Australia’s national trends in the incidence of Type 1 diabetes in 0–14‐year‐olds, 2000–2006

Aims To determine the national incidence of Type 1 diabetes in children aged 0–14 years and examine trends in incidence between 2000 and 2006 by age, sex and calendar year. Methods Case ascertainment was from the Australian National Diabetes Register, a prospective population‐based incidence register established in 1999, with two sources of ascertainment: the National Diabetes Services Scheme and the Australasian Paediatric Endocrine Group’s state‐based registers. Denominator data were from the Australian Bureau of Statistics. Results There were 6350 new cases of Type 1 diabetes (3323 boys and 3027 girls). Case ascertainment was 97.1% complete using the capture–recapture method. The mean adjusted incidence rate for 2000–2006 was 21.6 per 100 000 person‐years [95% confidence interval (CI) 21.0, 22.1], and increased from 19.8 in 2000 to 23.4 per 100 000 in 2006, an average increase of 2.8% (95% CI 1.5, 4.1) per year. Mean incidence for the 7‐year period increased with age, and was significantly higher in boys aged 0–4 years and 10–14 years than in girls of the same age. Conclusions The incidence of Type 1 diabetes among 0–14‐year‐olds in Australia is very high compared with available data from many other countries. The rate of increase observed globally in the last decade has continued well into this decade in Australia. The rising incidence cannot be explained by changes in genetic susceptibility; there is an urgent need to examine the environmental factors that have contributed to this increase. The findings of this study also have important implications for resource planning.     

Type 2 diabetes and risk of non-embolic ischaemic stroke in Japanese men and women

Aims/hypothesis The aim of this study was to examine the relationship between type 2 diabetes and risk of ischaemic stroke in Asian populations.Methods We conducted a 17-year prospective cohort study in 10,582 Japanese individuals (4287 men and 6295 women) aged 40–69 years living in five communities in Japan. All subjects were free of stroke and CHD at baseline. Diabetes was defined as a fasting glucose level of 7.0 mmol/l, a non-fasting glucose of 11.1 mmol/l, or receiving medication for diabetes.Results The risk of non-embolic ischaemic stroke was approximately two-fold higher in diabetic subjects than in subjects with normal glucose levels. The multivariate relative risk after adjustment for age, community, hypertensive status, BMI, triceps and subscapular skinfold thickness (TSF and SSF), and other known cardiovascular risk factors was 1.8 (95% CI 1.0–3.2) for men and 2.2 (1.2–4.0) for women. This excess risk was primarily observed among non-hypertensive subjects and individuals with higher values for measures of adiposity (BMI, TSF and SSF values above the median), particularly those with higher values for SSF. The association between non-embolic ischaemic stroke and glucose abnormality was particularly strong among non-hypertensive subjects with higher SSF values: the multivariate relative risk was 1.9 (1.0–3.7) for borderline diabetes and 4.9 (2.5–9.5) for diabetes.Conclusions/interpretation In this cohort, type 2 diabetes was a significant risk factor for non-embolic ischaemic stroke, particularly in non-hypertensive and non-lean individuals. Due to the nationwide decrease in blood pressure and increase in mean BMI among the Japanese population, with current levels approaching those observed in Western countries, the impact of glucose abnormalities on risk of ischaemic stroke represents a forthcoming public health issue in Japan.     

Incidence and trends of childhood Type 1 diabetes worldwide 1990–1999

Aims To examine incidence and trends of Type 1 diabetes worldwide for the period 1990–1999. Methods The incidence of Type 1 diabetes (per 100 000/year) was analysed in children aged ≤ 14 years from 114 populations in 112 centres in 57 countries. Trends in the incidence of Type 1 diabetes were analysed by fitting Poisson regression models to the dataset. Results A total of 43 013 cases were diagnosed in the study populations of 84 million children. The age‐adjusted incidence of Type 1 diabetes among 112 centres (114 populations) varied from 0.1 per 100 000/year in China and Venezuela to 40.9 per 100 000/year in Finland. The average annual increase in incidence calculated from 103 centres was 2.8% (95% CI 2.4–3.2%). During the years 1990–1994, this increase was 2.4% (95% CI 1.3–3.4%) and during the second study period of 1995–1999 it was slightly higher at 3.4% (95% CI 2.7–4.3%). The trends estimated for continents showed statistically significant increases all over the world (4.0% in Asia, 3.2% in Europe and 5.3% in North America), except in Central America and the West Indies where the trend was a decrease of 3.6%. Only among the European populations did the trend in incidence diminish with age. Conclusions The rising incidence of Type 1 diabetes globally suggests the need for continuous monitoring of incidence by using standardized methods in order to plan or assess prevention strategies.     

Time trends in incidence,etiology, and case fatality rate of the first attack of acute pancreatitis

Abstract

Purpose. The purpose of this study was to establish estimates of incidence and fatality rates, and to identify likely etiologies of first attack acute pancreatitis (FAAP) in an urban Norwegian population. Material and methods. A total of 874 patients were discharged with a diagnosis of acute pancreatitis from the two hospitals in this region between 1.1.1996 and 31.12.2006. Patient records were reviewed and patients with a verifiable FAAP were identified. Demographic variables, likely etiology, and outcome were registered. Results. FAAP was verified in 567 (65%) of the patients (300 women and 267 men) with a median age of 58 years (range 7–98). The average yearly incidence rate of FAAP was 14.6/100 000 and the gender-specific incidence rates increased yearly by approx. 6% (p = 0.006). There was a decline in diagnoses by s-Amylase from approx. 90% to 62% in 2006 and an increase in diagnoses obtained by CT (p < 0.001). The case fatality rate was low (3.5%), but higher among men (5.8%) than women (2%, p = 0.037). The case fatality rate was lowest among patients with gallstones (0.7%) and higher among patients with alcohol (9%), miscellaneous (10.4%), and non-assessed etiology (6.6%) of FAAP (p < 0.05). Male gender, increasing age, and etiology (alcohol, miscellaneous causes, and non-assessed) were associated with increased case fatality rate in an adjusted regression model (p < 0.001). Conclusions. The incidence rate of FAAP is low and differs from that of official registries. The case fatality rate is low, but related to gender, age, and likely etiology of FAAP.     

Association between diabetes mellitus and incidence of intracerebral haemorrhage and case fatality rates: A retrospective population‐based cohort study

We investigated the associations between diabetes (type 1, type 2 or no diabetes) and intracerebral haemorrhage (ICH) incidence as well as case fatality after ICH, in a retrospective cohort study of people aged 40 to 89 years in Scotland during the period 2004 to 2013, using linkage of population‐based records of diagnosed diabetes, hospital discharges and deaths. We calculated ICH incidence and 30‐day case fatality after hospital admission for ICH, along with their relative risks (RR) and 95% confidence intervals (CIs), among people with type 1 or type 2 diabetes compared to people without diabetes, adjusting for age, sex and socio‐economic status (SES). There were 77, 1275 and 9778 incident ICH events and the case‐fatality rate was 44% (95% CI 33, 57), 38% (95% CI 35, 41) and 36% (95% CI 35, 37) in people with type 1, type 2 and without diabetes, respectively. In comparison with absence of diabetes, type 1 diabetes was associated with a higher incidence of ICH (1.74, 95% CI 1.38‐2.21) and higher case fatality after ICH (1.35, 95% CI 1.01‐1.70), after adjustment for age, sex and SES. The small increases in ICH incidence (1.06, 95% CI 0.99‐1.12) and case‐fatality (1.04, 95% CI 0.96‐1.13) in people with type 2 diabetes compared with people without diabetes were not statistically significant.     

Human listeriosis in Scotland 1967–1988

In order to study the epidemiology of listeriosis from 1967–1988 in Scotland, various sources of data were examined. These included reports by laboratories, reference laboratory records, hospital death and discharge records, death certificates and hospital laboratory records. Cases were reported from 13 of Scotland's 15 Health Boards. Case ascertainment via laboratory reports to the Communicable Diseases (Scotland) Unit was validated in two Health Boards. A total of 198 cases was identified with an overall attack rate which increased from 0·5 per million in 1967–1971 to 7·0 per million in 1987–1988. Feto-maternal cases were the commonest (64%). Of all cases, 33%. were neonates; 53 % presented with bacteraemia and 41 % with meningitis. The predominant serovar of Listeria monocytogenes was 4b.     

Type 2 diabetes pharmacotherapy trends in high-risk subgroups

Medication use trends among patients with type 2 diabetes from 2015 to 2019 were investigated in relation to the clinical group-specific recommendations from the 2018 American Diabetes Association (ADA)/European Association for the Study of Diabetes (EASD) consensus report. Data were drawn from a large health insurance claims database representing Commercial (total patient-year count: 2,379,704) and Medicare (total patient-year count: 845,823) insurance programmes (IBM® MarketScan®). The utilization of sodium-glucose co-transporter-2 inhibitors or glucagon-like peptide-1 receptor agonists increased over time but was lower in the Medicare cohort in every year evaluated. Patients diagnosed with obesity received recommended therapies at higher rates than those without obesity. Differences were more modest between those with versus without atherosclerotic cardiovascular disease (ASCVD) or chronic kidney disease, with greater treatment adoption in those without ASCVD in the Medicare cohort. Utilization of recommended treatments was paradoxically lower in those with versus without heart failure, and worse in the Medicare than in the Commercial cohort. Utilization of sulphonylureas was not different in those with versus without severe hypoglycaemia history. In conclusion, utilization of therapies recommended in the guidelines is increasing overall, which is not preferentially guided by ADA/EASD-defined clinical groups, and there exists a persistent gap in utilization between Commercial and Medicare populations.     

Secular trends in cardiovascular disease mortality, incidence, and case fatality rates in adults in the United States

PURPOSE: To assess the effects of changes in cardiovascular disease incidence and case fatality rates on secular trends in mortality in the U.S. population between 1971-1982 and 1982-1992. METHODS: Using data from the first National Health and Nutrition Examination Survey Epidemiologic Follow-up Study, two cohorts (10,869 subjects in the 1971-1982 cohort and 9774 in the 1982-1992 cohort) of participants aged 35 to 74 years were created. Baseline medical history questionnaires were administered in 1971-1975 and 1982-1984, with follow-up interviews, hospital record reviews, and death certificate searches conducted in 1982-1984, 1986, 1987, and 1992. RESULTS: Between 1971-1982 and 1982-1992, age-standardized cardiovascular disease mortality declined from 79.1 (95% confidence interval [CI]: 75.2 to 83.0) to 53.0 (95% CI: 49.5 to 56.5) per 10,000 person-years, while cardiovascular disease incidence rates decreased from 293.5 (95% CI: 284.5 to 302.4) to 225.1 (95% CI: 216.6 to 233.5) per 10,000 person-years. The 28-day case fatality rate for cardiovascular disease declined from 15.7% (95% CI: 14.5% to 16.8%) to 11.7% (95% CI: 10.3% to 13.0%). After adjustment for age, sex, and race, rates were 31% lower for cardiovascular disease mortality, 21% lower for incidence, and 28% lower for 28-day case fatality in the 1982-1992 cohort than in the 1971-1982 cohort (each P <0.001). CONCLUSION: The decrease in cardiovascular disease mortality between 1971-1982 and 1982-1992 was due to declines in both the incidence and case fatality rates in this national sample. These findings suggest that both primary and secondary prevention and treatment contributed to the decline in cardiovascular disease mortality in the United States.     

Cardiovascular autonomic dysfunction predicts acute ischaemic stroke in patients with Type 2 diabetes mellitus: a 7‐year follow‐up study

Aims We investigated whether cardiovascular autonomic neuropathy (CAN) is associated with acute ischaemic stroke in patients with Type 2 diabetes. Methods From 1999 to 2000, cardiovascular autonomic function tests were conducted in patients with Type 2 diabetes (n = 1458). Patients were followed up between 2006 and 2007. Standard tests for CAN measured heart rate variability parameters [expiration‐to‐inspiration (E/I) ratio, responses to the Valsalva manoeuvre and standing]. Using the American Diabetes Association criteria, the CAN scores were determined from the results of each test as follows: 0 = normal, 1 = abnormal (total maximum score 3). We assessed the development of acute ischaemic stroke events. Results The prevalence of CAN at baseline was 55.7% (E/I 17.1%, Valsalva 39.4%, posture 27.3%) (n = 1126). During follow‐up, 131 patients (11.6%) developed acute ischaemic stroke. The vascular events were more frequent in older patients (P < 0.001) and in those with diabetes of longer duration (P = 0.022), hypertension (P < 0.001) or diabetic retinopathy (P = 0.03) than in patients without vascular events. Patients with ischaemic stroke had higher creatinine levels (P = 0.045) and higher urine albumin excretion (P = 0.025) than those of patients without stroke. Cox proportional hazard regression analysis revealed that the CAN score was associated with the development of acute ischaemic stroke (total score 0 vs. 3, adjusted hazard ratio 2.7, 95% CI 1.3–5.5, P = 0.006). Conclusion Cardiovascular autonomic dysfunction was significantly associated with the development of ischaemic stroke in patients with Type 2 diabetes.