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Vlad A, Serban V, Timar R, Sima A, Botea V, Albai O, Timar B, Vlad M. Increased Incidence of Type 1 Diabetes during the COVID-19 Pandemic in Romanian Children. ACTA ACUST UNITED AC 2021; 57:medicina57090973. [PMID: 34577896 PMCID: PMC8470921 DOI: 10.3390/medicina57090973] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 09/02/2021] [Accepted: 09/13/2021] [Indexed: 12/22/2022]
Abstract
Background and Objective: It is known that several viruses are involved in the pathogenesis of type 1 diabetes. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a new worldwide spread virus that may act as a trigger for the autoimmune destruction of the β-cells, as well, and thus lead to an increase in the incidence of type 1 diabetes. Material and Methods: The Romanian National Organization for the Protection of Children and Adolescents with Diabetes (ONROCAD) has collected information regarding new cases of type 1 diabetes in children aged 0 to 14 years from all over the country since 1996 and has computed the incidence of type 1 diabetes in this age group. Results: We observed a marked increase in the incidence of type 1 diabetes in the first year of the COVID-19 pandemic, with 16.9%, from 11.4/100,000 in 2019 to 13.3/100,000 in 2020, much higher compared to previous years (mean yearly increase was 5.1% in the period 1996-2015 and 0.8% in the interval 2015-2019). The proportion of newly diagnosed cases was significantly higher in the second half of 2020 compared to the second half of the previous years (57.8 vs. 51%, p < 0.0001). Conclusions: All these aspects suggest the role that SARS-CoV-2 could have in triggering pancreatic autoimmunity. To confirm this, however, collecting information from larger populations from different geographical regions, monitoring the incidence curves over a period of several years, and gathering background information on COVID-19 and/or data on COVID-19 specific antibodies are needed.
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Affiliation(s)
- Adrian Vlad
- Department of Internal Medicine II, Division of Diabetes, Nutrition and Metabolic Diseases, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Sq. no. 2, 300041 Timișoara, Romania; (A.V.); (R.T.); (O.A.); (B.T.)
- Center for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq. no. 2, 300041 Timișoara, Romania;
| | - Viorel Serban
- “Cristian Serban” Medical Center for Evaluation and Rehabilitation for Children and Adolescents, str. Avram Iancu 18, 305100 Buzias, Romania;
| | - Romulus Timar
- Department of Internal Medicine II, Division of Diabetes, Nutrition and Metabolic Diseases, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Sq. no. 2, 300041 Timișoara, Romania; (A.V.); (R.T.); (O.A.); (B.T.)
- Center for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq. no. 2, 300041 Timișoara, Romania;
| | - Alexandra Sima
- Department of Internal Medicine II, Division of Diabetes, Nutrition and Metabolic Diseases, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Sq. no. 2, 300041 Timișoara, Romania; (A.V.); (R.T.); (O.A.); (B.T.)
- Center for Research in Preventive Medicine, Faculty of Medicine, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq. no. 2, 300041 Timișoara, Romania
- Correspondence:
| | - Veronica Botea
- Diabetes Outpatient Clinic, “Pius Brinzeu” Clinical County Emergency Hospital Timisoara, L. Rebreanu str. 156, 300723 Timisoara, Romania;
| | - Oana Albai
- Department of Internal Medicine II, Division of Diabetes, Nutrition and Metabolic Diseases, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Sq. no. 2, 300041 Timișoara, Romania; (A.V.); (R.T.); (O.A.); (B.T.)
| | - Bogdan Timar
- Department of Internal Medicine II, Division of Diabetes, Nutrition and Metabolic Diseases, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Sq. no. 2, 300041 Timișoara, Romania; (A.V.); (R.T.); (O.A.); (B.T.)
- Center for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq. no. 2, 300041 Timișoara, Romania;
| | - Mihaela Vlad
- Center for Molecular Research in Nephrology and Vascular Disease, Faculty of Medicine, “Victor Babeș” University of Medicine and Pharmacy, Eftimie Murgu Sq. no. 2, 300041 Timișoara, Romania;
- Department of Internal Medicine II, Division of Endocrinology, “Victor Babes” University of Medicine and Pharmacy, Eftimie Murgu Sq. no. 2, 300041 Timișoara, Romania
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Adeloye D, Chan KY, Thorley N, Jones C, Johnstone D, L'Heveder A, Saftic V, Henderson D, Chopra M, Campbell H, Rudan I. Global and regional estimates of the morbidity due to type I diabetes among children aged 0-4 years: a systematic review and analysis. J Glob Health 2018; 8:021101. [PMID: 30410744 PMCID: PMC6214490 DOI: 10.7189/jogh.08.021101] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Epidemiology of type 1 diabetes mellitus (T1DM) among children aged 0-4 years globally is not well understood. We aim to assess the incidence of T1DM in low- and middle-income countries (LMIC) by conducting a systematic review of previous reports. We also aim to address possible contribution to child mortality and to identify any temporal trends. Methods A systematic review was performed using a carefully designed search strategy to explore MEDLINE, EMBASE and Global Health databases. Data was extracted from all studies that satisfied the inclusion criteria –a total of 83 records extracted from 26 830 sources that were analysed. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) process to assess quality of evidence and applied meta-analysis approaches to assess global and regional incidence and time trends. Results The overall pooled incidence of T1DM in children aged 0-4 years globally is 11.2 (95% CI = 10.0-12.3) per 100 000 child years. The regional incidence were the highest for European Region A (EUR A) at 15.5 (95% CI = 13.5-17.5) per 100 000 child years. EUR C had the incidence of 10.0 (95% CI = 6.5-13.6) and EUR B 5.8 (95% CI = 4.7-7.0), Region of the Americas A (AMR A) 11.4 (95% CI = 7.8-14.9), AMR B of 2.5 (95% CI = 0.2-4.8), Eastern Mediterranean Region (EMR B) 7.1 (95% CI = 4.2-10.0) and Western Pacific Region (WPR A) 7.0 (95% CI = 2.9-11.0) per 100 000 child years, while other regions had very low rates or no data. When data points were categorised in the study periods and re-analysed, an increasing trend of the T1DM incidence was observed, with the incidence of 20.9 (95% CI = 7.8-34.1) per 100 000 child years in the years 2010-2015, preceded by 13.2 (95% CI = 11.0-15.5) in 2000-2009 study period, 10.0 (95% CI = 8.4-11.7) in 1990-1999 and 8.3 (95% CI = 5.1-11.6) in 1980-1989, respectively. Although the data are scarce, and variation and uncertainty are large, we estimated that the number of new cases of T1DM among children aged 0-4 years in the world each year is between 100 000 and 150 000. Conclusions The identified large variation in incidence estimates for different parts of the world, along with scarcity of information and the identified strong temporal increase in T1DM incidence suggest a clear need for further research into this subject.
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Affiliation(s)
- Davies Adeloye
- Centre for Global Health Research and World Health Organization's Collaborating Centre for Population Health, Research and Training, The Usher Institute, University of Edinburgh, UK
| | - Kit Yee Chan
- Centre for Global Health Research and World Health Organization's Collaborating Centre for Population Health, Research and Training, The Usher Institute, University of Edinburgh, UK
| | - Natasha Thorley
- Centre for Global Health Research and World Health Organization's Collaborating Centre for Population Health, Research and Training, The Usher Institute, University of Edinburgh, UK
| | - Charlotte Jones
- Centre for Global Health Research and World Health Organization's Collaborating Centre for Population Health, Research and Training, The Usher Institute, University of Edinburgh, UK
| | - David Johnstone
- Centre for Global Health Research and World Health Organization's Collaborating Centre for Population Health, Research and Training, The Usher Institute, University of Edinburgh, UK
| | - Ari L'Heveder
- Centre for Global Health Research and World Health Organization's Collaborating Centre for Population Health, Research and Training, The Usher Institute, University of Edinburgh, UK
| | - Vanja Saftic
- Child and Youth Protection Center of Zagreb, Croatia.,Croatian Catholic University, Zagreb, Croatia
| | - David Henderson
- Centre for Global Health Research and World Health Organization's Collaborating Centre for Population Health, Research and Training, The Usher Institute, University of Edinburgh, UK
| | | | - Harry Campbell
- Centre for Global Health Research and World Health Organization's Collaborating Centre for Population Health, Research and Training, The Usher Institute, University of Edinburgh, UK
| | - Igor Rudan
- Centre for Global Health Research and World Health Organization's Collaborating Centre for Population Health, Research and Training, The Usher Institute, University of Edinburgh, UK
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Vlad A, Serban V, Green A, Möller S, Vlad M, Timar B, Sima A, ONROCAD Study Group OBOT. Time Trends, Regional Variability and Seasonality Regarding the Incidence of Type 1 Diabetes Mellitus in Romanian Children Aged 0-14 Years, Between 1996 and 2015. J Clin Res Pediatr Endocrinol 2018; 10:92-99. [PMID: 29082895 PMCID: PMC5985393 DOI: 10.4274/jcrpe.5456] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE The incidence of type 1 diabetes mellitus in children is highly variable in the world. The aim of our study was to: 1) analyze the evolution of the incidence of childhood type 1 diabetes in Romania between 1996 and 2015, and: 2) to search for differences amongst age groups, gender, geographic regions and month of diagnosis. METHODS Data on all new cases of type 1 diabetes, aged <15 years, obtained from two independent sources, were included in the study. The statistical methods included modeling of the incidence rates, adjusting for age, sex, calendar year, geographic region and seasonality. RESULTS The study group was composed of 5422 children, with overall completeness of ascertainment estimated at 93.7%. The incidence rate (per 100.000 person-years) rose continuously, from 4.7 [95% confidence interval (CI) 3.9-5.7] in 1996 to 11.0 (95% CI 9.9-12.2) in 2015, by a yearly rate of 5.1%, highest in the youngest and lowest in the oldest children. The mean incidence was significantly higher (p<0.0001) in Transylvania (7.9, 95% CI 7.6-8.3) than in Moldavia (6.5, 95% CI 6.2-6.9) and Muntenia (7.0, 95% CI 6.7-7.3), probably due to differences regarding ethnicity and lifestyle. The monthly incidence showed a sinusoidal pattern, peaking in January and being minimum in June. CONCLUSION The incidence of type 1 diabetes mellitus in Romanian children increased continuously during the study period by a rate that, if maintained, would lead to its doubling every 14 years. Important differences were established between geographic regions and seasonality at diagnosis.
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Affiliation(s)
- Adrian Vlad
- Victor Babes University of Medicine and Pharmacy, Department of Diabetes and Metabolic Diseases, Timisoara, Romania
| | - Viorel Serban
- Cristian Serban Medical Center of Evaluation and Rehabilitation for Children and Adolescents, Buzias, Romania
| | - Anders Green
- University of Southern Denmark, Odense University Hospital, Department of Clinical Research, Odense Patient Data Exploratory Network (OPEN), Odense, Denmark
| | - Sören Möller
- University of Southern Denmark, Odense University Hospital, Department of Clinical Research, Odense Patient Data Exploratory Network (OPEN), Odense, Denmark
| | - Mihaela Vlad
- Victor Babes University of Medicine and Pharmacy, Department of Endocrinology, Timisoara, Romania,* Address for Correspondence: Victor Babes University of Medicine and Pharmacy, Department of Biostatistics and Medical Informatics, Timisoara, Romania Phone: +40722872666 E-mail:
| | - Bogdan Timar
- Victor Babes University of Medicine and Pharmacy, Department of Biostatistics and Medical Informatics, Timisoara, Romania
| | - Alexandra Sima
- Victor Babes University of Medicine and Pharmacy, Department of Diabetes and Metabolic Diseases, Timisoara, Romania
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Milas O, Gadalean F, Vlad A, Dumitrascu V, Gluhovschi C, Gluhovschi G, Velciov S, Popescu R, Bob F, Matusz P, Pusztai AM, Cretu OM, Secara A, Simulescu A, Ursoniu S, Vlad D, Petrica L. Deregulated profiles of urinary microRNAs may explain podocyte injury and proximal tubule dysfunction in normoalbuminuric patients with type 2 diabetes mellitus. J Investig Med 2017; 66:747-754. [PMID: 29279420 DOI: 10.1136/jim-2017-000556] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2017] [Indexed: 12/14/2022]
Abstract
MicroRNAs (miRNAs) are short non-coding RNA species that are important post-transcriptional regulators of gene expression. The aim of the study was to establish a potential explanation of podocyte damage and proximal tubule (PT) dysfunction induced by deregulated miRNAs expression in the course of type 2 diabetes mellitus (DM). A total of 68 patients with type 2 DM and 11 healthy subjects were enrolled in a cross-sectional study and assessed concerning urinary albumin:creatinine ratio (UACR), urinary N-acetyl-β-D-glucosamininidase (NAG), urinary kidney injury molecule-1, urinary nephrin, podocalyxin, synaptopodin, estimated glomerular filtration rate (eGFR), urinary miRNA21, miRNA124, and miRNA192. In univariable regression analysis, miRNA21, miRNA124, and miRNA192 correlated with urinary nephrin, synaptopodin, podocalyxin, NAG, KIM-1, UACR, and eGFR. Multivariable regression analysis yielded models in which miRNA192 correlated with synaptopodin, uNAG, and eGFR (R2=0.902; P<0.0001), miRNA124 correlated with synaptopodin, uNAG, UACR, and eGFR (R2=0.881; P<0.0001), whereas miRNA21 correlated with podocalyxin, uNAG, UACR, and eGFR (R2=0.882; P<0.0001). Urinary miRNA192 expression was downregulated, while urinary miRNA21 and miRNA124 expressions were upregulated. In patients with type 2 DM, there is an association between podocyte injury and PT dysfunction, and miRNA excretion, even in the normoalbuminuria stage. This observation documents a potential role of the urinary profiles of miRNA21, miRNA124, and miRNA192 in early DN. Despite their variability across the segments of the nephron, urinary miRNAs may be considered as a reliable tool for the identification of novel biomarkers in order to characterize the genetic pattern of podocyte damage and PT dysfunction in early DN of type 2 DM.
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Affiliation(s)
- Oana Milas
- Department of Nephrology, County Emergency Hospital Timisoara, Timisoara, Romania.,'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania
| | - Florica Gadalean
- Department of Nephrology, County Emergency Hospital Timisoara, Timisoara, Romania.,'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania
| | - Adrian Vlad
- 'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania.,Department of Diabetes and Metabolic Diseases, County Emergency Hospital Timisoara, Timisoara, Romania
| | - Victor Dumitrascu
- 'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania.,Department of Pharmacology, Timisoara, Romania
| | - Cristina Gluhovschi
- Department of Nephrology, County Emergency Hospital Timisoara, Timisoara, Romania.,'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania
| | - Gheorghe Gluhovschi
- Department of Nephrology, County Emergency Hospital Timisoara, Timisoara, Romania.,'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania
| | - Silvia Velciov
- Department of Nephrology, County Emergency Hospital Timisoara, Timisoara, Romania.,'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania
| | - Roxana Popescu
- 'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania.,Department of Cellular and Molecular Biology, Timisoara, Romania
| | - Flaviu Bob
- Department of Nephrology, County Emergency Hospital Timisoara, Timisoara, Romania.,'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania
| | - Petru Matusz
- 'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania.,Department of Anatomy and Embryology, Timisoara, Romania
| | - Agneta-Maria Pusztai
- 'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania.,Department of Anatomy and Embryology, Timisoara, Romania
| | - Octavian M Cretu
- 'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania.,Department of Surgery I, Timisoara, Romania
| | - Alina Secara
- Department of Nephrology, County Emergency Hospital Timisoara, Timisoara, Romania.,'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania
| | - Anca Simulescu
- Department of Nephrology, County Emergency Hospital Timisoara, Timisoara, Romania.,'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania
| | - Sorin Ursoniu
- 'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania.,Department of Public Health Medicine, Timisoara, Romania.,Centre of Translational Research and Systems Medicine, Timisoara, Romania
| | - Daliborca Vlad
- 'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania.,Department of Pharmacology, Timisoara, Romania
| | - Ligia Petrica
- Department of Nephrology, County Emergency Hospital Timisoara, Timisoara, Romania.,'Victor Babes' University of Medicine and Pharmacy, Timisoara, Romania.,Centre of Translational Research and Systems Medicine, Timisoara, Romania
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Compés ML, Feja C, Niño De Guzman E, Aguilar I, Conde S, Alonso JP, Rodrigo MP. Bayesian analysis of the geographical variation of type 1 diabetes mellitus in under 15 yr olds in northeast Spain, 1991-2009. Pediatr Diabetes 2013; 14:66-76. [PMID: 22816867 DOI: 10.1111/j.1399-5448.2012.00892.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Revised: 05/18/2012] [Accepted: 05/23/2012] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE High variability has been observed in type 1 diabetes mellitus (DM1) incidence rates (IRs) in childhood. The aim of this study was to characterize DM1 in Aragón and to identify variations in the geographical pattern by gender. METHODS A descriptive and ecological study was conducted to determine geographical variations in the DM1 incidence for the period 1991-2009. The source of information was the registry of DM1. To determine data completeness, a capture-recapture analysis was performed. Cases were georeferenced according to the Basic Healthcare Area (BHA) of residence. IRs for both genders, age group, 5 yr of diagnosis, and 95% confidence intervals (95% CIs) were calculated. Geographical pattern was studied applying Bayesian statistical model. The standardized incidence ratios (SIRs), smoothed SIR, and the posteriori risk probability (PRP) were represented cartographically for BHA stratified by gender. RESULTS The completeness was 93.5%. The global IR was 19.2 cases/10(5) person-years (95% CI: 17.6-20.8), boys 21.4 (95% CI: 19.0-23.8) and girls 16.8 (95% CI: 14.7-19.1). The age-specific rates were significantly lower in the 0-4 year age group with respect to the groups of 5-9 and 10-14 years. For boys, areas with a statistically significant excess of risk were found in the north [smoothed SIR: 118-167.9 and PRP of what the smoothed SIR would be greater than 100 (PRP) above 0.8] and below average risk in the south (smoothed SIR: 65.9-79.1 and PRP less than 0.2). CONCLUSIONS DM1 IR presented a north-south geographical pattern in boys. This pattern was not observed in girls or when both genders were considered together. Later studies should include gender as an essential variable.
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Affiliation(s)
- Maria Luisa Compés
- Group Health Services Research of Aragon, GRISSA, Government of Aragon, Zaragoza, Spain
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Wood J, Rami B. Report of the 35th ISPAD-Meeting, Ljubljana, Slovenia, 2-5 September 2009. Pediatr Diabetes 2010; 11:74-80. [PMID: 19958459 DOI: 10.1111/j.1399-5448.2009.00623.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Jamie Wood
- Center for Endocrinology, Diabetes, and Metabolism, Childrens Hospital Los Angeles, Keck School of Medicine, University of Southern California, USA.
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