups remains unclear. The aim of this study was to examine the number and class of antidiabetics and non-antidiabetics prescribed to Japanese patients with diabetes, stratified by age for reducing polypharmacy. This cross-sectional study examined all prescriptions of patients prescribed antidiabetics at 257 pharmacies of Matsumotokiyoshi Holdings in Japan from May 2018 to March 2019. Total prescription numbers including antidiabetic drugs were 263,915 in this study. Mean numbers of antidiabetic drugs per prescription were 1.71, 2.17, and 1.52 in the patient age groups of 10-19, 50-59, and 90-99 years, respectively. Count of antidiabetics was not related to age. However, the mean total number of drugs prescribed increased with age, which was 2.22 and 7.99 in the age groups of 10-19 and 90-99 years, respectively. The linear regression coefficient (b) according to age was 0.07 (p < 0.001) for 10-99 years. The mean non-antidiabetic number of agents prescribed increased with age among 10-99 years (b = 0.07, p < 0.001). Among outpatients treated for diabetes, dipeptidyl peptidase-4 inhibitors (29%) and antihypertensive, β-blocking and renin-angiotensin system blocking drugs (32%) were the most prescribed antidiabetics and non-antidiabetics in all ages, respectively. The number of prescribed antidiabetic agents did not increase with age, whereas the total and non-antidiabetic numbers of medications prescribed increased linearly. For reduction of polypharmacy in older people with diabetes, we need to focus on non-antidiabetics.
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Affiliation(s)
- Rena Kuribayashi
- Department of Drug Informatics, Graduate School and Faculty of Pharmaceutical Sciences, Chiba University, Chiba, Japan
| | - Shiori Hasebe
- Department of Drug Informatics, Graduate School and Faculty of Pharmaceutical Sciences, Chiba University, Chiba, Japan
| | - Daisuke Ishida
- Department of Drug Informatics, Graduate School and Faculty of Pharmaceutical Sciences, Chiba University, Chiba, Japan
- MatsukiyoCocokara & Co., Matsudo, Chiba, Japan
| | - Shinichi Hirose
- Department of Drug Informatics, Graduate School and Faculty of Pharmaceutical Sciences, Chiba University, Chiba, Japan
- MatsukiyoCocokara & Co., Matsudo, Chiba, Japan
| | - Seisuke Mimori
- Department of Clinical Medicine, Faculty of Pharmacy, Chiba Institute of Science, Choshi, Chiba, Japan
| | - Tsuyoshi Takizawa
- Department of Biostatistics, Faculty of Pharmacy, Chiba Institute of Science, Choshi, Chiba, Japan
| | - Yuki Yamasaki
- Division of Food, National Institute of Health Sciences, Kawasaki, Kanagawa, Japan
| | - Satoko Suzuki
- Department of Drug Informatics, Graduate School and Faculty of Pharmaceutical Sciences, Chiba University, Chiba, Japan
| | - Tetsuto Kanzaki
- Department of Drug Informatics, Graduate School and Faculty of Pharmaceutical Sciences, Chiba University, Chiba, Japan
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14
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Abidin ZZ, Halim RA, Noor E, Nor NSM, Nazari NSM, Zaini AA, Azizi NZ, Soelar SA. Knowledge and Perception of Bidirectional Relationship Between Periodontal Disease and Type 1 Diabetes Mellitus: A Questionnaire Study. J Int Soc Prev Community Dent 2023; 13:416-425. [PMID: 38124724 PMCID: PMC10729881 DOI: 10.4103/jispcd.jispcd_123_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/22/2023] [Accepted: 09/23/2023] [Indexed: 12/23/2023] Open
Abstract
Aim The bidirectional relationship between type 1 diabetes mellitus (T1DM) and inflammatory periodontal disease (PD) is globally recognized. However, oral health components are often given lower priority, and studies related to knowledge and the bidirectional association are limited. This study assesses the knowledge and perceptions of PD and its associated risk factors among T1DM patients and/or their parents. Materials and Methods Patients under 18 with T1DM at Universiti Teknologi MARA and Universiti Malaya were invited to participate. Structured interviews were conducted to assess participants' knowledge and perceptions of T1DM, and statistical analysis was performed to examine their associations using Pearson's chi-squared test and Fisher's exact test. Results A total of 113 T1DM patients, with a mean age of 11.4 ± 4, completed the interviews. Poor knowledge was observed among parents and T1DM patients (P-value = 0.007) and those who exercised regularly (P-value = 0.047). A significant association with good perception was found among individuals with uncontrolled HbA1c levels (P-value = 0.0018) and those experiencing bleeding symptoms (P-value = 0.021). Conclusions The study highlights the importance of increasing awareness, a key factor in improving oral health knowledge. Interestingly, despite poor control of clinical parameters, the population displayed good perception, suggesting a potential lack of understanding regarding disease control.
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Affiliation(s)
- Zaridah Zainal Abidin
- Centre of Studies for Paediatric Dentistry & Orthodontics, Faculty of Dentistry, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, Malaysia
| | - Rohaida Abdul Halim
- Centre of Studies for Paediatric Dentistry & Orthodontics, Faculty of Dentistry, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, Malaysia
| | - Erni Noor
- Centre of Studies for Periodontology, Faculty of Dentistry, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, Malaysia
| | - Noor Shafina Mohd Nor
- Department of Paediatrics, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, Malaysia
- Institute for Pathology, Laboratory and Forensic Medicine (I-PPerForM), Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, Malaysia
| | - Nor Shafina Mohamed Nazari
- Department of Restorative Dentistry, Faculty of Dentistry, Universiti Malaya, Sungai Buloh, Selangor, Malaysia
| | - Azriyanti Anuar Zaini
- Department of Paediatric, Faculty of Medicine, Universiti Malaya, Sungai Buloh, Selangor, Malaysia
| | - Nurul Zeety Azizi
- Department of Paediatric Dentistry & Orthodontics, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Shahrul Aiman Soelar
- Clinical Research Centre, Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia
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Peltonen EJ, Veijola R, Ilonen J, Knip M, Niinikoski H, Toppari J, Virtanen HE, Virtanen SM, Peltonen J, Nevalainen J. What is the role of puberty in the development of islet autoimmunity and progression to type 1 diabetes? Eur J Epidemiol 2023:10.1007/s10654-023-01002-7. [PMID: 37079135 DOI: 10.1007/s10654-023-01002-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 03/31/2023] [Indexed: 04/21/2023]
Abstract
In many populations, the peak period of incidence of type 1 diabetes (T1D) has been observed to be around 10-14 years of age, coinciding with puberty, but direct evidence of the role of puberty in the development of T1D is limited. We therefore aimed to investigate whether puberty and the timing of its onset are associated with the development of islet autoimmunity (IA) and subsequent progression to T1D. A Finnish population-based cohort of children with HLA-DQB1-conferred susceptibility to T1D was followed from 7 years of age until 15 years of age or until a diagnosis of T1D (n = 6920). T1D-associated autoantibodies and growth were measured at 3- to 12-month intervals, and pubertal onset timing was assessed based on growth. The analyses used a three-state survival model. IA was defined as being either positive for islet cell antibodies plus at least one biochemical autoantibody (ICA + 1) or as being repeatedly positive for at least one biochemical autoantibody (BC1). Depending on the IA definition, either 303 (4.4%, ICA + 1) or 435 (6.3%, BC1) children tested positive for IA by the age of 7 years, and 211 (3.2%, ICA + 1)) or 198 (5.3%, BC1) developed IA during follow-up. A total of 172 (2.5%) individuals developed T1D during follow-up, of whom 169 were positive for IA prior to the clinical diagnosis. Puberty was associated with an increase in the risk of progression to T1D, but only from ICA + 1-defined IA (hazard ratio 1.57; 95% confidence interval 1.14, 2.16), and the timing of pubertal onset did not affect the association. No association between puberty and the risk of IA was detected. In conclusion, puberty may affect the risk of progression but is not a risk factor for IA.
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Affiliation(s)
- Essi J Peltonen
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland.
| | - Riitta Veijola
- Department of Pediatrics, Research Unit of Clinical Medicine, Medical Research Center, University of Oulu, Oulu, Finland
- Department of Children and Adolescents, Oulu University Hospital, Oulu, Finland
| | - Jorma Ilonen
- Immunogenetics Laboratory, Institute of Biomedicine, University of Turku, Turku, Finland
| | - Mikael Knip
- Pediatric Research Center, New Children's Hospital, Helsinki University Hospital, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland
- Center for Child Health Research, Tampere University and Tampere University Hospital, Tampere, Finland
| | - Harri Niinikoski
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
- Department of Pediatrics, Turku University Hospital, Turku, Finland
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Jorma Toppari
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
- Department of Pediatrics, Turku University Hospital, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Helena E Virtanen
- Research Centre for Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
| | - Suvi M Virtanen
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
- Center for Child Health Research, Tampere University and Tampere University Hospital, Tampere, Finland
- Tays Research, Development and Innovation Center, Tampere University Hospital, Tampere, Finland
- Health and Well-Being Promotion Unit, Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Jaakko Peltonen
- Faculty of Information Technology and Communication Sciences, Tampere University, Tampere, Finland
| | - Jaakko Nevalainen
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
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16
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Matsuda F, Itonaga T, Maeda M, Ihara K. Long-term trends of pediatric type 1 diabetes incidence in Japan before and after the COVID-19 pandemic. Sci Rep 2023; 13:5803. [PMID: 37037893 PMCID: PMC10085994 DOI: 10.1038/s41598-023-33037-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 04/06/2023] [Indexed: 04/12/2023] Open
Abstract
Type 1 diabetes incidence has increased worldwide, although the long-term trends on pediatric type 1 diabetes in Japan remain elusive. To investigate the incidence and secular trend of pediatric type 1 diabetes from 1999 to 2021, including the coronavirus disease 2019 (COVID-19) pandemic years, in Oita Prefecture, Japan. We investigated the number of newly diagnosed patients with type 1 diabetes aged < 15 years from 1999 to 2021. We surveyed hospital databases in Oita Prefecture in Japan. The type 1 diabetes incidence in children aged < 15 years increased annually by 5.3% among all children, especially in boys aged 10-14 years by 8.1%, over the past 23 years. The average incidence rate of 3.9/100,000/year was nearly consistent with the previous reports on Asian countries. No significant change was found in the increasing incidence trend of type 1 diabetes before and during the COVID-19 pandemic. The incidence of pediatric type 1 diabetes has significantly increased over the past 23 years in Oita Prefecture, Japan, which is consistent with the worldwide trend.
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Affiliation(s)
- Fumika Matsuda
- Department of Pediatrics, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Tomoyo Itonaga
- Department of Pediatrics, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Miwako Maeda
- Department of Pediatrics, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan
| | - Kenji Ihara
- Department of Pediatrics, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama, Yufu, Oita, 879-5593, Japan.
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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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18
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Huang A, Chen Q, Yang W, Cui Y, Wang Q, Wei H. Clinical characteristics of 683 children and adolescents, aged 0-18 years, newly diagnosed with type 1 diabetes mellitus in Henan Province: a single-center study. BMC Pediatr 2023; 23:39. [PMID: 36683033 PMCID: PMC9869500 DOI: 10.1186/s12887-023-03847-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 01/12/2023] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Type 1 diabetes mellitus (T1DM) is a common chronic systemic disease that threatens the health of children worldwide. Diabetic ketoacidosis (DKA) is the most severe acute complication of diabetes and can lead to death. This study aimed to explore the epidemiological features, clinical manifestations, and risk factors for DKA in children and adolescents newly diagnosed with T1DM in the Department of Endocrinology of the Children's Hospital of Henan Province. METHODS Medical records of 683 children and adolescents newly diagnosed with T1DM in our center from March 2014 to November 2021 were retrospectively analyzed. The data included the general condition, laboratory indexes, and clinical symptoms. The patients were divided into three groups according to age: Group I, 0-3 years; Group II, 4-9 years; and Group III, 10-18 years. RESULTS The incidence of DKA was 62.96% and was highest in Group I. Group I had the lowest C-peptide and hemoglobin A1c, but the highest blood glucose at first diagnosis, and 25-hydroxyvitamin D3 levels, hospitalization lengths, and medical costs. 25.5% of the children were delayed in diagnosis. Logistic regression analysis showed that elevated HbA1c levels and hyperglycemia were independent risk factors for DKA. On the other hand, C-peptide and 25- hydroxyvitamin D were protective factors for DKA. CONCLUSIONS The incidence of DKA among children and adolescents in the Henan Province is very high. Moreover, DKA can be easily delayed in diagnosis. Newly diagnosed infants with T1DM are more likely to present with DKA, suffer more severe metabolic disorders, endure longer hospital stays, and accrue higher medical costs.
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Affiliation(s)
- Ai Huang
- Department of Endocrinology, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, 33 Longhu Outer Ring East Road, Zhengzhou, Henan, 450018, People's Republic of China
| | - Qiong Chen
- Department of Endocrinology, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, 33 Longhu Outer Ring East Road, Zhengzhou, Henan, 450018, People's Republic of China
| | - Wei Yang
- Department of Endocrinology, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, 33 Longhu Outer Ring East Road, Zhengzhou, Henan, 450018, People's Republic of China
| | - Yan Cui
- Department of Endocrinology, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, 33 Longhu Outer Ring East Road, Zhengzhou, Henan, 450018, People's Republic of China
| | - Qingzhi Wang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Haiyan Wei
- Department of Endocrinology, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, 33 Longhu Outer Ring East Road, Zhengzhou, Henan, 450018, People's Republic of China.
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19
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Miyamura K, Nawa N, Isumi A, Doi S, Ochi M, Fujiwara T. Association between skipping breakfast and prediabetes among adolescence in Japan: Results from A-CHILD study. Front Endocrinol (Lausanne) 2023; 14:1051592. [PMID: 36909337 PMCID: PMC9992887 DOI: 10.3389/fendo.2023.1051592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 02/06/2023] [Indexed: 02/24/2023] Open
Abstract
OBJECTIVE Adolescents with prediabetes are at high risk of developing type 2 diabetes in later life. It is necessary to identify risk factors for prediabetes in adolescents. This study aimed to examine the association between skipping breakfast and prediabetes among adolescents in Japan. STUDY DESIGN We used the population-based cross-sectional data of eighth grade in junior high school students from the Adachi Child Health Impact of Living Difficulty (A-CHILD) study conducted in Adachi City, Tokyo, Japan, in 2016, 2018, and 2020. Skipping breakfast was assessed using self-reported questionnaires (N=1510). Prediabetes was defined as hemoglobin A1c (HbA1c) levels of 5.6-6.4%. The association between skipping breakfast and prediabetes was evaluated using multivariate logistic regression analysis. Stratified analysis was also performed using BMI, 1 SD or more, or less than 1SD, as overweight was defined as 1SD or more. RESULTS Students who skipped breakfast were 16.4% (n=248). The prevalence of prediabetes was 3.8% (n=58). Skipping breakfast exhibited a significant association with prediabetes (OR:1.95, 95% CI: 1.03 to 3.69) after adjusting for sex, annual household income, family history of diabetes mellitus, BMI, and survey year. Stratified analysis showed stronger association among students with overweight (BMI ≥1SD) (OR=4.31, 95% CI 1.06-17.58), while non-sigificant among students without overweight (BMI<1SD) (OR=1.62, 95% CI 0.76-3.47). CONCLUSIONS Skipping breakfast in Japanese adolescents, especially those with overweight, was associated with prediabetes. The promotion of avoiding skipping breakfast may help to prevent prediabetes.
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Affiliation(s)
- Keitaro Miyamura
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| | - Nobutoshi Nawa
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| | - Aya Isumi
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| | - Satomi Doi
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| | - Manami Ochi
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
- National Institute of Public Health, Department of Health and Welfare Services, Saitama, Japan
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
- *Correspondence: Takeo Fujiwara,
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20
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Murata T, Hosoda K, Kunihiro Nishimura, Miyamoto Y, Sakane N, Satoh-Asahara N, Toyoda M, Hirota Y, Matsuhisa M, Kuroda A, Kato K, Kouyama R, Miura J, Tone A, Kasahara M, Kasama S, Suzuki S, Ito Y, Watanabe T, Suganuma A, Shen Z, Kobayashi H, Takagi S, Hoshina S, Shimura K, Tsuchida Y, Kimura M, Saito N, Shimada A, Oikawa Y, Satomura A, Haisa A, Kawashima S, Meguro S, Itoh H, Saisho Y, Irie J, Tanaka M, Mitsuishi M, Nakajima Y, Inaishi J, Kinouchi K, Yamaguchi S, Itoh A, Sugiyama K, Yagi K, Tsuchiya T, Kodani N, Shimizu I, Fukuda T, Kusunoki Y, Katsuno T, Matoba Y, Hitaka Y, Abe K, Tanaka N, Taniguchi R, Nagao T, Hida K, Iseda I, Takeda M, Matsushita Y, Tenta M, Tanaka T, Kouyama K, Fukunaga M. Prevention of hypoglycemia by intermittent-scanning continuous glucose monitoring device combined with structured education in patients with type 1 diabetes mellitus: A randomized, crossover trial. Diabetes Res Clin Pract 2023; 195:110147. [PMID: 36396114 DOI: 10.1016/j.diabres.2022.110147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/17/2022] [Accepted: 11/03/2022] [Indexed: 11/16/2022]
Abstract
AIMS We conducted a randomized, crossover trial to compare intermittent-scanning continuous glucose monitoring (isCGM) device with structured education (Intervention) to self-monitoring of blood glucose (SMBG) (Control) in the reduction of time below range. METHODS This crossover trial involved 104 adults with type 1 diabetes mellitus (T1DM) using multiple daily injections. Participants were randomly allocated to either sequence Intervention/Control or sequence Control/Intervention. During the Intervention period which lasted 84 days, participants used the first-generation FreeStyle Libre (Abbott Diabetes Care, Alameda, CA, USA) and received structured education on how to prevent hypoglycemia based on the trend arrow and by frequent sensor scanning (≥10 times a day). Confirmatory SMBG was conducted before dosing insulin. The Control period lasted 84 days. The primary endpoint was the decrease in the time below range (TBR; <70 mg/dL). RESULTS The time below range was significantly reduced in the Intervention arm compared to the Control arm (2.42 ± 1.68 h/day [10.1 %±7.0 %] vs 3.10 ± 2.28 h/day [12.9 %±9.5 %], P = 0.012). The ratio of high-risk participants with low blood glucose index >5 was significantly reduced (8.6 % vs 23.7 %, P < 0.001). CONCLUSIONS The use of isCGM combined with structured education significantly reduced the time below range in patients with T1DM.
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21
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Matsumoto H, Nio K, Kawamura T, Obayashi Y, Hotta Y, Yuyama Y, Nishikawa N. Perceptions of diabetes management among adolescents with type 1 diabetes and their caregivers: development and validation of the Japanese version of the diabetes family responsibility questionnaire. Diabetol Int 2022; 14:155-164. [PMID: 36533089 PMCID: PMC9734505 DOI: 10.1007/s13340-022-00609-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022]
Abstract
The shift in diabetes management responsibility is critical for adolescents with type 1 diabetes (T1D). Currently, in Japan, there is insufficient progress in the development of scales for evaluating diabetes management responsibility. We developed the Japanese version of the Diabetes Family Responsibility Questionnaire (DFRQ), a scale to evaluate diabetes management responsibility, and verified its reliability and validity. We recruited 12-18-year-old adolescents with T1D and their caregivers. The DFRQ questionnaires (DFRQ-A for adolescents and DFRQ-C for caregivers) were distributed. The responses of 31 pairs were analyzed (adolescents: 9 males, 22 females; mean age: 14.8 ± 1.5 years). The median total DFRQ scores of adolescents (30.0) and caregivers (32.0) were not significantly different (p = 0.269). The internal consistencies (Cronbach's α) were 0.784 and 0.687 for DFRQ-A and DFRQ-C, respectively. DFRQ-A scores and adolescent age demonstrated a weak statistically significant negative correlation (r = - 0.397, p = 0.027), whereas DFRQ-C scores and adolescent age demonstrated a weak negative correlation not statistically significant (r = - 0.311, p = 0.089). Both scores were significantly negatively correlated with self-efficacy for diabetes self-management scores (r = - 0.390, p = 0.030; r = - 0.478, p = 0.006, respectively). Furthermore, a significantly moderate positive correlation was found between these scores (r = 0.624, p < 0.001). We confirmed the reliability and validity of the Japanese version of DFRQ. DFRQ is expected to be used as a dyadic scale to evaluate the status of diabetes management responsibility and its transition during adolescence in Japan.
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Affiliation(s)
- Hiro Matsumoto
- Course of Nursing Science, Graduate School of Medicine, Mie University, Tsu, Mie Japan
- Department of Pediatrics, Graduate School of Medicine, Osaka Metropolitan University, Abeno-Ku, Osaka, Japan
| | - Kaori Nio
- Graduate School of Nursing, Osaka Metropolitan University, Habikino, Osaka Japan
| | - Tomoyuki Kawamura
- Department of Pediatrics, Graduate School of Medicine, Osaka Metropolitan University, Abeno-Ku, Osaka, Japan
| | - Yoko Obayashi
- Department of Nursing, School of Health Sciences, Toyohashi Sozo University, Toyohashi, Aichi Japan
| | - Yuko Hotta
- Kashiwara Municipal Hospital, Kashiwara, Osaka Japan
| | - Yoshihiko Yuyama
- Department of Pediatrics, Graduate School of Medicine, Osaka Metropolitan University, Abeno-Ku, Osaka, Japan
| | - Naoko Nishikawa
- Department of Pediatrics, Graduate School of Medicine, Osaka Metropolitan University, Abeno-Ku, Osaka, Japan
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22
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Miyamura K, Nawa N, Nishimura H, Fushimi K, Fujiwara T. Association between heat exposure and hospitalization for diabetic ketoacidosis, hyperosmolar hyperglycemic state, and hypoglycemia in Japan. ENVIRONMENT INTERNATIONAL 2022; 167:107410. [PMID: 35868079 DOI: 10.1016/j.envint.2022.107410] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 07/03/2022] [Accepted: 07/11/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND An increase in extreme heat events has been reported along with global warming. Heat exposure in ambient temperature is associated with all-cause diabetes mortality and all-cause hospitalization in diabetic patients. However, the association between heat exposure and hospitalization for hyperglycemic emergencies, such as diabetic ketoacidosis (DKA), hyperosmolar hyperglycemic state (HHS), and hypoglycemia is unclear. The objective of our study is to clarify the impact of heat exposure on the hospitalization for DKA, HHS, and hypoglycemia. METHODS Data of daily hospitalizations for hyperglycemic emergencies (i.e., DKA or HHS) and hypoglycemia was extracted from a nationwide administrative database in Japan and linked with temperature in each prefecture in Japan during 2012-2019. We applied distributed lag non-linear model to evaluate the non-linear and lagged effects of heat exposure on hospitalization for hyperglycemic emergencies. RESULTS The pooled relative risk for hyperglycemic emergencies of heat effect (the 90th percentile of temperature with reference to the 75th percentile of temperature) and extreme heat effect (the 99th percentile of temperature with reference to the 75th percentile of temperature) over 0-3 lag days was 1.27 (95 %CI: 1.16-1.39) and 1.64 (95 %CI: 1.38-1.93), respectively. The pooled relative risk for heat effect on hospitalization for hypoglycemia and extreme heat effect over 0-3 lag days was 1.33 (95 %CI: 1.17-1.52) and 1.65 (95 %CI: 1.29-2.10), respectively. These associations were consistent by type of hyperglycemic emergencies and type of diabetes and were generally consistent by regions. DISCUSSION Heat exposure was associated with hospitalizations for DKA, HHS and hypoglycemia. These results may be useful to guide preventive actions for the risk of fatal hyperglycemic emergencies and hypoglycemia.
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Affiliation(s)
- Keitaro Miyamura
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| | - Nobutoshi Nawa
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hisaaki Nishimura
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Information Section, Tokyo Medical and Dental University, Tokyo, Japan
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan.
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23
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Chen Q, Xu N, Chen Y, Yan M, Tian F, Yang W, Cui Y, Huang A, Li Y, Zhang H, Jiang Z, Zheng R, Ji Y, Zhang D, Ren Q, Ding L, Wei H. Incidence of Newly Diagnosed Type 1 Diabetes Mellitus in Children and Adolescents in Henan Province of China from 2017 to 2020: A Retrospective Multicenter Study Based on Hospitalization Data. J Clin Res Pediatr Endocrinol 2022; 14:287-292. [PMID: 35438270 PMCID: PMC9422922 DOI: 10.4274/jcrpe.galenos.2022.2022-12-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 03/25/2022] [Indexed: 12/01/2022] Open
Abstract
Objective The incidence of type 1 diabetes mellitus (T1DM) is rapidly increasing worldwide. However, the incidence in Henan Province of China has been unknown for more than two decades. This study aimed to estimate the incidence of T1DM in the 0.5-14.9 years age group in Henan Province of China from 2017 to 2020. Methods A retrospective analysis of hospital registration data from 18 cities in Henan Province, China, identified 1726 patients (843 males, 883 females) between 0.5-14.9 years of age with newly diagnosed T1DM in Henan Province from January 1st, 2017, to December 31st, 2020, covering more than 19 million children years at risk. Results The crude incidence of T1DM per 100 000 person years for the 0.5-14.9 years age group in the Henan Province of China was 2.19 [95% confidence interval (CI): 1.99, 2.40], with a peak in the 10-14.9 years age group. The rate ratio of females to males was 1.32 (95% CI: 1.20, 1.45) in the 0.5-14.9 years age group. The incidence rate was higher in females than males in the 5-9.9 years age group (p<0.01) and the 10-14.9 years age group (p<0.01). The seasonality of the incidence was different from that in previous reports, with the lowest incidence in the spring. Conclusion The incidence of T1DM in the 0.5-14.9 years age group in Henan Province was still among the lowest reported globally, but was in line with other incidence rates reported from China.
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Affiliation(s)
- Qiong Chen
- Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Department of Endocrinology, Genetics and Metabolism, Henan, China
| | - Na Xu
- Nanyang Central Hospital, Department of Endocrinology, Henan, China
| | - Yongxing Chen
- Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Department of Endocrinology, Genetics and Metabolism, Henan, China
| | - Mingming Yan
- Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Henan Key Laboratory of Children’s Genetics and Metabolic Diseases, Henan, China
| | - Fengyan Tian
- The First Affiliated Hospital of Zhengzhou University, Department of Pediatrics, Henan, China
| | - Wei Yang
- Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Department of Endocrinology, Genetics and Metabolism, Henan, China
| | - Yan Cui
- Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Department of Endocrinology, Genetics and Metabolism, Henan, China
| | - Ai Huang
- Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Department of Endocrinology, Genetics and Metabolism, Henan, China
| | - Yangshiyu Li
- Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Department of Endocrinology, Genetics and Metabolism, Henan, China
| | - He Zhang
- The First Affiliated Hospital of Xinxiang Medical University, Department of Endocrinology, Henan, China
| | - Zhihong Jiang
- The First Affiliated Hospital of Henan University of Science and Technology, Department of Endocrinology, Henan, China
| | - Ruizhi Zheng
- Henan Provincial People’s Hospital, Department of Endocrinology, Henan, China
| | - Yuan Ji
- Kaifeng Children’s Hospital, Department of Endocrinology, Henan, China
| | - Dongming Zhang
- The Second Affiliated Hospital of Zhengzhou University, Department of Endocrinology, Henan, China
| | - Qiao Ren
- 989 Hospital of PLA Joint Logistics Support Force, Department of Endocrinology, Henan, China
| | - Li Ding
- Anyang Maternal and Childcare Hospital, Department of Pediatrics, China
| | - Haiyan Wei
- Children’s Hospital Affiliated to Zhengzhou University, Henan Children’s Hospital, Zhengzhou Children’s Hospital, Department of Endocrinology, Genetics and Metabolism, Henan, China
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24
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Sarfo-Kantanka O, Asamoah-Boaheng M, Arthur J, Agyei M, Barnes NA, Tenkorang EY, Midodzi W. Trends in type 1 diabetes diagnosis in Ghana. Int Health 2022; 14:442-446. [PMID: 32050027 PMCID: PMC9248061 DOI: 10.1093/inthealth/ihz096] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 08/26/2019] [Accepted: 09/13/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Despite the fact that the rate of type 1 diabetes (T1D) is increasing worldwide, there exists a dearth of information on the disease in most sub-Saharan African countries. The goal of this study was to determine the enrolment trend of T1D using data compiled over 28 y from a teaching hospital in Kumasi, Ghana. METHODS Information collected included sex, age at diagnosis and date of T1D diagnosis. We identified trends from 1992 to 2018, divided into 3 y intervals. RESULTS From 1992 to 2018, 1717 individuals with T1D were enrolled in the diabetes clinic at the Komfo Anokye Teaching Hospital. The male:female ratio was 1:1.2. The number of individuals diagnosed with T1D decreased among the 10-19 y age group during the 1992-1994 period, followed by a progressive increase within the same age group during the subsequent period (from 35.4% in 1995-1997 to 63.2% in 2016-2018). There was a decline in the proportion of children 0-9 y of age diagnosed during the study period (from 5.1% in 1992-1994 to 3.6% in 2016-2018). CONCLUSIONS In our study population, a decreasing trend of T1D enrolments was observed in general while among adolescents an increasing trend was observed.
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Affiliation(s)
- Osei Sarfo-Kantanka
- Directorate of Internal Medicine, Komfo Anokye Teaching Hospital, PO Box 1934, Kumasi, Ghana
| | - Michael Asamoah-Boaheng
- Faculty of Medicine, Clinical Epidemiology Unit, Memorial University of Newfoundland, St John’s, NL, Canada
| | - Joshua Arthur
- Public Health Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Martin Agyei
- Directorate of Internal Medicine, Komfo Anokye Teaching Hospital, PO Box 1934, Kumasi, Ghana
- Department of Medicine, School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Nana Ama Barnes
- Department of Internal Medicine, School of Medical Sciences, University of Cape Coast, Cape Coast, Ghana
| | - Eric Y Tenkorang
- Department of Sociology, Memorial University of Newfoundland, St Johns, NL, Canada
| | - William Midodzi
- Faculty of Medicine, Clinical Epidemiology Unit, Memorial University of Newfoundland, St John’s, NL, Canada
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Kitamura M, Nishioka J, Matsumoto T, Umino S, Kawano A, Saiki R, Tanaka Y, Yatsuga S. Estimate incidence and predictive factors of pediatric central diabetes insipidus in a single-institute study. ENDOCRINE AND METABOLIC SCIENCE 2022. [DOI: 10.1016/j.endmts.2022.100119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
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James S, Maniam J, Cheung PT, Urakami T, von Oettingen J, Likitmaskul S, Ogle G. Epidemiology and phenotypes of diabetes in children and adolescents in non-European-origin populations in or from Western Pacific region. World J Clin Pediatr 2022; 11:173-195. [PMID: 35433305 PMCID: PMC8985498 DOI: 10.5409/wjcp.v11.i2.173] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 08/09/2021] [Accepted: 01/05/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Type 1 diabetes (T1D) incidence varies substantially between countries/ territories, with most studies indicating increasing incidence. In Western Pacific region (WPR), reported rates are much lower than European-origin populations. In contrast, there are reports of substantial numbers of young people with type 2 diabetes (T2D). A deeper understanding of T1D and T2D in the WPR may illuminate factors important in pathogenesis of these conditions. Furthermore, with varying resources and funding for diabetes treatment in this region, there is a need to more clearly determine the current burden of disease and also any gaps in knowledge. AIM To compile and summarise published epidemiologic and phenotypic data on childhood diabetes in non-European populations in and from WPR. METHODS Research articles were systematically searched from PubMed (MEDLINE), Embase, Cochrane library, and gray literature. Primary outcome measures were incidence and prevalence, with secondary measures including phenotypic descriptions of diabetes, including diabetes type categorization, presence of diabetic ketoacidosis (DKA) at onset, autoantibody positivity, C-peptide levels, and human leucocyte antigen phenotype. Extracted data were collected using a customized template. Three hundred and thirty relevant records were identified from 16 countries/territories, with analysis conducted on 265 (80.3%) records published from the year 2000. RESULTS T1D incidence ranged from < 1-7.3/100000 individuals/year, rates were highest in emigrant/ mixed populations and lowest in South-East Asia, with most countries/territories (71.4%) having no data since 1999. Incidence was increasing in all six countries/territories with data (annual increases 0.5%-14.2%, highest in China). Peak age-of-onset was 10-14 years, with a female case excess. Rate of DKA at onset varied from 19.3%-70%. Pancreatic autoantibodies at diagnosis were similar to European-origin populations, with glutamic acid decarboxylase-65 autoantibody frequency of 44.1%-64.5%, insulinoma-associated 2 autoantibody 43.5%-70.7%, and zinc transporter-8 autoantibody frequency 54.3% (one study). Fulminant T1D also occurs. T2D was not uncommon, with incidence in Japan and one Chinese study exceeding T1D rates. Monogenic forms also occurred in a number of countries. CONCLUSION T1D is less common, but generally has a classic phenotype. Some countries/ territories have rapidly increasing incidence. T2D is relatively common. Registries and studies are needed to fill many information gaps.
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Affiliation(s)
- Steven James
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Petrie 4502, Queensland, Australia
| | - Jayanthi Maniam
- Life for a Child Program, Diabetes NSW & ACT, Glebe 2017, New South Wales, Australia
| | - Pik-To Cheung
- Department of Paediatric Endocrinology, Genetics and Metabolism, Virtus Medical Group, Hong Kong, China
| | - Tatsuhiko Urakami
- Department of Pediatrics, Nihon University School of Medicine, Tokyo 173-8610, Japan
| | - Julia von Oettingen
- Research Institute, McGill University Health Centre, Montreal H4A 3JI, Quebec, Canada
| | - Supawadee Likitmaskul
- Siriraj Diabetes Center, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Graham Ogle
- Life for a Child Program, Diabetes NSW & ACT, Glebe 2017, New South Wales, Australia
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Eighteen-year trends in the management of patients with diabetes in the Shiga Diabetes Clinical Survey: overall trends and differences by age group. Diabetol Int 2022; 13:566-574. [PMID: 35693988 PMCID: PMC9174363 DOI: 10.1007/s13340-022-00573-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 02/02/2022] [Indexed: 10/19/2022]
Abstract
Aim To examine the trends in the management of patients with diabetes over an 18-year period in Japan. Participants and methods We recorded the height, body mass, laboratory data, diabetes treatment, and screening status of diabetic complications from the data collected during the Shiga Diabetes Clinical Survey, which has been performed every 6 years since 2000. We then evaluated the management of patients with diabetes in Shiga Prefecture. The study included 17,870, 18,398, 24,243, and 26,624 participants in each of the 4 years of measurements. Results The mean age and body mass index (BMI) of the participants gradually increased. The percentage of patients with BMI of ≥ 25 kg/m2 was higher in younger patients. Glycemic control significantly improved over 18 years (hemoglobin A1c: 7.3% ± 1.4% in 2000 to 7.1% ± 1.1% in 2018, P for trend < 0.001). The mean hemoglobin A1c levels were higher in younger patients than in elderly patients and increased from 2012 to 2018 in patients aged ≥ 65 years. The proportion of participants who underwent screening for albuminuria and diabetic retinopathy increased. The mean blood pressure and low-density lipoprotein cholesterol concentration decreased. Conclusions Glycemic control has been maintained at an acceptable level since the previous survey. Although glycemic control has become less strict in elderly patients with diabetes, glycemic control is poorer in younger patients than in elderly patients. Obesity is an increasingly important problem, particularly in younger patients. The frequency of screening for diabetic complications and the control of blood pressure should be improved. Supplementary Information The online version contains supplementary material available at 10.1007/s13340-022-00573-2.
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Current clinical state of type 1 diabetes in Saitama prefecture. Diabetol Int 2021; 13:436-446. [DOI: 10.1007/s13340-021-00557-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 10/24/2021] [Indexed: 10/19/2022]
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Liu C, Yuan YC, Guo MN, Xin Z, Chen GJ, Bentley AR, Hua L, Zheng JP, Ekoru K, Yang JK. Incidence of Type 1 Diabetes May Be Underestimated in the Chinese Population: Evidence From 21.7 Million People Between 2007 and 2017. Diabetes Care 2021; 44:2503-2509. [PMID: 34413068 PMCID: PMC8546282 DOI: 10.2337/dc21-0342] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 07/25/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Previous reports of the annual incidence of type 1 diabetes (T1D) in China were conducted using retrospective hospital cases, which may not reflect the reality. This longitudinal study estimated T1D incidence in a Chinese population of 21.7 million from 2007 to 2017. RESEARCH DESIGN AND METHODS A population-based registry of T1D was performed by the Beijing Municipal Health Commission Information Center. Annual incidence and 95% CIs were calculated by age group and sex. The association of sex with T1D incidence and predicted new cases of T1D were assessed using Poisson regression models. Annual percentage change and average annual percentage of change were assessed using Joinpoint regression. RESULTS Overall, there were 6,875 individuals who developed T1D from 2007 to 2017 in this population. T1D incidence (/100,000 persons) (95% CI) significantly increased from 2.72 (2.51, 2.93) in 2007 to 3.60 (3.38, 3.78) in 2017 (P < 0.001). The T1D onset peak was in the 10-14-year-old age group. While no significant trend was found in the 0-14- and 15-29-year-old age groups, T1D incidence markedly increased from 1.87 to 3.52 in the ≥30-year-old age group (P < 0.05). The prevalence of diabetic ketoacidosis at diagnosis was highest in the 0-4-year-old age group. We predicted new cases of T1D will increase 1.57-fold over the next decade. CONCLUSIONS T1D incidence in this large Chinese population is higher than has been reported previously. From 2007 to 2017, although the incidence peak was in the 10-14-year age group, the T1D incidence increased sharply in adults but not in youth.
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Affiliation(s)
- Chang Liu
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Beijing Diabetes Institute, Beijing, China
| | - Ying-Chao Yuan
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Beijing Diabetes Institute, Beijing, China
| | - Mo-Ning Guo
- Beijing Municipal Health Commission Information Center, Beijing, China
| | - Zhong Xin
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China.,Beijing Diabetes Institute, Beijing, China
| | - Guan-Jie Chen
- The Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| | - Amy R Bentley
- The Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| | - Lin Hua
- School of Biomedical Engineering, Capital Medical University, Beijing, China
| | - Jian-Peng Zheng
- Beijing Municipal Health Commission Information Center, Beijing, China
| | - Kenneth Ekoru
- The Center for Research on Genomics and Global Health, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
| | - Jin-Kui Yang
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, Beijing, China .,Beijing Diabetes Institute, Beijing, China
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Vomiting and hyperkalemia are novel clues for emergency room diagnosis of type 1 diabetic ketoacidosis: a retrospective comparison between diabetes types. Diabetol Int 2021; 13:272-279. [DOI: 10.1007/s13340-021-00539-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 08/23/2021] [Indexed: 10/20/2022]
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Kawamura T, Kikuchi T, Horio H, Rathor N, Ekelund M. Efficacy and safety of fast-acting insulin aspart versus insulin aspart in children and adolescents with type 1 diabetes from Japan. Endocr J 2021; 68:409-420. [PMID: 33518615 DOI: 10.1507/endocrj.ej20-0116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The aim of this post-hoc subgroup analysis, which was based on data from the treat-to-target, 26-week, onset 7 trial, was to confirm the efficacy and safety of fast-acting insulin aspart (faster aspart) versus insulin aspart (IAsp), both in combination with basal insulin degludec, in children and adolescents from Japan with type 1 diabetes (T1D). Of the onset 7 trial population (1 to <18 years; N = 777), 66 participants from Japan (65 Asian and one non-Asian) were randomized to mealtime faster aspart (n = 24), post-meal faster aspart (n = 19), or IAsp (n = 23). Data for the subgroup from Japan were analysed descriptively. Change from baseline in hemoglobin A1c 26 weeks after randomization was 0.23%, 0.74%, and 0.39%, for mealtime faster aspart, post-meal faster aspart, and IAsp respectively. Change from baseline in 1-h post-prandial glucose increment (based on 8-point self-measured blood glucose profiles) showed numerical differences in favor of mealtime faster aspart versus IAsp at breakfast (-30.70 vs. -2.88 mg/dL) and over all meals (-18.21 vs. -5.55 mg/dL). There were no clinically relevant numerical differences between treatment arms in the overall rate of severe or blood glucose-confirmed hypoglycemia. At week 26, mean total insulin dose was 1.119 U/kg/day for mealtime faster aspart, 1.049 U/kg/day for post-meal faster aspart, and 1.037 U/kg/day for IAsp. In conclusion, in children and adolescents with T1D from Japan, mealtime and post-meal faster aspart with insulin degludec was efficacious in controlling glycemia without additional safety concerns versus IAsp.
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Affiliation(s)
- Tomoyuki Kawamura
- Pediatrics Department, Osaka City University Graduate School of Medicine, Abeno Ward, Osaka 558-8585, Japan
| | - Toru Kikuchi
- Department of Pediatrics, Saitama Medical University, Iruma District, Saitama 350-0495, Japan
| | - Hiroshi Horio
- Novo Nordisk Pharma Ltd., Chiyoda Ward, Tokyo 100-1005, Japan
| | - Naveen Rathor
- Medical & Science, Global Development, Novo Nordisk A/S, 2860 Søborg, Denmark
| | - Magnus Ekelund
- Medical & Science, Global Development, Novo Nordisk A/S, 2860 Søborg, Denmark
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Saito T, Kobayashi K, Kobayashi K, Mochizuki M, Yagasaki H, Makino K, Narusawa H, Watanabe D, Mitsui Y, Sato K, Sano T, Ohta M, Yokomichi H, Amemiya S. Incidence of childhood type 1 diabetes mellitus in Yamanashi Prefecture, Japan, 1986-2018. Endocrinol Diabetes Metab 2021; 4:e00214. [PMID: 33855216 PMCID: PMC8029530 DOI: 10.1002/edm2.214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 10/19/2020] [Accepted: 11/19/2020] [Indexed: 11/27/2022] Open
Abstract
Introduction Several studies have examined the incidence of childhood T1DM in Japan from the 1970s onwards, but none have been long-term studies using registration data. We estimate the incidence of childhood type 1 diabetes mellitus (T1DM) from 1986 to 2018 in Yamanashi Prefecture, Japan. Methods We began a population-based, long-term study of childhood T1DM in 1986 involving every hospital paediatrics department in Yamanashi Prefecture. In the Prefecture, every child newly diagnosed with T1DM is referred to a hospital, and therefore, almost 100% of new patients aged <15 years are registered. We calculated the incidence of T1DM among children aged <15 years from 1986 to 2018. All cases met the Japan Diabetes Society diagnostic criteria and were tested for T1DM-related autoantibodies whenever possible. Results Ninety-nine patients (44 boys and 55 girls) were newly diagnosed with T1DM. The annual incidence among 5- to 9-year-olds increased by 5.35% over the study period (95% confidence interval 2.34%-8.35%, p = .0005), and there was a trend towards increasing 3-year incidence (15.52% increase, p = .0516). There were also trends towards increasing annual and 3-year incidence among 0- to 14-year-olds. However, there were no changes over time in annual or 3-year incidence in the 0-4 year or 10-14 year age groups. Conclusions The incidence of T1DM in Yamanashi Prefecture increased among children aged 0-14 years over the study period, with the most significant increase occurring among 5- to 9-year-olds. These data suggest that the number of children aged <15 years with T1DM is gradually increasing in one of the local prefectures in Japan, Yamanashi Prefecture and that the age of onset is decreasing.
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Affiliation(s)
- Tomohiro Saito
- Department of PediatricsFaculty of MedicineGraduate School of MedicineUniversity of YamanashiYamanashiJapan
- Department of PediatricsYamanashi Prefectural HospitalYamanashiJapan
| | - Koji Kobayashi
- Department of PediatricsFaculty of MedicineGraduate School of MedicineUniversity of YamanashiYamanashiJapan
- Department of PediatricsYamanashi Kosei HospitalYamanashiJapan
| | - Kisho Kobayashi
- Department of PediatricsFaculty of MedicineGraduate School of MedicineUniversity of YamanashiYamanashiJapan
- Kobanyashi Kids’ ClinicYamanashiJapan
| | - Mie Mochizuki
- Department of PediatricsFaculty of MedicineGraduate School of MedicineUniversity of YamanashiYamanashiJapan
- Department of PediatricsKyonan Medical Center Fujikawa HospitalYamanashiJapan
| | - Hideaki Yagasaki
- Department of PediatricsFaculty of MedicineGraduate School of MedicineUniversity of YamanashiYamanashiJapan
| | - Koichi Makino
- Department of PediatricsFaculty of MedicineGraduate School of MedicineUniversity of YamanashiYamanashiJapan
- Department of PediatricsFujiyoshida Municipal HospitalYamanashiJapan
| | - Hiromune Narusawa
- Department of PediatricsFaculty of MedicineGraduate School of MedicineUniversity of YamanashiYamanashiJapan
| | - Daisuke Watanabe
- Department of PediatricsFaculty of MedicineGraduate School of MedicineUniversity of YamanashiYamanashiJapan
- Department of PediatricsYamanashi Prefectural HospitalYamanashiJapan
| | - Yumiko Mitsui
- Department of PediatricsFaculty of MedicineGraduate School of MedicineUniversity of YamanashiYamanashiJapan
- Ryuoh Mitsui ClinicYamanashiJapan
| | - Kazumasa Sato
- Department of PediatricsFaculty of MedicineGraduate School of MedicineUniversity of YamanashiYamanashiJapan
- Department of PediatricsKyonan Medical Center Fujikawa HospitalYamanashiJapan
| | - Tomoaki Sano
- Department of PediatricsFaculty of MedicineGraduate School of MedicineUniversity of YamanashiYamanashiJapan
- Department of PediatricsYamanashi Red Cross HospitalYamanashiJapan
| | - Masanori Ohta
- Department of PediatricsFaculty of MedicineGraduate School of MedicineUniversity of YamanashiYamanashiJapan
- Department of PediatricsTsuru Municipal General HospitalYamanashiJapan
| | - Hiroshi Yokomichi
- Department of Health SciencesFaculty of MedicineGraduate School of MedicineUniversity of YamanashiYamanashiJapan
| | - Shin Amemiya
- Department of PediatricsFaculty of MedicineSaitama Medical UniversitySaitamaJapan
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Naito T, Suzuki K, Hirata J, Kamatani Y, Matsuda K, Toda T, Okada Y. A deep learning method for HLA imputation and trans-ethnic MHC fine-mapping of type 1 diabetes. Nat Commun 2021; 12:1639. [PMID: 33712626 PMCID: PMC7955122 DOI: 10.1038/s41467-021-21975-x] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/19/2021] [Indexed: 01/31/2023] Open
Abstract
Conventional human leukocyte antigen (HLA) imputation methods drop their performance for infrequent alleles, which is one of the factors that reduce the reliability of trans-ethnic major histocompatibility complex (MHC) fine-mapping due to inter-ethnic heterogeneity in allele frequency spectra. We develop DEEP*HLA, a deep learning method for imputing HLA genotypes. Through validation using the Japanese and European HLA reference panels (n = 1,118 and 5,122), DEEP*HLA achieves the highest accuracies with significant superiority for low-frequency and rare alleles. DEEP*HLA is less dependent on distance-dependent linkage disequilibrium decay of the target alleles and might capture the complicated region-wide information. We apply DEEP*HLA to type 1 diabetes GWAS data from BioBank Japan (n = 62,387) and UK Biobank (n = 354,459), and successfully disentangle independently associated class I and II HLA variants with shared risk among diverse populations (the top signal at amino acid position 71 of HLA-DRβ1; P = 7.5 × 10-120). Our study illustrates the value of deep learning in genotype imputation and trans-ethnic MHC fine-mapping.
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Affiliation(s)
- Tatsuhiko Naito
- grid.136593.b0000 0004 0373 3971Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, Japan ,grid.26999.3d0000 0001 2151 536XDepartment of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ken Suzuki
- grid.136593.b0000 0004 0373 3971Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, Japan
| | - Jun Hirata
- grid.136593.b0000 0004 0373 3971Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, Japan ,grid.419889.50000 0004 1779 3502Pharmaceutical Discovery Research Laboratories, Teijin Pharma Limited, Hino, Japan
| | - Yoichiro Kamatani
- grid.26999.3d0000 0001 2151 536XLaboratory of Complex Trait Genomics, Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, The University of Tokyo, Tokyo, Japan
| | - Koichi Matsuda
- grid.26999.3d0000 0001 2151 536XLaboratory of Clinical Genome Sequencing, Department of Computational Biology and Medical Sciences, Graduate School of Frontier Sciences, The University of Tokyo, Tokyo, Japan
| | - Tatsushi Toda
- grid.26999.3d0000 0001 2151 536XDepartment of Neurology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yukinori Okada
- grid.136593.b0000 0004 0373 3971Department of Statistical Genetics, Osaka University Graduate School of Medicine, Suita, Japan ,grid.136593.b0000 0004 0373 3971Laboratory of Statistical Immunology, Immunology Frontier Research Center (WPI-IFReC), Osaka University, Suita, Japan ,grid.136593.b0000 0004 0373 3971Integrated Frontier Research for Medical Science Division, Institute for Open and Transdisciplinary Research Initiatives, Osaka University, Suita, Japan
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Okui T, Nojiri C, Kimura S, Abe K, Maeno S, Minami M, Maeda Y, Tajima N, Kawamura T, Nakashima N. Performance evaluation of case definitions of type 1 diabetes for health insurance claims data in Japan. BMC Med Inform Decis Mak 2021; 21:52. [PMID: 33573645 PMCID: PMC7879626 DOI: 10.1186/s12911-021-01422-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 01/25/2021] [Indexed: 12/18/2022] Open
Abstract
Background No case definition of Type 1 diabetes (T1D) for the claims data has been proposed in Japan yet. This study aimed to evaluate the performance of candidate case definitions for T1D using Electronic health care records (EHR) and claims data in a University Hospital in Japan. Methods The EHR and claims data for all the visiting patients in a University Hospital were used. As the candidate case definitions for claims data, we constructed 11 definitions by combinations of International Statistical Classification of Diseases and Related Health Problems, Tenth Revision. (ICD 10) code of T1D, the claims code of insulin needles for T1D patients, basal insulin, and syringe pump for continuous subcutaneous insulin infusion (CSII). We constructed a predictive model for T1D patients using disease names, medical practices, and medications as explanatory variables. The predictive model was applied to patients of test group (validation data), and performances of candidate case definitions were evaluated. Results As a result of performance evaluation, the sensitivity of the confirmed disease name of T1D was 32.9 (95% CI: 28.4, 37.2), and positive predictive value (PPV) was 33.3 (95% CI: 38.0, 38.4). By using the case definition of both the confirmed diagnosis of T1D and either of the claims code of the two insulin treatment methods (i.e., syringe pump for CSII and insulin needles), PPV improved to 90.2 (95% CI: 85.2, 94.4). Conclusions We have established a case definition with high PPV, and the case definition can be used for precisely detecting T1D patients from claims data in Japan.
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Affiliation(s)
- Tasuku Okui
- Medical Information Center, Kyushu University Hospital, Maidashi 3-1-1 Higashi-ku, Fukuoka City, Fukuoka Prefecture, 812-8582, Japan.
| | - Chinatsu Nojiri
- Medical Information Center, Kyushu University Hospital, Maidashi 3-1-1 Higashi-ku, Fukuoka City, Fukuoka Prefecture, 812-8582, Japan
| | - Shinichiro Kimura
- Department of Molecular Medicine and Metabolism, Research Institute of Environmental Medicine, Nagoya University, Nagoya, Japan
| | - Kentaro Abe
- National Hospital Organization Kokura Medical Center, Fukuoka, Japan
| | | | | | | | - Naoko Tajima
- Jikei University School of Medicine, Tokyo, Japan
| | | | - Naoki Nakashima
- Medical Information Center, Kyushu University Hospital, Maidashi 3-1-1 Higashi-ku, Fukuoka City, Fukuoka Prefecture, 812-8582, Japan
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Efficacy of laparoscopic sleeve gastrectomy for patient with morbid obesity and type 1 diabetes mellitus: a case report. Surg Case Rep 2021; 7:7. [PMID: 33409743 PMCID: PMC7788116 DOI: 10.1186/s40792-020-00989-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 09/18/2020] [Indexed: 12/12/2022] Open
Abstract
Background Bariatric surgery is effective for the treatment of patients with morbid obesity and type 2 diabetes mellitus (T2DM), for body weight loss and glycemic control. However, in Japan, there has been no previous report of the effectiveness bariatric surgery in a case of morbid obesity associated with acute onset type 1 diabetes mellitus (T1DM), in which pancreatic β-cells were destroyed and endogenous insulin was depleted. Case presentation A 36-year-old woman with morbid obesity and T1DM, diagnosed when she was 6 years, was admitted for bariatric surgery. At her first consultation, she had a body weight of 106.7 kg and a body mass index of 42.2 kg/m2. Her HbA1c level was 9.0%, with a required daily insulin dose of 75 units. She underwent laparoscopic sleeve gastrectomy. At 1 year after surgery, her body weight had decreased to 81.0 kg and her body mass index to 32.2 kg/m2. In addition, her daily required dose of insulin had decreased to 24 units, with an improvement in her HbA1c level to 7.7%. Conclusions Although further evidence needs to be accumulated, including long-term outcomes, laparoscopic sleeve gastrectomy may provide an effective treatment for patients with morbid obesity and T1DM for body weight loss, improvement in HbA1c level, and insulin dose reduction.
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Chae HW, Seo GH, Song K, Choi HS, Suh J, Kwon A, Ha S, Kim HS. Incidence and Prevalence of Type 1 Diabetes Mellitus among Korean Children and Adolescents between 2007 and 2017: An Epidemiologic Study Based on a National Database. Diabetes Metab J 2020; 44:866-874. [PMID: 33142054 PMCID: PMC7801766 DOI: 10.4093/dmj.2020.0212] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/07/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The incidence of type 1 diabetes mellitus (T1DM) among children is high in Europe and the USA and relatively low in Asia, including Korea. The present study aimed to investigate the incidence and prevalence of childhood-onset T1DM in Korea and examine trends in incidence. METHODS This study was conducted using the national registry data provided by the Health Insurance Review and Assessment Service in Korea from 2007 to 2017. We included children aged 0 to 14 years who were newly registered with a T1DM diagnosis each year (code E10). RESULTS A total of 29,013 children were registered. The overall incidence of T1DM was 4.45 per 100,000 persons (girls, 4.93; boys, 4.01). The overall incidence of childhood-onset T1DM in Korea increased from 3.70 in 2008 to 4.77 in 2016 (P=0.002). The incidence of T1DM increased from 3.07 in 2008 to 4.89 in 2016 (P<0.001) among boys. Although the incidence of the disease increased significantly among boys aged 5-9 and 10-14 years, it remained constant among girls (4.39 in 2008, 4.64 in 2016). The overall prevalence of childhood-onset T1DM in Korea increased from 32.85 in 2007 to 41.03 per 100,000 persons in 2017 (girls, 35.54 to 43.88; boys, 32.85 to 41.03). CONCLUSION We calculated relatively accurate incidence and prevalence of childhood-onset T1DM from a nation-based registry. The incidence increased by 3% to 4% every year from 2007 to 2017. The increasing trend is noteworthy compared with previous reports.
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Affiliation(s)
- Hyun Wook Chae
- Department of Pediatrics, Endocrine Research Institute, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Gi Hyeon Seo
- Korean Health Insurance Review and Assessment Service, Seoul, Korea
| | - Kyungchul Song
- Department of Pediatrics, Endocrine Research Institute, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Han Saem Choi
- Department of Pediatrics, Endocrine Research Institute, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Junghwan Suh
- Department of Pediatrics, Endocrine Research Institute, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ahreum Kwon
- Department of Pediatrics, Endocrine Research Institute, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sangmi Ha
- Korean Health Insurance Review and Assessment Service, Seoul, Korea
| | - Ho-Seong Kim
- Department of Pediatrics, Endocrine Research Institute, Severance Children’s Hospital, Yonsei University College of Medicine, Seoul, Korea
- Corresponding author: Ho-Seong Kim Department of Pediatrics, Endocrine Research Institute, Severance Children’s Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea E-mail:
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Odineal DD, Gershwin ME. The Epidemiology and Clinical Manifestations of Autoimmunity in Selective IgA Deficiency. Clin Rev Allergy Immunol 2020; 58:107-133. [PMID: 31267472 DOI: 10.1007/s12016-019-08756-7] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Selective immunoglobulin A deficiency (SIgAD) is the most common primary immunodeficiency, defined as an isolated deficiency of IgA (less than 0.07 g/L). Although the majority of people born with IgA deficiency lead normal lives without significant pathology, there is nonetheless a significant association of IgA deficiency with mucosal infection, increased risks of atopic disease, and a higher prevalence of autoimmune disease. To explain these phenomena, we have performed an extensive literature review to define the geoepidemiology of IgA deficiency and particularly the relative risks for developing systemic lupus erythematosus, hyperthyroidism, hypothyroidism, type 1 diabetes mellitus, Crohn's disease, ulcerative colitis, rheumatoid arthritis, juvenile idiopathic arthritis, ankylosing spondylitis, and vitiligo; these diseases have strong data to support an association. We also note weaker associations with scleroderma, celiac disease, autoimmune hepatitis, immune thrombocytopenic purpura, and autoimmune hemolytic anemia. Minimal if any associations are noted with myasthenia gravis, lichen planus, and multiple sclerosis. Finally, more recent data provide clues on the possible immunologic mechanisms that lead to the association of IgA deficiency and autoimmunity; these lessons are important for understanding the etiology of autoimmune disease.
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Affiliation(s)
- David D Odineal
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis School of Medicine, 451 Health Sciences Drive, Suite 6510, Davis, CA, 95616, USA.
| | - M Eric Gershwin
- Division of Rheumatology, Allergy and Clinical Immunology, University of California at Davis School of Medicine, 451 Health Sciences Drive, Suite 6510, Davis, CA, 95616, USA
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Nishizono R, Kogou H, Ishizaki Y, Minakawa A, Kikuchi M, Inagaki H, Sato Y, Fujimoto S. Concurrent minimal change nephrotic syndrome and type 1 diabetes mellitus in an adult Japanese woman: a case report. BMC Nephrol 2020; 21:410. [PMID: 32967631 PMCID: PMC7510261 DOI: 10.1186/s12882-020-02071-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 09/15/2020] [Indexed: 01/04/2023] Open
Abstract
Background Concurrent type 1 diabetes mellitus (T1DM) and idiopathic nephrotic syndrome is rare, and most previously reported cases were in children. We report the case of an adult woman who developed T1DM and minimal change nephrotic syndrome (MCNS) nearly simultaneously. Case presentation A 24-year-old woman had first presented to another hospital with nausea, vomiting, and fatigue. She was diagnosed with diabetic ketoacidosis and T1DM on the basis of her hyperglycemia, ketoacidosis, and positive anti-glutamic acid decarboxylase antibody test result. Rapid infusion of normal saline and insulin administration alleviated hyperglycemia and ketoacidosis. Two weeks after admission, however, she developed nephrotic syndrome (NS) with rapidly decreasing urine volume. She was referred to our hospital with a diagnosis of acute kidney injury. Although she temporarily required dialysis and high doses of insulin, within 1 month NS and acute kidney injury had been alleviated by oral prednisolone and low-density lipoprotein apheresis. Renal biopsy showed minor glomerular abnormalities without diabetic nephropathy, so we diagnosed her with MCNS. Seven weeks after the discharge, NS relapsed, and cyclosporine was added to prednisolone. However, NS relapsed twice within the next 4 months, so we started her on rituximab. At 6 months after initiating rituximab therapy, she remained in complete remission. Her mother also had T1DM but not MCNS. The patient had HLA-DRB1*09:01/09:01, DQB1*03:03/03:03, and her mother had HLA-DRB1*04:05/09:01, DQB1*03:03/04:01. Conclusions Concurrent T1DM and MCNS is rare and their coexistence might be coincidental. Alternatively, they might have been caused by an underlying, unidentified genetic predisposition. Previous reports and our patient’s findings suggest that specific HLA alleles and haplotypes or a Th1/Th2 imbalance might be associated with T1DM and MCNS that occurred nearly simultaneously.
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Affiliation(s)
- Ryuzoh Nishizono
- Department of Nephrology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.
| | - Hiroki Kogou
- Department of Nephrology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Yuri Ishizaki
- Department of Nephrology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Akihiro Minakawa
- Department of Nephrology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Masao Kikuchi
- Department of Nephrology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Hiroko Inagaki
- Dialysis Division, University of Miyazaki Hospital, Miyazaki, Japan
| | - Yuji Sato
- Department of Nephrology, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan.,Dialysis Division, University of Miyazaki Hospital, Miyazaki, Japan
| | - Shouichi Fujimoto
- Dialysis Division, University of Miyazaki Hospital, Miyazaki, Japan.,Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
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Nishioka Y, Noda T, Okada S, Myojin T, Kubo S, Higashino T, Ishii H, Imamura T. Incidence and seasonality of type 1 diabetes: a population-based 3-year cohort study using the National Database in Japan. BMJ Open Diabetes Res Care 2020; 8:8/1/e001262. [PMID: 32994226 PMCID: PMC7526280 DOI: 10.1136/bmjdrc-2020-001262] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 05/16/2020] [Accepted: 06/06/2020] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION To investigate the incidence of type 1 diabetes by age group (0-19, 20-39, 40-59, ≥60 years) in Japan and whether there is seasonality in this incidence. RESEARCH DESIGN AND METHODS The incidence of type 1 diabetes from September 2014 to August 2017 was estimated using 2013-2018 data from the National Database of Health Insurance Claims and Specific Health Check-ups of Japan. The incidence rate was analyzed using Tango's Index and the self-controlled case series method. RESULTS Overall, 10 400 of the 79 175 553 included individuals were diagnosed with type 1 diabetes. The incidence of type 1 diabetes from September 2014 to August 2017 was 4.42/100 000 person-years. The incidence rates for men aged 0-19, 20-39, 40-59, and ≥60 years were 3.94, 5.57, 5.70, and 3.48, respectively. Among women, the incidence rates for the same age ranges were 5.22, 4.83, 4.99, and 3.31, respectively. Tango's index showed that the incidence rate of type 1 diabetes was significantly associated with seasons among those aged 0-19 years. Further, the self-controlled case series method showed a significant interaction between age and season, with the incidence of type 1 diabetes being higher in spring for patients younger than 20 years of age. CONCLUSIONS In Japan, men aged 40-59 years and women aged 0-19 years are the groups with the highest incidence of type 1 diabetes. Further, the incidence of younger-onset diabetes in Japan was higher in spring (from March to May).
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Affiliation(s)
- Yuichi Nishioka
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
- Department of Diabetes and Endocrinology, Nara Medical University, Kashihara, Nara, Japan
| | - Tatsuya Noda
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Sadanori Okada
- Department of Diabetes and Endocrinology, Nara Medical University, Kashihara, Nara, Japan
| | - Tomoya Myojin
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Shinichiro Kubo
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
| | - Tsuneyuki Higashino
- Healthcare and Wellness Division, Mitsubishi Research Institute, Inc, Tokyo, Japan
| | - Hitoshi Ishii
- Department of Diabetes and Endocrinology, Nara Medical University, Kashihara, Nara, Japan
| | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, Nara Medical University, Kashihara, Nara, Japan
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40
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Tung JYL, Kwan EYW, But BWM, Wong WHS, Fu ACC, Pang G, Tsang JWY, Yau HC, Belaramani K, Wong LM, Wong SMY, Lo P, Ng KL, Yeung WKY, Chan KT, Chan AMK, Wong SWC, Tay MK, Chung J, Lee CY, Lam YY, Cheung PT. Increasing incidence of type 1 diabetes among Hong Kong children and adolescents: The Hong Kong Childhood Diabetes Registry 2008 to 2017. Pediatr Diabetes 2020; 21:713-719. [PMID: 32267057 DOI: 10.1111/pedi.13016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 03/09/2020] [Accepted: 03/29/2020] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVE The incidence of childhood-onset type 1 diabetes (T1D) has been reported to be rising but there is also evidence that it has been attenuated in recent years. We described the time trends and the incidence of T1D in children in Hong Kong from 2008 to 2017 and compared with the previous local registry in 1997 to 2007. METHODS Data were extracted from the Hong Kong Childhood Diabetes Registry, which was established in 2016. It consists of a retrospective registry (including all childhood diabetes diagnosed in 2008 to 2015) and a prospective registry (including all T1D children diagnosed from 2016 onwards). All T1D children diagnosed at the age of less than 18 years from 1 January 2008 to 31 December 2017 and managed in the public system were included in this study. RESULTS For the incident years in the 2008 to 2017 period, a total of 498 children with T1D was identified. The crude incidence rate was 4.3 per 100 000 person/year (95% confidence interval 3.96-4.72), which was much higher than the last registry of 2.2 per 100 000 persons/year. Using general linear model, the increment is statistically significant (P = .02). When compared to the last registry, the rate of increment had attenuated, with annual increment in crude incidence in the two periods for T1D <15 years changing from 4.3% to 3.5% (P = .02). CONCLUSIONS The incidence of T1D children increased significantly in the past two decades in Hong Kong, but the rate of increase had attenuated in recent years.
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Affiliation(s)
- Joanna Yuet-Ling Tung
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China.,Department of Paediatrics, Hong Kong Children's Hospital, Hong Kong, China
| | - Elaine Yin-Wai Kwan
- Department of Paediatrics, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Betty Wai-Man But
- Department of Paediatrics, Queen Elizabeth Hospital, Hong Kong, China
| | - Wilfred Hing-Sang Wong
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | | | - Gloria Pang
- Department of Paediatrics, Princess Margaret Hospital, Hong Kong, China
| | | | - Ho-Chung Yau
- Department of Paediatrics, Prince of Wales Hospital, Hong Kong, China
| | | | - Lap-Ming Wong
- Department of Paediatrics, Tuen Mun Hospital, Hong Kong, China
| | | | - Priscilla Lo
- Department of Paediatrics, United Christian Hospital, Hong Kong, China
| | - Kwok-Leung Ng
- Department of Paediatrics, United Christian Hospital, Hong Kong, China
| | - Wilson Kwan-Yee Yeung
- Department of Paediatrics, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Kwong-Tat Chan
- Department of Paediatrics, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Angela Mo-Kit Chan
- Department of Paediatrics, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China
| | - Sammy Wai-Chun Wong
- Department of Paediatrics, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China
| | - Ming-Kut Tay
- Department of Paediatrics, Tseung Kwan O Hospital, Hong Kong, China
| | - Jacky Chung
- Department of Paediatrics, Caritas Medical Centre, Hong Kong, China
| | - Ching-Yin Lee
- Department of Paediatrics, Caritas Medical Centre, Hong Kong, China
| | - Yuen-Yu Lam
- Department of Paediatrics, Kwong Wah Hospital, Hong Kong, China
| | - Pik-To Cheung
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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Buzzetti R, Zampetti S, Pozzilli P. Impact of obesity on the increasing incidence of type 1 diabetes. Diabetes Obes Metab 2020; 22:1009-1013. [PMID: 32157790 DOI: 10.1111/dom.14022] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 03/04/2020] [Accepted: 03/05/2020] [Indexed: 02/06/2023]
Abstract
Published estimates of the incidence of type 1 diabetes (T1D) in children in the last decade varies between 2% and 4% per annum. If this trend continued, the disease incidence would double in the next 20 years. The risk of developing T1D is determined by a complex interaction between multiple genes (mainly human leukocyte antigens) and environmental factors. Notwithstanding that genetic susceptibility represents a relevant element in T1D risk, genetics alone cannot explain the increase in incidence. Various environmental factors have been suggested as potential triggers for T1D, including several viruses and the hygiene hypothesis; however, none of these seems to explain the large increase in T1D incidence observed over the last decades. Several studies have demonstrated that the prevalence of childhood/adolescence overweight and obesity has risen during the past 30 years in T1D. Currently, at diagnosis, the majority of patients with T1D have normal or elevated body weight and ~50% of patients with longstanding T1D are either overweight or obese. The growing prevalence of obesity in childhood and adolescence offers a plausible explanation for the increase in T1D incidence observed in recent decades. Possible mechanisms of the enhancement of β-cell autoimmunity by obesity include: a) insulin resistance-induced β-cell secretory demand triggering autoimmunity through cytokine release, neo-epitope antigen formation and increase in β-cell apoptosis, and b) obesity-induced low-grade inflammation with pro-inflammatory cytokines secreted by locally infiltrating macrophages, which contribute to the presentation by islet cells of autoantigens generally not accessible to T cells. Further studies are needed to clarify whether the control of body weight can prevent or delay the current and continuing rise in T1D incidence.
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Affiliation(s)
| | - Simona Zampetti
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Paolo Pozzilli
- Department of Medicine, Unit of Endocrinology and Diabetes, Campus Bio-Medico University of Rome, Rome, Italy
- Centre of Immunobiology, Barts and London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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42
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Sugihara S, Yokota I, Mukai T, Mochizuki T, Nakayama M, Tachikawa E, Kawada Y, Minamitani K, Kikuchi N, Urakami T, Kawamura T, Kawasaki E, Kikuchi T, Amemiya S, The Japanese Study Group of Insulin Therapy for Childhood, Adolescent Diabetes (JSGIT). Increased diagnosis of autoimmune childhood-onset Japanese type 1 diabetes using a new glutamic acid decarboxylase antibody enzyme-linked immunosorbent assay kit, compared with a previously used glutamic acid decarboxylase antibody radioimmunoassay kit. J Diabetes Investig 2020; 11:594-602. [PMID: 31756289 PMCID: PMC7232289 DOI: 10.1111/jdi.13184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 10/24/2019] [Accepted: 11/12/2019] [Indexed: 12/19/2022] Open
Abstract
AIMS/INTRODUCTION We compared the results of testing for glutamic acid decarboxylase antibodies (GADAb) using a radioimmunoassay (RIA) and an enzyme-linked immunosorbent assay (ELISA) in individuals with childhood-onset type 1 diabetes mellitus. MATERIALS AND METHODS Serum specimens were collected from 1,024 Japanese children (426 boys and 598 girls) in 2013. The median age at diagnosis was 7 years (0-18 years). The blood specimens were obtained at a median age of 13 years (2-22 years). RESULTS Among the 628 children whose serum specimens were collected within 5 years after diagnosis, the rate of GADAb positivity was 47.9% using RIA and 69.4% using ELISA. The participants were divided into four groups according to their RIA and ELISA results for GADAb as follows: group I (RIA+/ELISA+), group II (RIA+/ELISA-), group III (RIA-/ELISA+) and group IV (RIA-/ELISA-). The clinical and genetic characteristics of group I and group III were quite similar in terms of age at diagnosis, male/female ratio, relatively high positive rates for both autoantibody to protein tyrosine phosphatase IA-2 and autoantibody to the cation efflux transporter zinc transporter 8, and human leukocyte antigen genotype. Group II contained just five patients, and was characterized by a younger age at diagnosis, low positive rates for both autoantibody to protein tyrosine phosphatase IA-2 and autoantibody to the cation efflux transporter zinc transporter 8, and a unique human leukocyte antigen genotype. If the positive rates of either autoantibody to protein tyrosine phosphatase IA-2 or autoantibody to the cation efflux transporter zinc transporter 8 or both were added to the GADAb results using RIA, the percentage of autoimmune type 1 diabetes increased from 47.9% to 78.5%. CONCLUSIONS The diagnosis of autoimmune childhood-onset Japanese type 1 diabetes increased when GADAb results were obtained using a new ELISA method, compared with a previously utilized RIA method.
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Affiliation(s)
- Shigetaka Sugihara
- Department of PediatricsTokyo Women’s Medical University Medical Center EastTokyoJapan
| | - Ichiro Yokota
- Department of Pediatric Endocrinology and MetabolismShikoku Medical Center for Children and AdultsKagawaJapan
| | - Tokuo Mukai
- Department of PediatricsAsahikawa‐Kosei General HospitalAsahikawaJapan
| | | | | | - Emiko Tachikawa
- Department of PediatricsTokyo Women's Medical University HospitalTokyoJapan
| | - Yasumasa Kawada
- Department of PediatricsKyushu Rousai HospitalKitakyushuJapan
| | - Kinship Minamitani
- Department of PediatricsTeikyo University Chiba Medical CenterChibaJapan
| | - Nobuyuki Kikuchi
- Department of PediatricsYokohama City Minato Red Cross HospitalYokohamaJapan
| | - Tatsuhiko Urakami
- Department of PediatricsNihon University School of MedicineTokyoJapan
| | - Tomoyuki Kawamura
- Department of PediatricsOsaka City University School of MedicineOsakaJapan
| | - Eiji Kawasaki
- Department of Diabetes and EndocrinologyShin‐Koga HospitalKurumeJapan
| | - Toru Kikuchi
- Department of PediatricsSaitama Medical UniversityIrumaSaitamaJapan
| | - Shin Amemiya
- Department of PediatricsSaitama Medical UniversityIrumaSaitamaJapan
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Kume A, Kashiwagi K. Recent Epidemiological Status of Ocular and Other Major Complications Related to Diabetes Mellitus in Japan. Ophthalmologica 2020; 243:404-412. [PMID: 32097907 DOI: 10.1159/000506747] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 02/24/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE To investigate the epidemiological status of diabetes mellitus (DM)-related complications in Japan. METHODS The subjects were 3.11 million Japanese individuals who were registered in the Japanese claim database between 2005 and 2014. Subjects with a diagnosis associated with codes related to DM and/or DM-related complications as classified by the International Classification of Diseases version 10 and those who were prescribed any therapeutic agents for DM were considered to have DM. The status of ocular, renal, and neural complications was investigated. RESULTS A total of 66,923 patients with DM were included. The prevalence of subjects with DM was 3.8% in 2005 and 4.2% in 2014. The most frequent complication was diabetic retinopathy (23.6%, 95% CI: 21.7-25.5%), followed by diabetic nephropathy (14.8%, 95% CI: 14.0-15.6%) and diabetic neuropathy (4.9%, 95% CI: 4.5-5.3%). Among the subjects with ocular complications, 1.8% had proliferative diabetic retinopathy, 1.1% had diabetic macular edema (DME), 0.3% had neovascular glaucoma, and 1.5% had vitreous hemorrhage. Only DME significantly increased during the study period. The frequencies of the ocular and neural complications significantly decreased, while that of renal complications significantly increased during the study period. CONCLUSIONS Ocular complications were the most common DM-related major complications in Japan. Notably, DME significantly increased in recent years.
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Affiliation(s)
- Atsuki Kume
- Department of Ophthalmology, University of Yamanashi, Chuo, Japan
| | - Kenji Kashiwagi
- Department of Ophthalmology, University of Yamanashi, Chuo, Japan,
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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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Keshawarz A, Pyle L, Alman A, Sassano C, Westfeldt E, Sippl R, Snell-Bergeon J. Type 1 Diabetes Accelerates Progression of Coronary Artery Calcium Over the Menopausal Transition: The CACTI Study. Diabetes Care 2019; 42:2315-2321. [PMID: 31558547 PMCID: PMC6868458 DOI: 10.2337/dc19-1126] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 09/07/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Type 1 diabetes is associated with a higher risk of cardiovascular disease (CVD) in women. Although menopause increases risk of CVD, it is uncertain how menopause affects risk of CVD in women with type 1 diabetes. We examined whether risk of CVD changes differentially in women with and those without type 1 diabetes over the transition through menopause. RESEARCH DESIGN AND METHODS Premenopausal women with type 1 diabetes (n = 311) and premenopausal women without diabetes (n = 325) enrolled in the Coronary Artery Calcification in Type 1 Diabetes (CACTI) study and attended up to four study visits over 18 years. Coronary artery calcium (CAC) volume was measured from computed tomography scans obtained at each visit. Longitudinal repeated-measures modeling estimated the effect of diabetes on CAC volume over time and the effect of menopause on the diabetes-CAC relationship. RESULTS CAC volume was higher at baseline and increased more over time in women with type 1 diabetes than in women without diabetes. A significant diabetes-by-menopause interaction was found (P < 0.0001): postmenopausal women with type 1 diabetes had significantly higher CAC volumes than premenopausal women (5.14 ± 0.30 vs. 2.91 ± 0.18 mm3), while there was no difference in women without diabetes (1.78 ± 0.26 vs. 1.78 ± 0.17 mm3). This interaction remained significant after adjusting for CVD risk factors. CONCLUSIONS Type 1 diabetes was associated with higher CAC volume and accelerated progression of CAC over time. Menopause increased CAC progression more in women with diabetes than in women without diabetes independent of age and other CVD risk factors known to worsen with menopause.
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Affiliation(s)
- Amena Keshawarz
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO .,Barbara Davis Center for Diabetes, Aurora, CO
| | - Laura Pyle
- Barbara Davis Center for Diabetes, Aurora, CO.,Department of Biostatistics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Amy Alman
- Department of Epidemiology & Biostatistics, University of South Florida, Tampa, FL
| | | | | | | | - Janet Snell-Bergeon
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO.,Barbara Davis Center for Diabetes, Aurora, CO
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Wang J, Wang S, Wang W, Chen J, Zhang Z, Zheng Q, Liu Q, Cai L. Protection against diabetic cardiomyopathy is achieved using a combination of sulforaphane and zinc in type 1 diabetic OVE26 mice. J Cell Mol Med 2019; 23:6319-6330. [PMID: 31270951 PMCID: PMC6714218 DOI: 10.1111/jcmm.14520] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/20/2019] [Accepted: 06/15/2019] [Indexed: 12/17/2022] Open
Abstract
Sulforaphane (SFN) can effectively induce nuclear factor E2-related factor 2 (Nrf2), and zinc (Zn) can effectively induce metallothionein (MT), both of which have been shown to protect against diabetic cardiomyopathy (DCM). However, it is unclear whether combined treatment with SFN and Zn offers better cardiac protection than either one alone. Here, we treated 5-week-old OVE mice that spontaneously develop type 1 diabetes with SFN and/or Zn for 18 weeks. Cardiac dysfunction, by echocardiography, and pathological alterations and remodelling, shown by cardiac hypertrophy, fibrosis, inflammation and oxidative damage, examined by histopathology, Western blotting and real-time PCR, were observed in OVE mice. All these dysfunction and pathological abnormalities seen in OVE mice were attenuated in OVE mice with treatment of either SFN, Zn or SFN/Zn, and the combined treatment with SFN/Zn was better than single treatments at ameliorating DCM. In addition, combined SFN and Zn treatment increased Nrf2 function and MT expression in the heart of OVE mice to a greater extent than SFN or Zn alone. This indicates that the dual activation of Nrf2 and MT by combined treatment with SFN and Zn may be more effective than monotherapy at preventing the development of DCM via complementary, additive mechanisms.
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Affiliation(s)
- Jiqun Wang
- The Center of Cardiovascular DiseasesThe First Hospital of Jilin UniversityChangchunChina
- Pediatric Research Institute, Department of PediatricsUniversity of LouisvilleLouisvilleKentuckyUSA
| | - Shudong Wang
- The Center of Cardiovascular DiseasesThe First Hospital of Jilin UniversityChangchunChina
| | - Wanning Wang
- Pediatric Research Institute, Department of PediatricsUniversity of LouisvilleLouisvilleKentuckyUSA
- Department of NephrologyThe First Hospital of Jilin UniversityChangchunChina
| | - Jing Chen
- Department of OtolaryngologyStanford UniversityPalo AltoCaliforniaUSA
| | - Zhiguo Zhang
- The Center of Cardiovascular DiseasesThe First Hospital of Jilin UniversityChangchunChina
| | - Qi Zheng
- Department of Bioinformatics and BiostatisticsUniversity of LouisvilleLouisvilleKentuckyUSA
| | - Quan Liu
- The Center of Cardiovascular DiseasesThe First Hospital of Jilin UniversityChangchunChina
| | - Lu Cai
- Pediatric Research Institute, Department of PediatricsUniversity of LouisvilleLouisvilleKentuckyUSA
- Departments of Radiation Oncology, Pharmacology and ToxicologyUniversity of LouisvilleLouisvilleKentuckyUSA
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47
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Nakamura N, Yakushijin Y, Kanamaru T, Tani H, Ideno K, Nakai A. Development and validity testing of the revised diabetes self-care inventory for children and adolescents. Diabetol Int 2019; 10:117-125. [PMID: 31139530 DOI: 10.1007/s13340-018-0377-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 09/24/2018] [Indexed: 11/24/2022]
Abstract
Recently, self-care in children and adolescents with type 1 diabetes has changed with regard to both adherence to treatment and self-management. Only one diabetes self-care scale for children and adolescents is used in Japan which lacks reflection on flexible regimens. The aims of this study were to modify and subsequently test the validity of the revised diabetes self-care inventory (R-DSCI) for children and adolescents, and to construct the diabetes self-care model on the R-DSCI, HbA1c, duration of diabetes and age. Based on qualitative secondary analysis of the self-care framework for teenagers and a literature review of diabetes self-care instruments, the items concerning insulin injection and meal planning were modified from the original DSCI and new items concerning negotiation with parents and others were added. The participants in the validity testing were 122 children and adolescents with type 1 diabetes, 50.8% were girls, aged 9-18 years, mean HbA1c of 7.9%. The final version of the R-DSCI was composed of 41 items. Eight factors, which explained 40.9% of the variance, were identified using the varimax method; Cronbach's alpha for the 41 items was 0.79. The diabetes self-care model showed a negative direct effect of "diabetes self-care practice" on HbA1c (P = 0.004), and the negative indirect effect of "support and perception of life with diabetes" on HbA1c through "diabetes self-care practice" (P = 0.002; estimated effect - 0.21). In addition, "independent self-care behavior" was directly affected by age (P < 0.001). The R-DSCI should be useful for clinicians and researchers to assess the self-management in children and adolescents.
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Affiliation(s)
- Nobue Nakamura
- 1Chiba University Graduate School of Nursing, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8672 Japan
| | - Yuko Yakushijin
- 2Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295 Japan
| | - Tomo Kanamaru
- 3Shumei University School of Nursing, 1-1 Daigaku-cho, Yachiyo, Chiba 276-0003 Japan
| | - Hiroe Tani
- 4Tokushima University Graduate School, 3-18-15 Kuramoto-cho, Tokushima, 770-8503 Japan
| | - Keiko Ideno
- 5Faculty of Nursing, Toho University, 4-16-20 Omorinishi, Ota-ku, Tokyo, 143-0015 Japan
| | - Aya Nakai
- 1Chiba University Graduate School of Nursing, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8672 Japan
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48
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de Oliveira Rassi T, Xavier Pietra R, Melo Silva Canton J, Novato Silva I. Temporal trend of newly diagnosed type 1 diabetes children and adolescents identified over a 35-year period in a Brazilian institution. Diabetes Res Clin Pract 2019; 151:82-87. [PMID: 30935926 DOI: 10.1016/j.diabres.2019.03.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 01/25/2019] [Accepted: 03/28/2019] [Indexed: 11/21/2022]
Abstract
AIMS To evaluate the temporal trend of newly diagnosed Type 1 Diabetes cases over a 35-year period in a reference Pediatric Endocrinology service in the city of Belo Horizonte, Brazil. METHODS Subjects were all children and adolescents diagnosed with Type 1 Diabetes in the Federal University of Minas Gerais Hospital. Information collected included: gender, age and date of Type 1 diabetes diagnosis. Temporal trends were analyzed between 1980 and 2014 and divided in 5-year intervals. RESULTS During this period 642 children and adolescents were diagnosed with Type 1 diabetes. From 1980 to 1994 there was an increase in the proportion of children diagnosed between 0 and 4 years old, followed by progressive decrease in the subsequent decades (47% in 1990-1994 to 20% in 2010-2014; p = 0.01). There was an increase in the proportion of children diagnosed between 10 and 18 years old (13% in 1990-1994 to 54% in 2010-2014; p = 0.01). There was no statistical difference in the proportion of children diagnosed between 5 and 9 years old through the studied time. CONCLUSIONS In the studied population Type 1 Diabetes in infants and toddlers seems to be decreasing throughout the years while in the age group older than 10 years, it seems to be increasing.
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Affiliation(s)
- Tatiana de Oliveira Rassi
- Federal University of Minas Gerais, School of Medicine, Av. Prof. Alfredo Balena, 190, Belo Horizonte, Minas Gerais CEP:30130-100, Brazil.
| | - Rafaella Xavier Pietra
- Belo Horizonte University Center, School of Medicine, Av. Professor Mário Werneck, 1685, Buritis, Belo Horizonte, Minas Gerais CEP 30575-180, Brazil
| | - Juliane Melo Silva Canton
- Federal University of Minas Gerais, University Hospital, Av. Prof. Alfredo Balena, 110, Belo Horizonte, Minas Gerais CEP:30130-100, Brazil
| | - Ivani Novato Silva
- Federal University of Minas Gerais, School of Medicine, Av. Prof. Alfredo Balena, 190, Belo Horizonte, Minas Gerais CEP:30130-100, Brazil
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49
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Yamamoto Y, Kikuchi T, Urakami T, Goto M, Tsubouchi K, Sasaki G, Mizuno H, Abe Y, Kitsuda K, Amemiya S, Sugihara S. Status and trends in the use of insulin analogs, insulin delivery systems and their association with glycemic control: comparison of the two consecutive recent cohorts of Japanese children and adolescents with type 1 diabetes mellitus. J Pediatr Endocrinol Metab 2019; 32:1-9. [PMID: 30517078 DOI: 10.1515/jpem-2018-0329] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 11/08/2018] [Indexed: 11/15/2022]
Abstract
Background Treatment for type 1 diabetes mellitus (T1DM) has greatly changed by the general use of insulin analogs and continuous subcutaneous insulin infusion (CSII). To investigate whether these advances have been translated into continued improvement in glycemic control in Japanese children and adolescents, we analyzed the registration data of the two consecutive recent cohorts of Japanese childhood-onset T1DM patients. Methods The registration data including hemoglobin A1c (HbA1c), hypoglycemia and insulin regimen were compared between the two cohorts (862 patients in the 2008 cohort and 1090 in the 2013 cohort). Results The proportion of subjects with multiple daily insulin injection therapy (MDI) and CSII significantly increased (p<0.0001) from 67.4% and 9.7% to 71.8% and 23.4%, respectively. In the 2013 cohort, almost all patients were treated with basal-bolus treatment using insulin analogs. The use of CSII increased in all age groups, especially in the age group 0-5 years. The rates of overall, moderate and severe hypoglycemia significantly declined from 10.24, 10.18 and 0.056 events/100 persons/period in the 2008 cohort to 0.66, 0.62 and 0.033 in the 2013 cohort (p<0.0001, <0.0001, 0.04), respectively. Contrarily, there were no significant changes in HbA1c values between the two cohorts. Conclusions The popularization of the basal-bolus treatment using insulin analogs hascontributed to a significant decrease in hypoglycemia. In contrast, the intensive insulin treatment may not be enough for the satisfactory improvement of glycemic control in Japanese children and adolescents with T1DM. Considerable points remain, such as diabetic education and support to motivate patients.
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Affiliation(s)
- Yukiyo Yamamoto
- Director of Medical Education, Department of Pediatrics, School of Medicine, University of Occupational and Environmental Health, Japan, 1-1, Iseigaoka, Yahatanishi-ku, Kitakyushu City 807-8555, Japan.,The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT), Kyoto, Japan.,Department of Pediatrics, University of Occupational and Environmental Health Japan, Kitakyushu, Japan
| | - Toru Kikuchi
- The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT), Kyoto, Japan.,Department of Pediatrics, Faculty of Medicine, Saitama Medical University, Saitama, Japan
| | - Tatsuhiko Urakami
- The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT), Kyoto, Japan.,Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan
| | - Motohide Goto
- Department of Pediatrics, University of Occupational and Environmental Health Japan, Kitakyushu, Japan
| | - Kohji Tsubouchi
- The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT), Kyoto, Japan.,Department of Pediatrics, Chuno Kosei Hospital, Gifu, Japan
| | - Goro Sasaki
- The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT), Kyoto, Japan.,Department of Pediatrics, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Haruo Mizuno
- The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT), Kyoto, Japan.,Departments of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yuki Abe
- The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT), Kyoto, Japan.,Department of Pediatrics, Niigata City General Hospital, Niigata, Japan
| | - Kazuteru Kitsuda
- The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT), Kyoto, Japan.,Department of Pediatrics, Kitasato University, Kanagawa, Japan
| | - Shin Amemiya
- The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT), Kyoto, Japan.,Department of Pediatrics, Faculty of Medicine, Saitama Medical University, Saitama, Japan
| | - Shigetaka Sugihara
- The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT), Kyoto, Japan.,Department of Pediatrics, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
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50
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Xia Y, Xie Z, Huang G, Zhou Z. Incidence and trend of type 1 diabetes and the underlying environmental determinants. Diabetes Metab Res Rev 2019; 35:e3075. [PMID: 30207035 DOI: 10.1002/dmrr.3075] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 08/27/2018] [Accepted: 09/09/2018] [Indexed: 12/15/2022]
Abstract
A wealth of epidemiological studies concerning the distribution of type 1 diabetes (T1D) around the world have pointed to the appreciable variation in the incidence of T1D among disparate age groups, ethnicities, and geographical locations. On the whole, the incidence of childhood T1D has been on the rise, and a plausible inverse relationship between the initial incidence rate and the following annual increase in incidence has been raised. Countries that used to exhibit lower incidences tend to have steep annual increase whereas those with already-established high incidences are more likely to show a modest increase or even stabilization in T1D incidence. Environmental agents considered responsible for the current evolving pattern of T1D incidence will be detailed, mainly including the increasing prevalence of childhood obesity, viral infections in a chronic manner, maternal-child interaction such as breastfeeding, and latitude-ultraviolet B-vitamin D pathway. Certain rationale has been put forward in an attempt to explain the potential association between environmental agents and development of T1D. For instance, accelerator hypothesis regards insulin resistance as the promoter of earlier disease onset in obese children whereas the negative correlation of microbial infections in background populations with incidence of T1D represents the basic component of the hygiene hypothesis. Further investigations are still warranted to verify these theories across multiple ethnic groups and to identify additional contributors to the variation in T1D incidence.
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Affiliation(s)
- Ying Xia
- Department of Metabolism & Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education; National Clinical Research Center for Metabolic Diseases, Changsha, Hunan, China
| | - Zhiguo Xie
- Department of Metabolism & Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education; National Clinical Research Center for Metabolic Diseases, Changsha, Hunan, China
| | - Gan Huang
- Department of Metabolism & Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education; National Clinical Research Center for Metabolic Diseases, Changsha, Hunan, China
| | - Zhiguang Zhou
- Department of Metabolism & Endocrinology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
- Key Laboratory of Diabetes Immunology (Central South University), Ministry of Education; National Clinical Research Center for Metabolic Diseases, Changsha, Hunan, China
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