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Fyvie MJ, Gillespie KM. The importance of biomarker development for monitoring type 1 diabetes progression rate and therapeutic responsiveness. Front Immunol 2023; 14:1158278. [PMID: 37256143 PMCID: PMC10225507 DOI: 10.3389/fimmu.2023.1158278] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/28/2023] [Indexed: 06/01/2023] Open
Abstract
Type 1 diabetes (T1D) is an autoimmune condition of children and adults in which immune cells target insulin-producing pancreatic β-cells for destruction. This results in a chronic inability to regulate blood glucose levels. The natural history of T1D is well-characterized in childhood. Evidence of two or more autoantibodies to the islet antigens insulin, GAD, IA-2 or ZnT8 in early childhood is associated with high risk of developing T1D in the future. Prediction of risk is less clear in adults and, overall, the factors controlling the progression rate from multiple islet autoantibody positivity to onset of symptoms are not fully understood. An anti-CD3 antibody, teplizumab, was recently shown to delay clinical progression to T1D in high-risk individuals including adults and older children. This represents an important proof of concept for those at risk of future T1D. Given their role in risk assessment, islet autoantibodies might appear to be the most obvious biomarkers to monitor efficacy. However, monitoring islet autoantibodies in clinical trials has shown only limited effects, although antibodies to the most recently identified autoantigen, tetraspanin-7, have not yet been studied in this context. Measurements of beta cell function remain fundamental to assessing efficacy and different models have been proposed, but improved biomarkers are required for both progression studies before onset of diabetes and in therapeutic monitoring. In this mini-review, we consider some established and emerging predictive and prognostic biomarkers, including markers of pancreatic function that could be integrated with metabolic markers to generate improved strategies to measure outcomes of therapeutic intervention.
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Affiliation(s)
| | - Kathleen M. Gillespie
- Diabetes and Metabolism, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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2
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Laron Z, Shulman L, Hampe C, Blumenfeld O. Hypothesis: Viral infections of pregnant women may be early triggers of childhood type 1 diabetes and other autoimmune disease. J Autoimmun 2023; 135:102977. [PMID: 36621175 DOI: 10.1016/j.jaut.2022.102977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 12/06/2022] [Accepted: 12/06/2022] [Indexed: 01/09/2023]
Abstract
Children and adolescents with early onset autoimmune diseases have a different seasonality of month of birth than the general population. This pattern is consistent with an infection during pregnancy affecting the fetus or an infection immediately after birth that act as early triggers of the autoimmune diseases. We present data supporting the use of Rotavirus vaccinations in the reduction of incidence of childhood T1D and propose further investigations into whether other anti-virus vaccinations may reduce the burden of other autoimmune diseases such as multiple sclerosis, atopic dermatitis, psoriasis and subtypes of rheumatoid arthritis, Hashimoto thyroiditis.
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Affiliation(s)
- Zvi Laron
- Schneider Children's Medical Center, Israel.
| | - Lester Shulman
- Central Virology Laboratory, Public Health Services MOH, Israel
| | | | - Orit Blumenfeld
- Israel Center for Disease Control, Ministry of Health, Israel
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3
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Libman I, Haynes A, Lyons S, Pradeep P, Rwagasor E, Tung JYL, Jefferies CA, Oram RA, Dabelea D, Craig ME. ISPAD Clinical Practice Consensus Guidelines 2022: Definition, epidemiology, and classification of diabetes in children and adolescents. Pediatr Diabetes 2022; 23:1160-1174. [PMID: 36537527 DOI: 10.1111/pedi.13454] [Citation(s) in RCA: 36] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/09/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Ingrid Libman
- Division of Pediatric Endocrinology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Aveni Haynes
- Children's Diabetes Centre, Telethon Kids Institute, Perth, Western Australia, Australia
| | - Sarah Lyons
- Pediatric Diabetes and Endocrinology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Praveen Pradeep
- Department of Endocrinology, All India Institute of Medical Sciences, New Delhi, India
| | - Edson Rwagasor
- Rwanda Biomedical Center, Rwanda Ministry of Health, Kigali, Rwanda
| | - Joanna Yuet-Ling Tung
- Department of Paediatrics and Adolescent Medicine, Hong Kong Children's Hospital, Hong Kong, Hong Kong
| | - Craig A Jefferies
- Starship Children's Health, Te Whatu Ora Health New Zealand, Auckland, New Zealand
| | - Richard A Oram
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| | - Dana Dabelea
- Department of Epidemiology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Maria E Craig
- The Children's Hospital at Westmead, Sydney, New South Wales (NSW), Australia.,University of Sydney Children's Hospital Westmead Clinical School, Sydney, NEW, Australia.,Discipline of Paediatrics & Child Health, School of Clinical Medicine, University of NSW Medicine & Health, Sydney, NSW, Australia
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4
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Gillespie KM, Fareed R, Mortimer GL. Four decades of the Bart's Oxford study: Improved tests to predict type 1 diabetes. Diabet Med 2021; 38:e14717. [PMID: 34655243 DOI: 10.1111/dme.14717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 10/13/2021] [Indexed: 11/29/2022]
Abstract
Recent success in clinical trials to delay the onset of type 1 diabetes has heralded a new era of type 1 diabetes research focused on the most accurate methods to predict risk and progression rate in the general population. Risk prediction for type 1 diabetes has been ongoing since the 1970s and 1980s when human leucocyte antigen (HLA) variants and islet autoantibodies associated with type 1 diabetes were first described. Development of prediction methodologies has relied on well-characterised cohorts and samples. The Bart's Oxford (BOX) study of type 1 diabetes has been recruiting children with type 1 diabetes and their first (and second)-degree relatives since 1985. In this review, we use the timeline of the study to review the accompanying basic science developments which have facilitated improved prediction by genetic (HLA analysis through to genetic risk scores) and biochemical strategies (islet cell autoantibodies through to improved individual tests for antibodies to insulin, glutamate decarboxylase, the tyrosine phosphatase IA-2, zinc transporter 8 and tetraspanin 7). The type 1 diabetes community are poised to move forward using the best predictive markers to predict and delay the onset of type 1 diabetes.
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Affiliation(s)
- Kathleen M Gillespie
- Diabetes and Metabolism, Bristol Medical School, Southmead Hospital, University of Bristol, Bristol, UK
| | - Rana Fareed
- Diabetes and Metabolism, Bristol Medical School, Southmead Hospital, University of Bristol, Bristol, UK
| | - Georgina L Mortimer
- Diabetes and Metabolism, Bristol Medical School, Southmead Hospital, University of Bristol, Bristol, UK
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5
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Harvey JN, Hibbs R, Maguire MJ, O'Connell H, Gregory JW. The changing incidence of childhood-onset type 1 diabetes in Wales: Effect of gender and season at diagnosis and birth. Diabetes Res Clin Pract 2021; 175:108739. [PMID: 33711398 DOI: 10.1016/j.diabres.2021.108739] [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: 01/15/2021] [Revised: 02/15/2021] [Accepted: 02/22/2021] [Indexed: 10/22/2022]
Abstract
AIMS Determinants of the changing incidence of childhood-onset type 1 diabetes remain uncertain. We determined the recent time-trend of type 1 diabetes incidence in Wales and explored the role of vitamin D by evaluating the influence of season both at diagnosis and at birth. METHODS Data from all Welsh paediatric units 1990-2019, and from primary care to determine ascertainment. RESULTS Log-linear modelling indicated a non-linear secular trend in incidence with peak and subsequent decline. The peak occurred around June 2010: 31∙3 cases/year/100,000 children aged < 15y. It occurred earlier in children younger at diagnosis and earlier in boys. There were more cases in males aged <2y and >12y but more in females aged 9-10 y. More were diagnosed in winter. Also, children born in winter had less risk of future diabetes. CONCLUSIONS The risk of developing type 1 diabetes before age 15y in Wales is no longer increasing. The data on season are consistent with a preventative role for vitamin D both during pregnancy and later childhood. Metereological Office data shows increasing hours of sunlight since 1980 likely to increase vitamin D levels with less diabetes. Additional dietary supplementation with vitamin D might further reduce the incidence of type 1 diabetes.
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Affiliation(s)
- J N Harvey
- Wrexham Academic Unit, Bangor University, United Kingdom.
| | - R Hibbs
- Wrexham Academic Unit, Bangor University, United Kingdom
| | - M J Maguire
- Department of Child Health, Prince Charles Hospital, Merthyr Tydfil, United Kingdom
| | - H O'Connell
- Division of Population Health, School of Medicine, Cardiff University, United Kingdom
| | - J W Gregory
- Division of Population Health, School of Medicine, Cardiff University, United Kingdom
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6
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Paun A, Yau C, Meshkibaf S, Daigneault MC, Marandi L, Mortin-Toth S, Bar-Or A, Allen-Vercoe E, Poussier P, Danska JS. Association of HLA-dependent islet autoimmunity with systemic antibody responses to intestinal commensal bacteria in children. Sci Immunol 2020; 4:4/32/eaau8125. [PMID: 30709843 DOI: 10.1126/sciimmunol.aau8125] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 12/13/2018] [Indexed: 12/11/2022]
Abstract
Microbiome sequence analyses have suggested that changes in gut bacterial composition are associated with autoimmune disease in humans and animal models. However, little is known of the mechanisms through which the gut microbiota influences autoimmune responses to distant tissues. Here, we evaluated systemic antibody responses against cultured human gut bacterial strains to determine whether observed patterns of anticommensal antibody (ACAb) responses are associated with type 1 diabetes (T1D) in two cohorts of pediatric study participants. In the first cohort, ACAb responses in sera collected from participants within 6 months of T1D diagnosis were compared with age-matched healthy controls and also with patients with recent onset Crohn's disease. ACAb responses against multiple bacterial species discriminated among these three groups. In the second cohort, we asked whether ACAb responses present before diagnosis were associated with later T1D development and with HLA genotype in participants who were discordant for subsequent progression to diabetes. Serum IgG2 antibodies against Roseburia faecis and against a bacterial consortium were associated with future T1D diagnosis in an HLA DR3/DR4 haplotype-dependent manner. These analyses reveal associations between antibody responses to intestinal microbes and HLA-DR genotype and islet autoantibody specificity and with a future diagnosis of T1D. Further, we present a platform to investigate antibacterial antibodies in biological fluids that is applicable to studies of autoimmune diseases and responses to therapeutic interventions.
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Affiliation(s)
- Alexandra Paun
- Hospital for Sick Children, Toronto, ON, Canada. .,Department of Immunology, University of Toronto, Faculty of Medicine, Toronto, ON, Canada
| | - Christopher Yau
- Hospital for Sick Children, Toronto, ON, Canada. .,Department of Immunology, University of Toronto, Faculty of Medicine, Toronto, ON, Canada
| | | | - Michelle C Daigneault
- Department of Molecular and Cellular Biology, University of Guelph, Guelph, ON, Canada
| | | | | | - Amit Bar-Or
- Montreal Neurological Institute, McGill University, Montreal, QC, Canada.,Department of Neurology, Perelman Center for Advanced Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, U.S.A
| | - Emma Allen-Vercoe
- Department of Molecular and Cellular Biology, University of Guelph, Guelph, ON, Canada
| | - Philippe Poussier
- Department of Immunology, University of Toronto, Faculty of Medicine, Toronto, ON, Canada.,Sunnybrook Research Institute, Toronto, ON Canada
| | - Jayne S Danska
- Hospital for Sick Children, Toronto, ON, Canada. .,Department of Immunology, University of Toronto, Faculty of Medicine, Toronto, ON, Canada.,Department of Medical Biophysics, University of Toronto, Faculty of Medicine, Toronto, ON, Canada
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7
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Mobasseri M, Shirmohammadi M, Amiri T, Vahed N, Hosseini Fard H, Ghojazadeh M. Prevalence and incidence of type 1 diabetes in the world: a systematic review and meta-analysis. Health Promot Perspect 2020; 10:98-115. [PMID: 32296622 PMCID: PMC7146037 DOI: 10.34172/hpp.2020.18] [Citation(s) in RCA: 295] [Impact Index Per Article: 73.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Accepted: 10/26/2019] [Indexed: 12/13/2022] Open
Abstract
Background: Diabetes is referred to a group of diseases characterized by high glucose levels in blood. It is caused by a deficiency in the production or function of insulin or both, which can occur because of different reasons, resulting in protein and lipid metabolic disorders. The aim of this study was to systematically review the prevalence and incidence of type 1 diabetes in the world. Methods: A systematic search of resources was conducted to investigate the prevalence and incidence of type 1 diabetes in the world. The databases of Medline (via PubMed and Ovid),ProQuest, Scopus, and Web of Science from January 1980 to September 2019 were searched to locate English articles. The located articles were screened in multiple levels of title, abstract,and full-text and final studies that met the inclusion criteria were retrieved and included in the study. Results: From 1202 located articles, 193 studies were included in this systematic review. The results of meta-analysis showed that the incidence of type 1 diabetes was 15 per 100,000 people and the prevalence was 9.5% (95% CI: 0.07 to 0.12) in the world, which was statistically significant. Conclusion: According to the results, the incidence and prevalence of type 1 diabetes are increasing in the world. As a result, insulin will be difficult to access and afford, especially in underdeveloped and developing countries.
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Affiliation(s)
- Majid Mobasseri
- Endocrine Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Masoud Shirmohammadi
- Liver and Gastrointestinal Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Tarlan Amiri
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Nafiseh Vahed
- Emergency Medicine Research Team, Tabriz University of Medical Sciences, Tabriz, Iran
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A Joanna Briggs Institute Affiliated Group, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hossein Hosseini Fard
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A Joanna Briggs Institute Affiliated Group, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Morteza Ghojazadeh
- Research Center for Evidence-Based Medicine, Iranian EBM Centre: A Joanna Briggs Institute Affiliated Group, Tabriz University of Medical Sciences, Tabriz, Iran
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8
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Williams CL, Long AE. What has zinc transporter 8 autoimmunity taught us about type 1 diabetes? Diabetologia 2019; 62:1969-1976. [PMID: 31444530 PMCID: PMC6805822 DOI: 10.1007/s00125-019-04975-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Accepted: 05/21/2019] [Indexed: 12/23/2022]
Abstract
Zinc transporter 8 (ZnT8), a protein highly specific to pancreatic insulin-producing beta cells, is vital for the biosynthesis and secretion of insulin. ZnT8 autoantibodies (ZnT8A) are among the most recently discovered and least-characterised islet autoantibodies. In combination with autoantibodies to several other islet antigens, including insulin, ZnT8A help predict risk of future type 1 diabetes. Often, ZnT8A appear later in the pathogenic process leading to type 1 diabetes, suggesting that the antigen is recognised as part of the spreading, rather than the initial, autoimmune response. The development of autoantibodies to different forms of ZnT8 depends on the genotype of an individual for a polymorphic ZnT8 residue. This genetic variant is associated with susceptibility to type 2 but not type 1 diabetes. Levels of ZnT8A often fall rapidly after diagnosis while other islet autoantibodies can persist for many years. In this review, we consider the contribution made by ZnT8 to our understanding of type 1 diabetes over the past decade and what remains to be investigated in future research.
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Affiliation(s)
- Claire L Williams
- Translational Health Sciences, Bristol Medical School, University of Bristol, Level 2, Learning and Research, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Anna E Long
- Translational Health Sciences, Bristol Medical School, University of Bristol, Level 2, Learning and Research, Southmead Hospital, Bristol, BS10 5NB, UK.
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9
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Aeppli TRJ, Mahler FL, Konrad D. Future glycemic control of children diagnosed with type 1 diabetes mellitus at toddler and preschool/school age. J Pediatr Endocrinol Metab 2019; 32:929-933. [PMID: 31323008 DOI: 10.1515/jpem-2019-0152] [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: 03/29/2019] [Accepted: 05/16/2019] [Indexed: 11/15/2022]
Abstract
Background The main objective of this study was to compare future glycemic control in children diagnosed with type 1 diabetes mellitus (T1DM) at toddler age and preschool/school age. In addition, we aimed to examine risk factors known to be associated with future glycated hemoglobin A1c (HbA1c) levels in children diagnosed with T1DM. Methods This is a retrospective cohort study of 85 patients diagnosed with T1DM at toddler age (group 1; 0-2.9 years; n = 36) or preschool/school age (group 2; 5-6.9 years; n = 49) who were followed up at the University Children's Hospital in Zurich for at least 10 consecutive years or until the age of 15 years. Results The mean HbA1c level in the first year after diagnosis had a highly predictive value about glycemic control in the following 6 years. In addition, a longer duration of T1DM was associated with higher HbA1c values. HbA1c values did not differ significantly within 11 years after diagnosis between children in the two age groups. Neither was a difference found when comparing the two groups in respect to their chronological age, although a trend was noted (p = 0.09). This trend is very likely due to a longer duration of diabetes in group 1. Conclusions HbA1c level in the first year predicts glycemic control for the next 6 years and deterioration of HbA1c values can be noted with longer duration of T1DM. Moreover, our study demonstrated similar future glycemic control in patients diagnosed with T1DM at toddler age and preschool/school age.
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Affiliation(s)
- Tim R J Aeppli
- Department of Endocrinology and Diabetology, University Children's Hospital, Zurich, Switzerland
| | - Fiona L Mahler
- Department of Endocrinology and Diabetology, University Children's Hospital, Zurich, Switzerland.,Department of Clinical Psychology, University Children's Hospital, Zurich, Switzerland
| | - Daniel Konrad
- Children's Research Centre, University Children's Hospital, Zurich, Switzerland.,Department of Pediatric Endocrinology and Diabetology, University Children's Hospital, Steinwiesstrasse 75, CH-8032 Zurich, Switzerland
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10
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Ye J, Richardson TG, McArdle WL, Relton CL, Gillespie KM, Suderman M, Hemani G. Identification of loci where DNA methylation potentially mediates genetic risk of type 1 diabetes. J Autoimmun 2018; 93:66-75. [PMID: 30146008 DOI: 10.1016/j.jaut.2018.06.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 06/19/2018] [Accepted: 06/19/2018] [Indexed: 12/18/2022]
Abstract
The risk of Type 1 Diabetes (T1D) comprises both genetic and environmental components. We investigated whether genetic susceptibility to T1D could be mediated by changes in DNA methylation, an epigenetic mechanism that potentially plays a role in autoimmune diabetes. From enrichment analysis, we found that there was a common genetic influence for both DNA methylation and T1D across the genome, implying that methylation could be either on the causal pathway to T1D or a non-causal biomarker of T1D genetic risk. Using data from a general population comprising blood samples taken at birth (n = 844), childhood (n = 846) and adolescence (n = 907), we then evaluated the associations between 64 top GWAS single nucleotide polymorphisms (SNPs) and DNA methylation levels at 55 non-HLA loci. We identified 95 proximal SNP-cytosine phosphate guanine (CpG) pairs (cis) and 1 distal SNP-CpG association (trans) consistently at birth, childhood, and adolescence. Combining genetic co-localization and Mendelian Randomization analysis, we provided evidence that at 5 loci, ITGB3BP, AFF3, PTPN2, CTSH and CTLA4, DNA methylation is potentially mediating the genetic risk of T1D mainly by influencing local gene expression.
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Affiliation(s)
- Jody Ye
- Diabetes and Metabolism, Bristol Medical School (Translational Health Sciences), University of Bristol, Level 2 Learning and Research, Southmead Hospital, Bristol, BS10 5NB, UK.
| | - Tom G Richardson
- MRC Integrative Epidemiology Unit, Bristol Medical School (Population Health Sciences), University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Wendy L McArdle
- Bristol Medical School (Population Health Sciences), University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Caroline L Relton
- MRC Integrative Epidemiology Unit, Bristol Medical School (Population Health Sciences), University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Kathleen M Gillespie
- Diabetes and Metabolism, Bristol Medical School (Translational Health Sciences), University of Bristol, Level 2 Learning and Research, Southmead Hospital, Bristol, BS10 5NB, UK
| | - Matthew Suderman
- MRC Integrative Epidemiology Unit, Bristol Medical School (Population Health Sciences), University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
| | - Gibran Hemani
- MRC Integrative Epidemiology Unit, Bristol Medical School (Population Health Sciences), University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN, UK
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11
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Common ground: shared risk factors for type 1 diabetes and celiac disease. Nat Immunol 2018; 19:685-695. [DOI: 10.1038/s41590-018-0130-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 04/27/2018] [Indexed: 02/07/2023]
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12
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Mamoulakis D, Vrouvaki F, Louvari V, Galanakis E. Incidence of childhood Type 1 diabetes mellitus in Crete. Diabet Med 2018; 35:1210-1215. [PMID: 29791054 DOI: 10.1111/dme.13681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/17/2018] [Indexed: 11/28/2022]
Abstract
AIM To investigate the epidemiology of childhood Type 1 diabetes mellitus in Crete over the last 25 years and to evaluate incidence trends over time. METHODS The study included all children aged 0-14 years who live in Crete and were diagnosed during the 25-year period from 1 January 1992 to 31 December 2016. RESULTS A total of 271 children were diagnosed with Type 1 diabetes during the 25-year period: 148 boys and 123 girls (boy:girl ratio 1.2). The median (interquartile range) age at diagnosis was 8.3 (5.0-12.0) years for boys and 8.0 (5.3-11.3) years for girls. The standardized annual incidence rate was 10.5 per 100 000 children (95% CI 9.2 to 11.8). Incidence rates were higher in children aged 5-9 years. During the 25-year study period an average 4.4% annual increase in incidence was documented and was most prominent in the age group 5-14 years. Incidence seemed to remain relatively stable for the age group 0-4 years in the last decade. No seasonality of the clinical onset of Type 1 diabetes was observed. CONCLUSIONS The recent increase in Type 1 diabetes incidence places Crete among regions with high incidence as per the World Health Organization DiaMond project classification. The rising trends in incidence confirmed by this study are in accordance with the reported global trends in Type 1 diabetes incidence.
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Affiliation(s)
- D Mamoulakis
- Department of Paediatrics, Heraklion University Hospital, Crete, Greece
| | - F Vrouvaki
- Department of Paediatrics, Heraklion University Hospital, Crete, Greece
| | - V Louvari
- Department of Paediatrics, Heraklion University Hospital, Crete, Greece
| | - E Galanakis
- Department of Paediatrics, Heraklion University Hospital, Crete, Greece
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13
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Szalecki M, Wysocka-Mincewicz M, Ramotowska A, Mazur A, Lisowicz L, Beń-Skowronek I, Sieniawska J, Klonowska B, Charemska D, Nawrotek J, Jałowiec I, Bossowski A, Jamiołkowska M, Pyrżak B, Miszkurka G, Szypowska A. Epidemiology of type 1 diabetes in Polish children: A multicentre cohort study. Diabetes Metab Res Rev 2018; 34. [PMID: 29144024 DOI: 10.1002/dmrr.2962] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 10/05/2017] [Accepted: 10/14/2017] [Indexed: 01/29/2023]
Abstract
BACKGROUND The incidence of childhood type 1 diabetes (T1D) varies greatly between populations, and the estimates and/or predictions of the rates would aid in adequate planning of health care resources. The study's aim was to assess the incidence of T1D in the paediatric population of eastern and central Poland. METHODS In this cohort study covering the period from January 2010 to December 2014, data were collected for children and adolescents below 18 years of age with newly diagnosed T1D living in eastern and central Poland. A total of 2174 children were included in the analysis. The population estimates were from the Central Statistical Office of Poland. RESULTS Overall, the annual incidence of T1D increased from 12.84/100,000 in 2010 to 18.46/100,000 in 2014 with the incidence rate (IR) ratio of 1.5 (an increase in the IR by 12.7% per year over 5 years). The lowest increase in the IR by 7.1% per year was seen in 15 to 17-year-olds. In the urban population (age 0-17 years), the overall incidence rate was significantly higher than in subjects from rural communities (P < .02). The incidence of T1D in rural areas was significantly higher (p = .004) in voivodeships of higher population density. Such dependence was not observed in urban areas. CONCLUSIONS The incidence of T1D in children living in eastern and central Poland increased 1.5-fold over the 5-year observation period with the highest rise in 10 to 14-year-olds and significantly higher rates in urban children compared with their peers living in rural areas.
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Affiliation(s)
- Mieczysław Szalecki
- Department of Endocrinology and Diabetology, Children's Memorial Health Institute, Warsaw, Poland
- The Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Marta Wysocka-Mincewicz
- Department of Endocrinology and Diabetology, Children's Memorial Health Institute, Warsaw, Poland
| | - Anna Ramotowska
- Department of Paediatrics, Medical University of Warsaw, Warsaw, Poland
| | - Artur Mazur
- II Department of Paediatrics, Paediatric Endocrinology and Diabetes, Medical Faculty, University of Rzeszów, Rzeszów, Poland
| | - Lucyna Lisowicz
- II Department of Paediatrics, Paediatric Endocrinology and Diabetes, Medical Faculty, University of Rzeszów, Rzeszów, Poland
| | - Iwona Beń-Skowronek
- Department of Paediatric Endocrinology and Diabetology, Medical University of Lublin, Lublin, Poland
| | - Joanna Sieniawska
- Department of Paediatric Endocrinology and Diabetology, Medical University of Lublin, Lublin, Poland
| | - Bożena Klonowska
- Department of Clinical Paediatrics, Faculty of Medical Sciences, Provincial Specialist Children's Hospital, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Dorota Charemska
- Department of Clinical Paediatrics, Faculty of Medical Sciences, Provincial Specialist Children's Hospital, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Jolanta Nawrotek
- Endocrinology and Diabetology Ward, General District Hospital, Kielce, Poland
| | - Irena Jałowiec
- Endocrinology and Diabetology Ward, General District Hospital, Kielce, Poland
| | - Artur Bossowski
- Department of Paediatrics, Endocrinology and Diabetology with a Cardiology Division, Medical University of Białystok, Białystok, Poland
| | - Milena Jamiołkowska
- Department of Paediatrics, Endocrinology and Diabetology with a Cardiology Division, Medical University of Białystok, Białystok, Poland
| | - Beata Pyrżak
- Department of Paediatric Endocrinology, Medical University of Warsaw, Warsaw, Poland
| | - Grażyna Miszkurka
- Department of Paediatric Endocrinology, Medical University of Warsaw, Warsaw, Poland
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14
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Chen YL, Huang YC, Qiao YC, Ling W, Pan YH, Geng LJ, Xiao JL, Zhang XX, Zhao HL. Climates on incidence of childhood type 1 diabetes mellitus in 72 countries. Sci Rep 2017; 7:12810. [PMID: 28993655 PMCID: PMC5634499 DOI: 10.1038/s41598-017-12954-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 09/12/2017] [Indexed: 12/25/2022] Open
Abstract
We are aimed to systematically assess the worldwide trend in incidence of childhood type 1 diabetes mellitus (CT1DM) from 1965 to 2012 and to discuss whether climate affect incidence of CT1DM. We searched the relevant literatures in detail to judge the effect of different climates on incidence of CT1DM. The climates included Mediterranean, monsoon, oceanic, continental, savanna, and rainforest. According to different climates, we further researched relevant factor such as sunshine durations and latitudes. The overall incidence of CT1DM in 72 countries was 11.43 (95% CI 10.31–12.55) per 100,000 children/yr. The incidence of CT1DM in Oceanic climate [10.56 (8.69–12.42)] is highest compared with other climates; the incidence in 40°–66°34′N/S [14.71 (12.30–17.29)] is higher than other latitude groups; the incidence in sunshine durations with 3–4 hours per day [15.17 (11.14–19.20)] is highest compared with other two groups; the incidence of CT1DM from 2000 to 2012 [19.58 (14.55–24.60)] is higher than other periods; all p < 0.01. Incidence of CT1DM was increasing from 1965 to 2012, but incidence in Oceanic climate is higher than other climates. Furthermore, it is higher in centers with higher latitude and lower sunshine durations. The climates might play a key role in inducing CT1DM.
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Affiliation(s)
- Yin-Ling Chen
- Center of Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, 541004, China.,Department of Immunology, Faculty of basic Medicine, Guilin Medical University, Guilin, 541004, China
| | - Yong-Cheng Huang
- Center of Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, 541004, China
| | - Yong-Chao Qiao
- Department of Immunology, Xiangya School of Medicine, Central South University, Changsha, Hunan, 410078, China
| | - Wei Ling
- Center of Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, 541004, China
| | - Yan-Hong Pan
- Center of Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, 541004, China.,Department of Immunology, Faculty of basic Medicine, Guilin Medical University, Guilin, 541004, China
| | - Li-Jun Geng
- Center of Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, 541004, China.,Department of Immunology, Faculty of basic Medicine, Guilin Medical University, Guilin, 541004, China
| | - Jian-Long Xiao
- Center of Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, 541004, China.,Department of Immunology, Faculty of basic Medicine, Guilin Medical University, Guilin, 541004, China
| | - Xiao-Xi Zhang
- Center of Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, 541004, China. .,Department of Immunology, Faculty of basic Medicine, Guilin Medical University, Guilin, 541004, China.
| | - Hai-Lu Zhao
- Center of Diabetic Systems Medicine, Guangxi Key Laboratory of Excellence, Guilin Medical University, Guilin, 541004, China. .,Department of Immunology, Xiangya School of Medicine, Central South University, Changsha, Hunan, 410078, China. .,Department of Immunology, Faculty of basic Medicine, Guilin Medical University, Guilin, 541004, China.
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15
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Abstract
Toddlers with type 1 diabetes have distinctive combination of challenges to their families and healthcare providers. A major factor is the difficulty in achieving metabolic control without risking hypoglycemia. The rising incidence of type 1 diabetes in toddlers increases the magnitude of the problem and creates a greater need for providing specialized service to cater for this age group's unique need. Type 1 has a specific disease nature in younger children and its clinical presentation mimics common childhood diseases. Symptoms and signs in the newly presented toddler with diabetes might be unspecific causing diagnosis to be missed or delayed. With the low cognitive ability and immature communication, toddlers might not be able to express their ill-feeling resulting from hypoglycemia or hyperglycemia. Hypoglycemia fear is common, which aggravates stress and reduces adherence to strict metabolic control. Nocturnal hypoglycemia is more common in toddlers and can be undiagnosed unless continuous glucose monitoring is used. Insulin administration and adjustment can be challenging due to pain, fear, refusal, and frequent intercurrent illness. Glucose monitoring is crucial. However, it can be distressing to the child and difficult to adhere to due to commitment or financial reasons. Insulin pump therapy is proven to be an effective and a safe method of treatment for toddlers, but it requires intensive training, resources, and long-term support. Provision of multidisciplinary team with special expertise in managing toddlers with diabetes is essential. Providing more physiological insulin regimes and customized technology is required to improve treatment compliance and diabetes control.
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Affiliation(s)
- Asma Deeb
- Paediatric Endocrinology Department, Mafraq Hospital , Abu Dhabi, United Arab Emirates
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16
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Affiliation(s)
- Drew Bunker
- 1 Tulane University School of Medicine, New Orleans, LA, USA
| | - Edwin Frieberg
- 2 Tulane University Medical Center, New Orleans, LA, USA
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17
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Dunger DB. Banting Memorial Lecture 2016 Reducing lifetime risk of complications in adolescents with Type 1 diabetes. Diabet Med 2017; 34:460-466. [PMID: 27973749 DOI: 10.1111/dme.13299] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/08/2016] [Indexed: 12/19/2022]
Abstract
Adolescence is a challenging period of life for any young person, and for those with Type 1 diabetes, physiological and psychological factors can result in a deterioration in glycaemic control. In young people with Type 1 diabetes, puberty may be an additional risk factor impacting on the lifetime risk for renal and cardiovascular complications. Our longitudinal studies have identified that increases in urinary albumin excretion through childhood are associated with the development of microalbuminuria and a generalized endotheliopathy linked to cardiovascular risk. Screening of participants recruited to the Adolescent type 1 Diabetes cardio-renal Intervention Trial (AdDIT) confirms that these early changes in albumin excretion are related to both diabetic nephropathy and cardiovascular risk; in part, independent of glycaemic control. Thus, as well as current attempts to improve glycaemic control through enhanced targeted insulin delivery, pumps, sensors and closed loop, we have explored the role of angiotensin-converting enzyme inhibitors and statins in providing cardio-renal protection during adolescence.
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Affiliation(s)
- D B Dunger
- Department of Paediatrics, University of Cambridge, Cambridge, UK
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18
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Altobelli E, Petrocelli R, Verrotti A, Chiarelli F, Marziliano C. Genetic and environmental factors affect the onset of type 1 diabetes mellitus. Pediatr Diabetes 2016; 17:559-566. [PMID: 26697762 DOI: 10.1111/pedi.12345] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 11/13/2015] [Accepted: 10/03/2015] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Type 1 diabetes mellitus (T1DM) is influenced by genetic as well as environmental factors. Its incidence has risen considerably since the 1950s. OBJECTIVE This study investigates T1DM time trends from 1989 to 2008 and tries to establish whether breast/bottle feeding, a family history of diabetes, and childhood infectious diseases influence age at onset. METHODS The study used the population-based registry of childhood diabetes of Abruzzo (central Italy), which includes incident cases of patients aged less than 15 yr. The pooled 1989-2008 global ascertainment of the registry was 95%. The trend was estimated using age-period-cohort models RESULTS: Overall standardized incidence rates (SIR) increased by 73.38% from 8.94 (1989-1993) to 15.50 (2004-2008). A rising trend was found in all age groups; annual rises were significant for the overall population (3.40%, p < 0.01) and for 5-9 yr olds (5.48%, p < 0.01). SIR increased in males by 106.26%, from 9.26 in 1989-1993 to 19.10 in 2004-2008. Early T1DM onset was related to mixed feeding (6.80 yr ± 3.58 vs 8.20 ± 3.81 yr; p = 0.002), and a family history of T1DM (6.71 ± 3.96 yr vs. 8.09 ± 3.77 yr; p = 0.014), whereas multiple infections delayed age at onset (9.71 ± 2.37 yr vs 7.71 ± 2.82 yr; p = 0.03). CONCLUSIONS T1DM incidence exhibits a rising time trend that is particularly evident in males and in middle age group; mixed feeding and a family history of diabetes are associated with early onset, multiple bacterial infections contracted before diabetes are associated with a significant delay.
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Affiliation(s)
- Emma Altobelli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy. .,Epidemiologic and Biostatistics Unit, AUSL, Teramo, Italy.
| | | | | | | | - Ciro Marziliano
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
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19
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Wu HB, Zhong JM, Hu RY, Wang H, Gong WW, Pan J, Fei FR, Wang M, Guo LH, Yang L, Yu M. Rapidly rising incidence of Type 1 diabetes in children and adolescents aged 0-19 years in Zhejiang, China, 2007 to 2013. Diabet Med 2016; 33:1339-46. [PMID: 26499360 DOI: 10.1111/dme.13010] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/21/2015] [Indexed: 12/16/2022]
Abstract
AIMS To investigate the incidence rates and trends in Type 1 diabetes in children and adolescents aged 0-19 years in the registered Zhejiang population over the period 2007-2013 by age, sex and calendar year. METHODS In total, 611 individuals with newly diagnosed Type 1 diabetes were identified from 30 districts in Zhejiang province over the study period. Annual incidence and 95% confidence intervals (CI) by age group and sex were calculated per 100 000 person-years. Trends in diabetes incidence and the associations of age and sex with Type 1 diabetes were assessed using Poisson regression models. RESULTS The mean annual age-standardized incidence of diabetes was 2.02/100 000 person-years (95% CI: 1.92-2.12), with an average annual increase of 12.0% (95% CI: 7.6-16.6%) over the study period. The risk for Type 1 diabetes in girls was estimated to be 1.25 (95% CI: 1.07-1.47) times higher than that in boys. Compared with those aged 0-4 years, the 5-9, 10-14 and 15-19 years age groups were at significantly greater risk, with adjusting incidence rate ratios of 3.54, 6.58 and 5.39, respectively. The mean age at diagnosis decreased significantly from 12.85 years in 2007 to 11.21 years in 2013. A steep rise in diabetes incidence was observed in the under 5 years age group, which showed the greatest increase at 33.61%. CONCLUSIONS The incidence of diabetes in Zhejiang was relatively low, although rapidly rising trends have been found in recent years, particularly in younger children. Further monitoring and research are urgently required to better understand possible environmental risk factors and formulate preventive strategies.
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Affiliation(s)
- H B Wu
- Department of NCDs Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - J M Zhong
- Department of NCDs Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - R Y Hu
- Department of NCDs Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - H Wang
- Department of NCDs Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - W W Gong
- Department of NCDs Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - J Pan
- Department of NCDs Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - F R Fei
- Department of NCDs Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - M Wang
- Department of NCDs Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - L H Guo
- Department of NCDs Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - L Yang
- Zhejiang Provincial Center for Cardio-cerebrovascular Diseases Control and Prevention, Zhejiang Hospital, Hangzhou, China
| | - M Yu
- Department of NCDs Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China.
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20
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Mendez N, Nayak NV, Kolomeyer AM, Szirth BC, Khouri AS. Feasibility of Spectral Domain Optical Coherence Tomography Acquisition Using a Handheld Versus Conventional Tabletop Unit. J Diabetes Sci Technol 2015; 10:277-81. [PMID: 26719135 PMCID: PMC4773977 DOI: 10.1177/1932296815624712] [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: 11/15/2022]
Abstract
PURPOSE Patients afflicted with ocular complications of diabetes represent a diverse demographic who often cannot undergo spectral-domain optical coherence tomography (SD-OCT) imaging of the retina due to postural restraints. Our pilot study compared imaging acquisition methods using SD-OCT in the handheld (HH) mode versus the conventional tabletop (TT) method. METHODS Our study included 22 undilated eyes of 22 subjects (mean ± SD age, 35.8 ± 16.8 years) imaged using HH and TT iVue SD-OCT (Optovue, Fremont, CA). Statistical analysis was performed using Microsoft Excel 12.2.7 (Microsoft Corporation, Redmond, WA) software with an accepted significance of P < .05. RESULTS Strong intraclass correlation coefficient was observed for (1) overall (.97), superior (.93), and inferior (.94) ganglion cell complex thickness, and (2) central (.98), inferior (.90), superior (.92), nasal (.94), and temporal (.93) macular retinal thickness. Mean scan quality index was adequate but lower in HH versus TT SD-OCT (62.8 vs 68.1, respectively; P < .0001). Multiple attempts for adequate imaging were required more frequently in HH versus TT SD-OCT (34% vs 5%, respectively; P < .001). CONCLUSION HH SD-OCT may be a feasible alternative to TT SD-OCT in select situations, especially in patients suffering from diabetic complications with limited mobility.
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Affiliation(s)
- Nicole Mendez
- Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Natasha V Nayak
- Department of Ophthalmology, New York Eye and Ear Infirmary of Mount Sinai, NY, USA
| | - Anton M Kolomeyer
- Department of Ophthalmology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ben C Szirth
- Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Albert S Khouri
- Department of Ophthalmology and Visual Science, Rutgers New Jersey Medical School, Newark, NJ, USA
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21
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Katte JC, Djoumessi R, Njindam G, Fetse GT, Dehayem M, Kengne AP. New-onset diabetic ketoacidosis in a 13-months old african toddler: a case report. Pan Afr Med J 2015; 22:293. [PMID: 26966489 PMCID: PMC4769064 DOI: 10.11604/pamj.2015.22.293.7581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 11/14/2015] [Indexed: 11/11/2022] Open
Abstract
Type 1 diabetes mellitus is very rare in infants and toddlers and is usually associated with high mortality when complicated with diabetic ketoacidosis (DKA). Toddlers in DKA are often missed in our typical African setting where there is low index of suspicion. Usually, the classical symptoms are not usually at the forefront and many infants and toddlers who develop DKA are mistreated for infections. The case of a 13-months old toddler with new-onset type 1 diabetes mellitus, complicated with DKA at diagnosis is reported in view of its rarity and elevated mortality even when diagnosed in our African setting. She was subsequently treated with intravenous insulin and was passed over to subcutaneous insulin after the eradication of ketones in urine. She continues follow-up at the out-patient children diabetes clinic at the Bafoussam Regional Hospital.
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Affiliation(s)
- Jean-Claude Katte
- Bafoussam Regional Hospital, Ministry of Public Health, Bafoussam, Cameroon
| | - Romance Djoumessi
- Bafoussam Regional Hospital, Ministry of Public Health, Bafoussam, Cameroon
| | - Gisele Njindam
- Bafoussam Regional Hospital, Ministry of Public Health, Bafoussam, Cameroon
| | - Gerard Tama Fetse
- Bafoussam Regional Hospital, Ministry of Public Health, Bafoussam, Cameroon
| | - Mesmin Dehayem
- Yaoundé Central Hospital, Diabetes and Metabolic Disease Unit, Cameroon
| | - Andre-Pascal Kengne
- Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Non-communicable Disease Research Unit, South African Medical Research Council& University of Cape Town, PO Box 19070, Tygerberg, Cape Town 7505, South Africa
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22
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Rojnic Putarek N, Ille J, Spehar Uroic A, Skrabic V, Stipancic G, Krnic N, Radica A, Marjanac I, Severinski S, Svigir A, Bogdanic A, Dumic M. Incidence of type 1 diabetes mellitus in 0 to 14-yr-old children in Croatia--2004 to 2012 study. Pediatr Diabetes 2015; 16:448-53. [PMID: 25080870 DOI: 10.1111/pedi.12197] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Revised: 06/04/2014] [Accepted: 06/27/2014] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The incidence of type 1 diabetes mellitus (T1DM) among children and adolescents increased during the last 50 yr. The T1DM incidence in Croatia was 8.87/100.000/yr over 1995-2003, with an annual increase of 9%, which placed Croatia among countries with moderate risk for T1DM. AIM To investigate incidence rates and trends of T1DM from 2004 to 2012 in 0 to 14-yr-old Croatian children, and to compare the results with previous studies in Croatia and other European countries. METHODS T1DM crude incidence rates are estimated for the entire group and three subgroups: 0-4, 5-9, and 10-14 yr. Standardized incidence is calculated using the method of direct standardization according to World Health Organization (WHO) standard world population. The incidence rates by gender, age groups, seasonality, and calendar year, and their interactions were analyzed using Poisson regression model. RESULTS A total of 1066 cases were ascertained over 2004-2012. The standardized incidence was 17.23/100.000/yr (95% CI: 16.19-18.26), with no significant differences in incidence rates or trends between boys and girls. Statistically significant annual increase of 5.87% (p < 0.001) was found for the whole group, and for the subgroups 5-9 yr (6.82%; p < 0.001) and 10-14 yr (7.47%; p < 0.001). In the youngest subgroup (0-4 yr), annual increase was lower (2.43%; p = 0338) and not statistically significant. CONCLUSION The incidence of childhood T1DM is increasing in Croatia, thus placing Croatia among countries with high risk for T1DM. The annual increment of 5.87% is considerably lower than 9.0% reported earlier, but still higher than the European average (3.9%). The increase in incidence ceased in youngest children.
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Affiliation(s)
- Natasa Rojnic Putarek
- Department of Pediatric Endocrinology and Diabetes, University Hospital Zagreb, Zagreb, Croatia
| | - Jasenka Ille
- Department of Pediatric Endocrinology and Diabetes, University Hospital Zagreb, Zagreb, Croatia
| | - Anita Spehar Uroic
- Department of Pediatric Endocrinology and Diabetes, University Hospital Zagreb, Zagreb, Croatia
| | - Veselin Skrabic
- Department of Pediatrics, University Hospital Center Split, Split, Croatia
| | - Gordana Stipancic
- Department of Pediatrics, University Hospital 'Sestre milosrdnice', Zagreb, Croatia
| | - Nevena Krnic
- Department of Pediatric Endocrinology and Diabetes, University Hospital Zagreb, Zagreb, Croatia
| | - Ana Radica
- Department of Pediatric Endocrinology and Diabetes, University Hospital Zagreb, Zagreb, Croatia
| | - Igor Marjanac
- Department of Pediatrics, University Hospital Center Osijek, Osijek, Croatia
| | - Srecko Severinski
- Department of Pediatrics, University Hospital Center Rijeka-Kantrida, Rijeka, Croatia
| | - Alen Svigir
- Department of Pediatric Endocrinology and Diabetes, University Hospital Zagreb, Zagreb, Croatia
| | - Ana Bogdanic
- Department of Pediatric Endocrinology and Diabetes, University Hospital Zagreb, Zagreb, Croatia
| | - Miroslav Dumic
- Department of Pediatric Endocrinology and Diabetes, University Hospital Zagreb, Zagreb, Croatia
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Cedillo M, Libman IM, Arena VC, Zhou L, Trucco M, Ize-Ludlow D, Pietropaolo M, Becker DJ. Obesity, islet cell autoimmunity, and cardiovascular risk factors in youth at onset of type 1 autoimmune diabetes. J Clin Endocrinol Metab 2015; 100:E82-6. [PMID: 25250632 PMCID: PMC4283021 DOI: 10.1210/jc.2014-2340] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT The current increase in childhood type 1 diabetes (T1D) and obesity has led to two conflicting hypotheses and conflicting reports regarding the effects of overweight on initiation and spreading of islet cell autoimmunity vs earlier clinical manifestation of preexisting autoimmune β-cell damage driven by excess weight. OBJECTIVE The objective of the study was to address the question of whether the degree of β-cell autoimmunity and age are related to overweight at diabetes onset in a large cohort of T1D youth. DESIGN This was a prospective cross-sectional study of youth with autoimmune T1D consecutively recruited at diabetes onset. SETTING The study was conducted at a regional academic pediatric diabetes center. PATIENTS Two hundred sixty-three consecutive children younger than 19 years at onset of T1D participated in the study. MAIN OUTCOME MEASURES Relationships between body mass index and central obesity (waist circumference and waist to height ratio) and antigen spreading (islet cell autoantibody number), age, and cardiovascular (CVD) risk factors examined at onset and/or 3 months after the diagnosis were measured. RESULTS There were no significant associations between number of autoantibodies with measures of adiposity. Age relationships revealed that a greater proportion of those with central obesity (21%) were in the youngest age group (0-4 y) compared with those without central obesity (6%) (P = .001). PATIENTS with central obesity had increased CVD risk factors and higher onset C-peptide levels (P < .05). CONCLUSIONS No evidence was found to support the concept that obesity accelerates progression of autoantibody spreading once autoimmunity, marked by standard islet cell autoantibody assays, is present. Central obesity was present in almost one-third of the subjects and was associated with early CVD risk markers already at onset.
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Choleau C, Maitre J, Elie C, Barat P, Bertrand AM, de Kerdanet M, Le Tallec C, Nicolino M, Tubiana-Rufi N, Levy-Marchal C, Cahané M, Robert JJ. [Ketoacidosis at time of diagnosis of type 1 diabetes in children and adolescents: effect of a national prevention campaign]. Arch Pediatr 2014; 22:343-51. [PMID: 25497364 DOI: 10.1016/j.arcped.2014.11.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 10/03/2014] [Accepted: 11/01/2014] [Indexed: 02/02/2023]
Abstract
The aim of the study was to evaluate, after the first year of a national information campaign, the effect on the frequency and severity of diabetic ketoacidosis (DKA) at diagnosis of type 1 diabetes (T1D) in children and adolescents in France. The following data were collected during a 2-year period in people younger than 15 years of age at diagnosis of T1D, in 146 pediatric centers: age, sex, duration of symptoms, patient's previous care, clinical and biological signs, and family history of T1D. DKA was defined as pH<7.30 or bicarbonate<15mmol/L, severe DKA as pH<7.10 or bicarbonate <5mmol/L. During the 2nd year, an information campaign targeting health professionals and families was launched with the objective of reducing the time to diagnosis. Data were compared between the year before the campaign (year 0) and the first year of the campaign (year 1). The number of new cases of T1D was 1299 for year 0 and 1247 for year 1. Between year 0 and year 1, the rate of DKA decreased from 43.9% to 40.5% (P=0.08), exclusively due to the decrease of severe DKA from 14.8 to 11.4% (P=0.01). In the 0- to 5-year-old and 5- to 10-year-old age groups, the relative decrease in the rate of DKA was 13% and 15%, and 23% and 41% for severe DKA, respectively. In patients referred to the hospital by a pediatrician or who came at the family's initiative, the decrease was 34% and 7%, and 39% and 32% for severe DKA, respectively. No change was observed in the 10- to 15-year-old group or in those children who were referred by a general practitioner. In multivariate analyses, a higher DKA rate was associated with the young age of the child (<5 years), being hospitalized at the parents' initiative rather than being referred by a doctor, and the absence of a family history of T1D. A higher rate of severe DKA was associated with these last two factors but not with the child's age. The frequency of DKA at diagnosis of type 1 diabetes remains high in children and adolescents, but the first year of an information campaign decreased it. The results have also helped better define the strategy and targets of the continuing prevention campaign, to more efficiently reduce the morbidity and mortality of T1D at diagnosis in children and adolescents in France.
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Affiliation(s)
- C Choleau
- L'aide aux jeunes diabétiques (AJD), 9, avenue Pierre-de-Coubertin, 75013 Paris, France.
| | - J Maitre
- L'aide aux jeunes diabétiques (AJD), 9, avenue Pierre-de-Coubertin, 75013 Paris, France; Diabète de l'enfant et l'adolescent, hôpital Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France; Université René Descartes, Sorbonne Paris Cité, 12, rue de l'École-de-Médecine, 75006 Paris, France
| | - C Elie
- Université René Descartes, Sorbonne Paris Cité, 12, rue de l'École-de-Médecine, 75006 Paris, France; Unité de recherche clinique Paris Centre, hôpital Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France
| | - P Barat
- Endocrinologie et diabétologie pédiatrique, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France
| | - A M Bertrand
- Unité d'endocrinologie - diabétologie pédiatriques, médecine pédiatrique, CHU Jean-Minjoz, 3, boulevard Flemming, 25030 Besançon, France
| | - M de Kerdanet
- Endocrinologie et diabétologie pédiatriques, hôpital Sud, CHU de Rennes, 16, boulevard de Bulgarie, 35000 Rennes, France
| | - C Le Tallec
- Diabétologie pédiatrique, pôle pédiatrique, CHU de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse cedex 9, France
| | - M Nicolino
- Endocrinologie pédiatrique, hôpital Femme-Mère-Enfant, université de Lyon, 59, boulevard Pinel, 69677 Lyon, France
| | - N Tubiana-Rufi
- Endocrinologie et diabétologie pédiatriques, hôpital Robert-Debré, AP-HP, université Paris Diderot, Sorbonne Paris Cité, 48, boulevard Sérurier, 75019 Paris, France
| | - C Levy-Marchal
- Inserm CIC EC 05, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France
| | - M Cahané
- L'aide aux jeunes diabétiques (AJD), 9, avenue Pierre-de-Coubertin, 75013 Paris, France
| | - J-J Robert
- L'aide aux jeunes diabétiques (AJD), 9, avenue Pierre-de-Coubertin, 75013 Paris, France; Diabète de l'enfant et l'adolescent, hôpital Necker-Enfants-Malades, AP-HP, 149, rue de Sèvres, 75015 Paris, France; Université René Descartes, Sorbonne Paris Cité, 12, rue de l'École-de-Médecine, 75006 Paris, France
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Greene S. Diabetes in the young: technology, engagement and context. PRACTICAL DIABETES 2014. [DOI: 10.1002/pdi.1877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Stephen Greene
- Child Health, School of Medicine; University of Dundee; UK
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Lokulo-Sodipe K, Moon RJ, Edge JA, Davies JH. Identifying targets to reduce the incidence of diabetic ketoacidosis at diagnosis of type 1 diabetes in the UK. Arch Dis Child 2014; 99:438-42. [PMID: 24395643 DOI: 10.1136/archdischild-2013-304818] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Diabetic ketoacidosis (DKA) is the leading cause of mortality in childhood diabetes, and at diagnosis might represent delayed presentation. The extent and reasons for delays are unclear, but identifying and targeting factors associated with DKA could reduce this incidence. OBJECTIVE To compare the patient pathway before diagnosis of type 1 diabetes mellitus (T1DM) in children presenting with DKA and non-acidotic hyperglycaemia. DESIGN, SETTING AND PATIENTS Over a 3-month period, children newly diagnosed with T1DM were identified on admission to UK hospitals. Parents and medical teams completed a questionnaire about events before diagnosis. RESULTS Data were available for 261 children (54% male), median age 10.3y (range 0.8-16.6 y). 25% presented with DKA, but more commonly in children <2y (80% vs 23%, p<0.001). Fewer children with DKA reported polyuria (76% vs 86%) or polydipsia (86% vs 94%) (both p<0.05), but more reported fatigue (74% vs 52%) and weight loss (75% vs 54%) (both p<0.01). 24% of children had multiple healthcare professional (HCP) contacts, and these children had lower pH on admission. 46% of children with a delayed presentation to secondary care had non-urgent investigations. 64% of parents had considered a diagnosis of diabetes, and these children were less likely to present with DKA (13% vs 47%, p<0.001). CONCLUSIONS Multiple HCP contacts increased risk of presentation in DKA, whereas, parental awareness of diabetes was protective. Improved public and health professional education targeting non-classical symptoms, awareness of diabetes in under 2 y, and point-of-care testing could reduce DKA at diagnosis of diabetes.
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Affiliation(s)
- K Lokulo-Sodipe
- Department of Paediatric Endocrinology, University Hospital Southampton, , Southampton, UK
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Choleau C, Maitre J, Filipovic Pierucci A, Elie C, Barat P, Bertrand AM, de Kerdanet M, Letallec C, Levy-Marchal C, Nicolino M, Tubiana-Rufi N, Cahané M, Robert JJ. Ketoacidosis at diagnosis of type 1 diabetes in French children and adolescents. DIABETES & METABOLISM 2014; 40:137-42. [DOI: 10.1016/j.diabet.2013.11.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 11/15/2013] [Accepted: 11/16/2013] [Indexed: 12/29/2022]
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Vichi M, Iafusco D, Galderisi A, Stazi MA, Nisticò L. An easy, fast, effective tool to monitor the incidence of type 1 diabetes among children aged 0-4 years in Italy: the Italian Hospital Discharge Registry (IHDR). Acta Diabetol 2014; 51:287-94. [PMID: 24473635 DOI: 10.1007/s00592-014-0556-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Accepted: 01/09/2014] [Indexed: 12/14/2022]
Abstract
National data of type 1 diabetes incidence are currently missing in Italy. To fill this gap, we estimated the national rate of first hospitalizations for type 1 diabetes among children aged 0-4 years and resident in Italy, as well as rates for each of the twenty-one Italian regions. We extracted the first episode of hospitalization in years 2005-2010 from the Italian Hospital Discharge Registry (IHDR). Record-linkage procedure and cleansing data method were applied to exclude prevalent cases and potentially miscoded patients. At the end, 2,250 incident hospitalizations for type 1 diabetes were extracted. In the years 2005-2010, the mean nation-wide first hospitalization rate for type 1 diabetes in children aged 0-4 years was 13.4 (95% CI 12.8-14.0), 14.1 (95% CI 13.3-14.9) in males and 12.7 (95% CI 11.9-13.4) in females. A geographically heterogeneous pattern of incidence was found: even excluding Sardinia, incidence for this age range and calendar period tended to be slightly higher in Southern than in Northern Italy. Our incidence of first hospitalizations corresponds to the estimates of disease incidence obtained with different data sources by other authors in selected Italian regions. We provide, for the first time ever, the estimate of type 1 diabetes incidence for the overall population aged 0-4 years resident in Italy. When methodological cautions are adopted, IHDR emerges as a reasonable proxy of type 1 diabetes incidence and as a cost-effective tool for public health purposes.
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Affiliation(s)
- Monica Vichi
- Statistics Unit, National Centre of Epidemiology, Surveillance, and Health Promotion (CNESPS), Istituto Superiore di Sanità, 00161, Rome, Italy
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Skrivarhaug T, Stene LC, Drivvoll AK, Strøm H, Joner G. Incidence of type 1 diabetes in Norway among children aged 0-14 years between 1989 and 2012: has the incidence stopped rising? Results from the Norwegian Childhood Diabetes Registry. Diabetologia 2014; 57:57-62. [PMID: 24149838 DOI: 10.1007/s00125-013-3090-y] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 10/09/2013] [Indexed: 12/25/2022]
Abstract
AIMS/HYPOTHESIS Our study aimed to describe the incidence of type 1 diabetes in children below 15 years of age in Norway during the period 1989-2012 and to assess the regional variation during 2004-2012. We further set out to estimate the completeness of ascertainment in the Norwegian Childhood Diabetes Registry (NCDR). METHODS Incident cases of type 1 diabetes were registered in the NCDR and incidence rates were modelled using Poisson regression. Ascertainment for 2005-2008 was estimated using capture-recapture methodology by using data from the Norwegian Prescription Database (NorPD), a nationwide register established in 2004, which included insulin prescribed and dispensed at pharmacies to individual patients. Population data were obtained from Statistics Norway. RESULTS Observed incidence rates for 1989-2012 suggested three distinct time segments: in 1989-1996, the average incidence rate was 22.6 per 100,000 person-years (95% CI 21.4, 23.7); in 1996-2004, the average incidence rate was 28.4 per 100,000 person-years (95% CI 27.3, 29.6); and from 2004 to 2012, the average incidence rate per 100,000 person-years was 32.7 (95% CI 31.5, 34.0). After adjustment for age and sex, the estimated change per year was 1.8% for 1989-1996 (95% CI -0.07, 3.6; p = 0.059), 3.4% for 1996-2004 (95% CI 2.2, 4.7; p < 0.0001) and 0.3% for 2004-2012 (95% CI -0.9, 1.6; p = 0.64). The highest incidence was in the age group 10-14 years for both sexes. A significant regional variation in incidence was observed (p < 0.001). Completeness of ascertainment in the NCDR was estimated to be 91%. CONCLUSIONS/INTERPRETATION The previously observed increase in incidence of type 1 diabetes has levelled off and remained essentially constant at 32.7 per 100,000 person-years during 2004-2012. There is a significant variation in type 1 diabetes incidence within Norway.
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Affiliation(s)
- Torild Skrivarhaug
- Norwegian Childhood Diabetes Registry, Oslo University Hospital, Oslo, Norway,
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Exercise to preserve beta cell function in recent-onset type 1 diabetes mellitus (EXTOD)--a study protocol for a pilot randomized controlled trial. Trials 2013; 14:180. [PMID: 23777480 PMCID: PMC3693907 DOI: 10.1186/1745-6215-14-180] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 05/28/2013] [Indexed: 01/12/2023] Open
Abstract
Background Exercise has a beta cell preserving effect in patients with type 2 diabetes. This benefit of exercise has not been examined in type 1 diabetes. Significant beta cell function is present at the time of diagnosis of type 1 diabetes and therefore studies of beta cell preservation are ideally conducted immediately after diagnosis. Many of the variables required to design and power such a study are currently unknown. The aim of EXTOD is to obtain the information required to design a formal study of exercise and beta cell preservation in newly diagnosed patients with type 1 diabetes. Methods Barriers to exercise will initially be assessed in a qualitative study of newly diagnosed patients. Then, sixty newly diagnosed adult type 1 diabetes patients will be randomized to either conventional treatment or exercise, stratified on beta cell function and fitness. The exercise group will be encouraged to increase their level of activity to a minimum of 150 minutes of moderate to vigorous intensity exercise per week, aiming for 240 minutes per week of exercise for 12 months. Beta cell function will be measured by meal-stimulated C peptide. Primary outcomes are recruitment, adherence to exercise, loss to follow-up, and exercise levels in the non-intervention arm (contamination). The secondary outcome of the study is rate of loss of beta cell function. Discussion The outcomes of the EXTOD study will help define the barriers, uptake and benefits of exercise in adults newly diagnosed with type 1 diabetes. This information will enable design of a formal study to assess the effect of exercise on beta cell preservation in newly diagnosed patients with type 1 diabetes. Trial registration Current controlled trials ISRCTN91388505
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Sipetic S, Maksimovic J, Vlajinac H, Ratkov I, Sajic S, Zdravkovic D, Sipetic T. Rising incidence of type 1 diabetes in Belgrade children aged 0-14 years in the period from 1982 to 2005. J Endocrinol Invest 2013; 36:307-12. [PMID: 23013910 DOI: 10.3275/8619] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Type 1 diabetes (T1DM) is an autoimmune disease in which both genetic and environmental factors play a role in the etiology. AIM The aim of this study was to analyze the incidence of T1DM. METHODS A retrospective technique was used to register all newly diagnosed cases of T1DM in Belgrade (Serbia) children at the age of 0- 14 yr between 1982 and 2005. The incidence was adjusted directly by age using the Segi's world population as the standard. A total of 702 cases was identified from the two sources: patients' records from two pediatric hospitals in Belgrade referent for the disease, and from the population based register. RESULTS The average annual age adjusted incidence rate of T1DM for Belgrade was 10.4/100,000 [95% confidence interval (95% CI)=3.8-15.4]. It was slightly higher in boys than in girls. The age-specific annual incidence rates (per 100,000) for the age groups 0-4, 5-9, and 10-14 were 5.5 (95% CI=4.5-6.7), 11.9 (95% CI=10.5-13.5), and 15.4 (95% CI=13.8-17.1), respectively. Over the 24 yr incidence rates significantly increased by 8.5% for boys and 3.0% for girls. The highest increase of incidence rate was in the 5-9 age group. DISCUSSION The results obtained are in line with data from other studies showing that the incidence of T1DM has been increasing in almost all populations worldwide.
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Affiliation(s)
- S Sipetic
- Faculty of Medicine, Institute of Epidemiology, University of Belgrade, Visegradska 26, 11000 Belgrade, Serbia
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Parikka V, Näntö-Salonen K, Saarinen M, Simell T, Ilonen J, Hyöty H, Veijola R, Knip M, Simell O. Early seroconversion and rapidly increasing autoantibody concentrations predict prepubertal manifestation of type 1 diabetes in children at genetic risk. Diabetologia 2012; 55:1926-36. [PMID: 22441569 DOI: 10.1007/s00125-012-2523-3] [Citation(s) in RCA: 159] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2011] [Accepted: 02/10/2012] [Indexed: 12/21/2022]
Abstract
AIMS/HYPOTHESIS The aim of the study was to investigate the timing of the appearance of autoantibodies associated with type 1 diabetes between birth and puberty, the natural fate of these autoantibodies and the predictive power of autoantibody concentrations for early progression to clinical diabetes. METHODS Children were recruited to the Type 1 Diabetes Prediction and Prevention Project, an ongoing study based on HLA-conferred genetic risk. Autoantibodies against islet cells, insulin, GAD65 and islet antigen 2 were analysed at 3-12 month intervals, starting from birth. RESULTS During the follow-up, 1,320 children (18.4% of the cohort of 7,165 children) were autoantibody positive in at least one sample. Altogether, 184 autoantibody-positive children progressed to type 1 diabetes. Seroconversion occurred at an early age in the progressors (median 1.5 years), among whom 118 (64%) and 150 (82%) seroconverted to autoantibody positivity before the age of 2 and 3 years, respectively. The incidence of seroconversion peaked at 1 year of age. Compared with other autoantibody-positive children, the median autoantibody levels were already markedly higher 3 to 6 months after the seroconversion in children who later progressed to diabetes. CONCLUSIONS/INTERPRETATION Early initiation of autoimmunity and rapid increases in autoantibody titres strongly predict progression to overt diabetes before puberty, emphasising the importance of early life events in the development of type 1 diabetes.
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Affiliation(s)
- V Parikka
- Department of Pediatrics, Turku University Hospital, Kiinamyllynkatu 4-8, PO Box 52, 20521 Turku, Finland.
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Hodgson S, Beale L, Parslow RC, Feltbower RG, Jarup L. Creating a national register of childhood type 1 diabetes using routinely collected hospital data. Pediatr Diabetes 2012; 13:235-43. [PMID: 22017449 DOI: 10.1111/j.1399-5448.2011.00815.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION There is no national register of childhood type 1 diabetes mellitus for England. Our aim was to assess the feasibility of using routine hospital admissions data as a surrogate for a childhood diabetes register across England, and to create a geographically referenced childhood diabetes dataset for use in epidemiologic studies and health service research. METHODS Hospital Episodes Statistics data for England from April 1992 to March 2006 referring to a type 1 diabetes diagnosis in 0-14 yr olds were cleaned to approximate an incident dataset. The cleaned data were validated against regional population-based register data, available for Yorkshire and the area of the former Oxford Regional Health Authority. RESULTS There were 32 665 unique cases of type 1 and type unknown diabetes over the study period. The hospital-derived data improved in quality over time (91% concordance with regional register data over the period 2000-2006 vs. 52% concordance over the period 1992-1999), and data quality was better for younger (0-9 yr) (86.5% concordance with regional register data) than older cases (10-14 yr). Overall incidence was 24.99 (95% confidence interval 24.71-25.26) per 100 000. Basic trends in age distribution, seasonality of onset, and incidence matched well with previously reported findings. CONCLUSION We were able to create a surrogate register of childhood diabetes based on national hospital admissions data, containing approximately 2300 cases/yr, and geo-coded to a high resolution. For younger cases (0-9 yr) and more recent years (from 2000) these data will be a useful resource for epidemiological studies exploring the determinants of childhood diabetes.
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Affiliation(s)
- Susan Hodgson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, UK.
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Long AE, Gillespie KM, Rokni S, Bingley PJ, Williams AJ. Rising incidence of type 1 diabetes is associated with altered immunophenotype at diagnosis. Diabetes 2012; 61:683-6. [PMID: 22315309 PMCID: PMC3282823 DOI: 10.2337/db11-0962] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The incidence of type 1 diabetes has increased rapidly over recent decades, particularly in young children. We aimed to determine whether this rise was associated with changes in patterns of humoral islet autoimmunity at diagnosis. Autoantibodies to insulin (IAA), GAD (GADA), islet antigen-2 (IA-2A), and zinc transporter 8 (ZnT8A) were measured by radioimmunoassay in sera collected from children and young adults with newly diagnosed type 1 diabetes between 1985 and 2002. The influence of date of diagnosis on prevalence and level of autoantibodies was investigated by logistic regression with adjustment for age and HLA class II genetic risk. Prevalence of IA-2A and ZnT8A increased significantly over the period studied, and this was mirrored by raised levels of IA-2A, ZnT8A, and IA-2β autoantibodies (IA-2βA). IAA and GADA prevalence and levels did not change. Increases in IA-2A, ZnT8A, and IA-2βA at diagnosis during a period of rising incidence suggest that the process leading to type 1 diabetes is now characterized by a more intense humoral autoimmune response. Understanding how changes in environment or lifestyle alter the humoral autoimmune response to islet antigens should help explain why the incidence of type 1 diabetes is increasing and may suggest new strategies for preventing disease.
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Akesen E, Turan S, Güran T, Atay Z, Save D, Bereket A. Prevalence of type 1 diabetes mellitus in 6-18-yr-old school children living in Istanbul, Turkey. Pediatr Diabetes 2011; 12:567-71. [PMID: 21418453 DOI: 10.1111/j.1399-5448.2010.00744.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Type 1 diabetes mellitus (T1DM) is among the most common chronic diseases in childhood and the incidence of T1DM is increasing worldwide. There is no actual data regarding the frequency of T1DM in Turkish children. OBJECTIVES We aimed to assess current prevalence of T1DM in 6-18-yr-old school children living in Istanbul. METHODS Total number of students and children on insulin treatment were reported by the schools, as the first part of the study. At the second step, the study team visited 203 schools for confirmation of the reported data. RESULTS One thousand and ninety children in a population of 1 630 751 school children were reported to have T1DM, which made the total prevalence of T1DM 0.67/1000 (95% confidence interval 0.6/1000-0.7/1000). A population of 217 030 children (α=0.05 and β=0.20) from 203 schools were screened. The difference between the reported and detected prevalence was 0.032/1000 (215 detected vs. 222 reported, p>0.05). Comparison of the current data with the prevalence reported in a smaller population in Ankara, Turkey, 16 yr ago, demonstrated that the prevalence of T1DM is higher in the current study (0.46/1000 vs. 0.16/1000, 0.57/1000 vs. 0.34/1000, and 0.92/1000 vs. 0.69/1000 at primary, secondary, and high schools, respectively). CONCLUSION This first pediatric T1DM prevalence data in a large pediatric population in Istanbul, Turkey, estimated the prevalence of T1DM as 0.67/1000. This prevalence is 2.5-fold higher than that reported in Ankara, Turkey, in 1993, suggesting that T1DM prevalence is increasing in Turkey as in the other parts of the world.
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Affiliation(s)
- Eda Akesen
- Department of Pediatric Endocrinology, Marmara University, Istanbul, Turkey
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Daneman D, Frank M, Perlman K, Wittenberg J. The infant and toddler with diabetes: Challenges of diagnosis and management. Paediatr Child Health 2011; 4:57-63. [PMID: 20212991 DOI: 10.1093/pch/4.1.57] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Infants and toddlers comprise a small minority of individuals with type 1 diabetes. However, epidemiological data provide evidence of a trend towards diagnosis at a younger age. These very young children pose significant challenges to both the health care professionals involved in their care as well as to their families. At diagnosis, younger children often do not present with classical symptoms of diabetes. Unless health professionals remain alert to the possibility of diabetes being the underlying cause of a child's illness, the diagnosis may be missed. Once the diabetes has been diagnosed, the major challenge is to set up a treatment regimen that is both reasonable and realistic; in the youngest children, the goal of very tight metabolic control may expose them to episodes of severe hypoglycemia which may lead to subtle cognitive impairments later in life. The therapeutic regimen must balance the naturally erratic eating and exercise patterns of very young children with the need to maintain adequate metabolic control. Setting a blood glucose target range of 6 to 12 mmol/L usually allows this to be accomplished. Diabetes during early childhood creates a psychosocial challenge to the families of these children. Successful management of infants and toddlers with diabetes depends on a well functioning and educated family, the availability of diabetes health care team experienced in the treatment of these youngsters, and the involvement of the extended family, child care personnel and others who play a role in their daily care.
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Saleh HM, Rohowsky N, Leski M. The CTLA4 -819 C/T and +49 A/G dimorphisms are associated with Type 1 diabetes in Egyptian children. INDIAN JOURNAL OF HUMAN GENETICS 2011; 14:92-8. [PMID: 20300303 PMCID: PMC2840795 DOI: 10.4103/0971-6866.45001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND: Type 1 diabetes (T1D) is an organ-specific autoimmune disease characterized by T cell-mediated destruction of pancreatic islets. T cell proliferation is negatively regulated by cytotoxic lymphocyte antigen-4 (CTLA-4). CTLA-4 polymorphisms are associated with T1D in some but not all populations. AIMS: The study was conducted to investigate the association of the C-819T and A+49G single nucleotide polymorphisms (SNP) of CTLA-4 gene in T1D patients in the Egyptian population. METHODS: The association of the C-819T SNP in intron 1 and A+49G SNP in exon 1 of the CTLA-4 gene with T1D were investigated in 396 Egyptian patients ≤14 years old and 396 control subjects >24 years old, with the same ratio of males to females in both groups. The diagnosis of T1D was made on the basis of ketoacidosis or ketosis with severe symptoms of acute onset at presentation and continuous dependence on insulin. Controls were negative for anti-GAD antibodies and were greater than 24 years of age. Genotyping was performed using single strand conformation polymorphism (SSCP), temperature gradient gel electrophoresis (TGGE), and polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP). RESULTS: The results demonstrated an association of the C-819T and A+49G SNPs in the CTLA-4 gene with T1D patients (P=0.0047) and (P=0.000575), respectively. Moreover, this association was stratified by gender and age to female patients with age at onset 0-5 years old (P=0.0186) and (P=0.00115) more than male patient with the age at onset 0-5 years old (P= 0.3120) and (P=0.345161), respectively. CONCLUSION: The results support an association of the C-819T and A+49G SNPs in the CTLA-4 gene with Egyptian children, specifically, females of onset age 0-5 years old.
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Affiliation(s)
- Hatem Mohamed Saleh
- Genotyping Lab for Genetics of Type One Diabetes- Autoimmune Diseases Section, R and D Department, The Egyptian Organization for Biotechnology (EGYTEC) - The Egyptian Organization for Biological Products and Vaccines (EGYVAC-VACSERA), 1 El Batal Ahmed Abdel Aziz Street, Agouza, Cairo 1312, Egypt
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Vehik K, Dabelea D. The changing epidemiology of type 1 diabetes: why is it going through the roof? Diabetes Metab Res Rev 2011; 27:3-13. [PMID: 21218503 DOI: 10.1002/dmrr.1141] [Citation(s) in RCA: 123] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Revised: 07/12/2010] [Accepted: 09/29/2010] [Indexed: 12/23/2022]
Abstract
The incidence of type 1 diabetes is increasing and this may double the burden of disease in our youngest by 2020. The recent increase in incidence is mostly happening in the very young and those with moderate genetic susceptibility. Many environmental factors have been implicated, but no major determinants have been clearly identified, and the mechanisms of involvement remain elusive. This review summarizes current research efforts directed at understanding the possible reasons for this increase, including the role of viruses, gut microbiota, early life feeding patterns, perinatal factors and childhood growth patterns. It also provides a road map for future research directions.
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Affiliation(s)
- Kendra Vehik
- Department of Pediatrics, College of Medicine, University of South Florida, Pediatrics Epidemiology Center, Tampa, FL 33612, USA.
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Baruah MP, Ammini AC, Khurana ML. Demographic, breast-feeding, and nutritional trends among children with type 1 diabetes mellitus. Indian J Endocrinol Metab 2011; 15:38-42. [PMID: 21584165 PMCID: PMC3079868 DOI: 10.4103/2230-8210.77583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The pathogenesis of type 1 diabetes mellitus (T1DM) requires a genetic predisposition to particular environmental triggers that may activate mechanisms leading to progressive loss of pancreatic beta cells. AIMS We tried to compare the impact of some demographic and environmental factors and breast-feeding on children (aged < 18 years) with recent onset diabetes mellitus (≤1 year) with that on age, sex, and socioeconomic status-matched controls. MATERIAL AND METHODS A total of 43 consecutive patients (male, 24, mean age ± SD = 12.58 ± 9.6 years) and equal number of controls without diabetes mellitus or dysglycemia were included in this hospital-based case-control study. RESULTS AND CONCLUSIONS A distinct peak in the incidence noted in the early adolescence with segregation in the winter months. Our patients did not differ significantly from the controls with regard to birth order, mode of delivery, parental age, parental education, dietary practices, breast-feeding, and migration in the family. Growth characteristics and nutritional status were also similar. A population study with more power will be better equipped to answer such queries.
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Affiliation(s)
- Manash P. Baruah
- Department of Endocrinology, Excel center, Ulubari, Guwahati, Assam-781 007, India
| | - Ariachery C. Ammini
- Department of Endocrinology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110 011, India
| | - Madan L. Khurana
- Department of Endocrinology, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110 011, India
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Bremenkamp RM, Caris AR, Jorge AOC, Back-Brito GN, Mota AJ, Balducci I, Brighenti FL, Koga-Ito CY. Prevalence and antifungal resistance profile of Candida spp. oral isolates from patients with type 1 and 2 diabetes mellitus. Arch Oral Biol 2010; 56:549-55. [PMID: 21183157 DOI: 10.1016/j.archoralbio.2010.11.018] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Revised: 11/18/2010] [Accepted: 11/29/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The goal of the study was to measure the prevalence of Candida spp. in the oral cavity of patients with diabetes types 1 and 2 when compared to healthy individuals and to study antifungal resistance profile of the isolates. DESIGN There were 162 subjects in the study: diabetes type 1 (n=39); control group 1 (n=50): healthy individuals matched in gender, age, and oral conditions to diabetes type 1 patients; diabetes type 2 (n=37); control group 2 (n=36) who were matched to each patient of the diabetes type 2 group. Stimulated saliva was collected and isolates were identified with phenotypic tests. The presence of C. dubliniensis was determined by multiplex PCR. RESULTS There were no statistically significant differences in Candida spp. frequency between the diabetes 1 group and its control (p=0.443) nor between the diabetes 2 group and its control (p=0.429). C. albicans was the most frequently isolated yeast in all groups. In the diabetes groups, C. stellatoidea, C. parapsilosis, C. tropicalis, C. lipolytica, C. glabrata, and C. krusei were also identified. Additionally, in control groups, C. kefyr was also detected. None of the isolates were resistant to amphotericin B and flucytosine. A low percentage of the isolates were resistant to ketoconazole. CONCLUSIONS No differences were detected in colonization of Candida spp. oral isolates from type 1 and type 2 diabetes when compared to matched controls. The antifungal resistance of Candida spp. isolates for ketoconazole from type 1 diabetes patients was significantly higher than that of its matched control.
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Affiliation(s)
- R M Bremenkamp
- Department of Biosciences and Oral Diagnosis, Microbiology and Immunology, São José dos Campos Dental School, Univ Estadual Paulista, Av. Engenheiro Francisco José Longo, 777, São Dimas, 12245-000 São José dos Campos, SP, Brazil
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Leech NJ, O'Sullivan J, Avery P, Howey C, Burling K, Iyer S, Pascoe L, Walker M, Cheetham T. Increased maternal Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) associated with older age at diagnosis of Type 1 diabetes in offspring. Diabet Med 2010; 27:1450-3. [PMID: 21105490 DOI: 10.1111/j.1464-5491.2010.03130.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
AIMS Obesity and insulin resistance have been linked to rising incidence and earlier onset of Type 1 diabetes. Inherited differences in insulin action might also influence the evolution of Type 1 diabetes.Our aim was to determine whether parental BMI and insulin resistance influences age of onset of Type 1 diabetes in their offspring. METHODS BMI standard deviation score and age at diagnosis of Type 1 diabetes was examined in 227 children, and in 206 of these was compared with local matched control subjects. Non-diabetic parents of a subgroup of 80 children with Type 1 diabetes were recruited. Parental BMI was compared with local adult control subjects. The relationship between parental BMI, waist-hip ratio, homeostasis model assessment of insulin resistance (HOMA-IR), leptin and adiponectin levels and age at diagnosis of Type 1 diabetes in offspring was examined. RESULTS We found no relationship between age at diagnosis of Type 1 diabetes in children and BMI standard deviation score (P = 0.5). Children with Type 1 diabetes and their parents were heavier than matched control subjects (mean BMI standard deviation score sd in children = 0.66 1.06 vs. 0.32 1.16 in control subjects, P = 0.002; mean parental BMI sd 27.7 0.4 vs. 25.5 0.4 kg ⁄m2 in control subjects; P < 0.0001). Maternal HOMA-IR accounted for 20% of variation in age at diagnosis (P < 0.001) with increasing maternal insulin resistance associated with later age at diagnosis of Type 1 diabetes. CONCLUSIONS Childrenwith Type 1 diabetes and their parents have an increased BMI at diagnosis.Maternal insulin resistance is associated with later onset of Type 1 diabetes in children.
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Affiliation(s)
- N J Leech
- Department of Medicine, Newcastle upon Tyne Hospitals Foundation Trust, Newcastle University, Newcastle upon Tyne, UK.
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Rignell-Hydbom A, Elfving M, Ivarsson SA, Lindh C, Jönsson BAG, Olofsson P, Rylander L. A nested case-control study of intrauterine exposure to persistent organochlorine pollutants in relation to risk of type 1 diabetes. PLoS One 2010; 5:e11281. [PMID: 20585661 PMCID: PMC2890585 DOI: 10.1371/journal.pone.0011281] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2010] [Accepted: 05/16/2010] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The incidence of type 1 diabetes in Europe is increasing at a rate of about 3% per year and there is also an increasing incidence throughout the world. Type 1 diabetes is a complex disease caused by multiple genetic and environmental factors. Persistent organochlorine pollutants (POPs) have been suggested as a triggering factor for developing childhood type 1 diabetes. The aim of this case-control study was to assess possible impacts of in utero exposure to POPs on type 1 diabetes. METHODOLOGY/ PRINCIPAL FINDINGS The study was performed as a case-control study within a biobank in Malmö, a city located in the Southern part of Sweden. The study included 150 cases (children who had their diagnosis mostly before 18 years of age) and 150 controls, matched for gender and day of birth. 2,2',4,4',5,5'-hexachlorobiphenyl (PCB-153) and the major DDT metabolite 1,1-dichloro-2,2-bis (p-chlorophenyl)-ethylene (p,p'-DDE) were used as a biomarkers for POP exposure. When comparing the quartile with the highest maternal serum concentrations of PCB-153 with the other quartiles, an odds ratio (OR) of 0.73 (95% confidence interval [CI] 0.42, 1.27) was obtained. Similar results was obtained for p,p'-DDE (OR 0.56, 95% CI 0.29, 1.08). CONCLUSIONS The hypothesis that in utero exposure to POPs will trigger the risk for developing type 1 diabetes was not supported by the results. The risk estimates did, although not statistically significant, go in the opposite direction. However, it is not reasonable to believe that exposure to POPs should protect against type 1 diabetes.
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Affiliation(s)
- Anna Rignell-Hydbom
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.
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Abstract
AIM To describe the admission characteristics and outcomes of children admitted to paediatric intensive care because of acute diabetes complications in England and Wales. METHODS Retrospective review of children admitted to paediatric intensive care in England and Wales between April 2003 and March 2007 with acute diabetes complications using data from the Paediatric Intensive Care Audit Network (PICANet). RESULTS There were 341 admissions in 330 patients for acute diabetes complications, comprising 0.6% of all 56 322 intensive care admissions. There was a steady annual increase during this period from 0.54% to 0.67%. The majority of admissions were for ketoacidosis (87%), with more female admissions than males (56% vs. 44%). Forty per cent of the diabetes admissions were aged 11-15 years. There were five deaths (1.5%), all female. CONCLUSIONS Acute diabetes complications are an increasing cause of admission to paediatric intensive care, particularly for teenage girls. The overall mortality rate was low for intensive care admissions for diabetes. Earlier diagnosis of new cases, heightened awareness of this condition and better management of existing diabetic patients may obviate the need for costly intensive care treatment.
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Affiliation(s)
- M R Burns
- James Cook University Hospital, Middlesbrough, UK.
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Patton SR, Piazza-Waggoner C, Modi AC, Dolan LM, Powers SW. Family functioning at meals relates to adherence in young children with type 1 diabetes. J Paediatr Child Health 2009; 45:736-41. [PMID: 19863707 PMCID: PMC2860052 DOI: 10.1111/j.1440-1754.2009.01604.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS This study examined associations between mealtime family functioning, dietary adherence and glycaemic control in young children with type 1 diabetes mellitus (T1DM). We hypothesised that poorer family functioning would correlate with poorer dietary adherence and glycaemic control. METHODS Thirty-five families of children (M = 5.6 +/- 1.5 years) with T1DM had meals videotaped in their home, which were coded for family functioning according to the McMaster Interaction Coding System. Children's dietary adherence was assessed according to deviations from the prescribed number of carbohydrate units per meal and recommended carbohydrate intake levels per day. Glycaemic control was measured via 14 days of self-monitoring of blood glucose levels. RESULTS Findings demonstrated significant negative associations between children's dietary adherence and two dimensions of family functioning: Task Accomplishment (r=-0.43, P= 0.03) and Behavioral Control (r=-0.54, P= 0.00). Affect Management correlated negatively with the percent of blood glucose levels below the normal range (r=-0.33, P= 0.05). Eleven families (31%) of young children with type 1 diabetes demonstrated mealtime family functioning in the unhealthy range. CONCLUSIONS This was the first study to examine the relationship between mealtime family functioning and children's dietary adherence and glycaemic control in families of young children with T1DM. Previous research has found mealtime family functioning to be impaired in families of young children with T1DM when compared with families of children without diabetes. Research is needed to determine if family functioning and dietary adherence can be improved via specific family-based behavioural training around mealtimes.
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Affiliation(s)
- Susana R. Patton
- Division of Child Behavioral Health, Department of Pediatrics and Communicable Diseases, C.S. Mott Children’s Hospital and the University of Michigan, Ann Arbor, MI 48109-0318
| | - Carrie Piazza-Waggoner
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229
| | - Avani C. Modi
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229
| | - Lawrence M. Dolan
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229
| | - Scott W. Powers
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH 45229
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Abstract
Type 1 diabetes is a chronic autoimmune condition resulting from T cell-mediated destruction of the insulin-producing cells in the islets of Langerhans. Its primary cause remains unknown, but it has been established that the clinical presentation is preceded by a long prodrome. This enables individuals at high risk of disease to be identified and offers the possibility of intervention to prevent clinical disease. Many groups are working in this field, concentrating on manipulation of environmental exposures that are potential triggers of autoimmunity and on immunomodulation strategies that aim to prevent destruction of beta-cells. Some interventions have shown promising results in early trials, but effective disease prevention remains elusive. This article reviews current progress in the field.
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Affiliation(s)
- S L Thrower
- Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology, University of Bristol, Bristol, UK
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Helminth infection can reduce insulitis and type 1 diabetes through CD25- and IL-10-independent mechanisms. Infect Immun 2009; 77:5347-58. [PMID: 19752032 DOI: 10.1128/iai.01170-08] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Parasitic helminth infection has been shown to modulate pathological inflammatory responses in allergy and autoimmune disease. The aim of this study was to examine the effects of infection with a helminth parasite, Heligmosomoides polygyrus, on type 1 diabetes (T1D) in nonobese diabetic (NOD) mice and to elucidate the mechanisms involved in this protection. H. polygyrus inoculation at 5 weeks of age protected NOD mice from T1D until 40 weeks of age and also inhibited the more aggressive cyclophosphamide-induced T1D. Moreover, H. polygyrus inoculation as late as 12 weeks of age reduced the onset of T1D in NOD mice. Following H. polygyrus inoculation of NOD mice, pancreatic insulitis was markedly inhibited. Interleukin-4 (IL-4), IL-10, and IL-13 expression and the frequency of CD4(+) CD25(+) FoxP3(+) regulatory T cells were elevated in mesenteric and pancreatic lymph nodes. Depletion of CD4(+) CD25(+) T cells in vivo did not abrogate H. polygyrus-induced T1D protection, nor did anti-IL-10 receptor blocking antibody. These findings suggest that infection with H. polygyrus significantly inhibits T1D in NOD mice through CD25- and IL-10-independent mechanisms and also reduces the severity of T1D when administered late after the onset of insulitis.
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Evertsen J, Alemzadeh R, Wang X. Increasing incidence of pediatric type 1 diabetes mellitus in Southeastern Wisconsin: relationship with body weight at diagnosis. PLoS One 2009; 4:e6873. [PMID: 19727402 PMCID: PMC2731882 DOI: 10.1371/journal.pone.0006873] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2009] [Accepted: 07/20/2009] [Indexed: 11/24/2022] Open
Abstract
Introduction Several studies have confirmed the increasing rate of type 1 diabetes mellitus (T1DM) in children and the link with increasing BMI at diagnosis termed the ‘accelerator hypothesis’. Our objective was to assess whether changing incidence of type 1 diabetes in a group of children and adolescent from the Midwest United States was associated with changes in BMI. Methods Data from 1618 (52.1% M/47.9% F) newly-diagnosed children and adolescents (<19 years) with T1DM, admitted to Children's Hospital of Wisconsin (CHW) between January 1995 and December 2004, was analyzed in relationship to body mass index (BMI) standard deviation score (SDS). Results An overall, 10-year cumulative incidence of 27.92 per 100,000 (19.12 to 41.72/100,000) was observed, with an average yearly cumulative incidence of 2.39%. The increase was largest in the younger age groups, 0–4, 5–9, and 10–14 having an average yearly increase of 2.4, 2.3, and 3.0%, respectively, corresponding to a relative 10-year increase of 25.3, 33.8, and 38.0%, respectively. Age at diagnosis was inversely correlated with BMI SDS (p<0.001) and remained significant for both males and females. Conclusions Annual incidence of T1DM increased two-fold at CHW over the 10-year study period. The majority of the increase was observed in the youngest age groups, which also appeared to be the heaviest. This research adds to the growing literature supporting the hypothesis that excess weight gain during childhood may be a risk factor for early manifestation of T1DM.
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Affiliation(s)
- Jennifer Evertsen
- Department of Epidemiology, Medical College of Wisconsin, Milwaukee, Wisconsin, United States of America.
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Nikolic T, Welzen-Coppens JMC, Leenen PJM, Drexhage HA, Versnel MA. Plasmacytoid dendritic cells in autoimmune diabetes - potential tools for immunotherapy. Immunobiology 2009; 214:791-9. [PMID: 19628297 DOI: 10.1016/j.imbio.2009.06.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Type 1 diabetes (T1D) is an autoimmune disease in which a T-cell-mediated attack destroys the insulin-producing cells of the pancreatic islets. Despite insulin supplementation severe complications ask for novel treatments that aim at cure or delay of the onset of the disease. In spontaneous animal models for diabetes like the nonobese diabetic (NOD) mouse, distinct steps in the pathogenesis of the disease can be distinguished. In the past 10 years it became evident that DC and macrophages play an important role in all three phases of the pathogenesis of T1D. In phase 1, dendritic cells (DC) and macrophages accumulate at the islet edges. In phase 2, DC and macrophages are involved in the activation of autoreactive T cells that accumulate in the pancreas. In the third phase the islets are invaded by macrophages, DC and NK cells followed by the destruction of the beta-cells. Recent data suggest a role for a new member of the DC family: the plasmacytoid DC (pDC). pDC have been found to induce tolerance in experimental models of asthma. Several studies in humans and the NOD mouse support a similar role for pDC in diabetes. Mechanisms found to be involved in tolerance induction by pDC are inhibition of effector T cells, induction of regulatory T cells, production of cytokines and indoleamine 2,3-dioxygenase (IDO). The exact mechanism of tolerance induction by pDC in diabetes remains to be established but the intrinsic tolerogenic properties of pDC provide a promising, yet underestimated target for therapeutic intervention.
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Affiliation(s)
- Tatjana Nikolic
- Department of Immunology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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Svensson J, Lyngaae-Jørgensen A, Carstensen B, Simonsen LB, Mortensen HB. Long-term trends in the incidence of type 1 diabetes in Denmark: the seasonal variation changes over time. Pediatr Diabetes 2009; 10:248-54. [PMID: 19067889 DOI: 10.1111/j.1399-5448.2008.00483.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
There is a worldwide increase of type 1 diabetes mellitus (T1DM). In 1996, the Danish population-based registry was initiated including all newly diagnosed children aged 0-15 yr. This is the report of incidence and seasonal variation for the first 10 yr of the registry. The data was analyzed using Poisson's regression analysis. A total of 2166 children with diabetes were diagnosed before the age of 15 yr between 1996 and 2005. In this period, the annual increase in childhood T1DM was 3.43% (95% confidence interval: 1.91-4.97), which was unaffected by age and gender. Seasonal variation in incidence rates varied by year but not by age and gender. In conclusion, there is a steep increase in incidence of childhood T1DM in Denmark; the increase is comparable with the increase seen in other European countries. There is a significant seasonal variation that changes on a year-to-year basis. The observed variations in cadence rates may be associated with viral epidemics, sunshine exposure, or vitamin D levels and suggest further exploration of these relations.
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Affiliation(s)
- Jannet Svensson
- Paediatric Department, Glostrup University Hospital, Glostrup, Denmark.
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Lowes L, Davis R. A UK wide survey of insulin initiation in children with type 1 diabetes and nurses’ perceptions of associated decision-making. J Clin Nurs 2009; 18:1287-94. [DOI: 10.1111/j.1365-2702.2008.02705.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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