The inter- and intragenerational impact of gestational diabetes on the epidemic of type 2 diabetes

Objectives. We investigated the contribution of gestational diabetes mellitus (GDM) to the historic epidemic of type 2 diabetes mellitus (T2DM) in Saskatchewan.Methods. We constructed a population-level simulation model of the inter- and intragenerational interaction of GDM and T2DM for the period 1956 to 2006. The model was stratified by gender, ethnicity, and age; parameterized with primary and secondary data; and calibrated to match historic time series. Risk of diabetes was sigmoidally trended to capture exogenous factors.Results. Best-fit calibrations suggested GDM may be responsible for 19% to 30% of the cases of T2DM among Saskatchewan First Nations people, but only for approximately 6% of cases among other persons living in Saskatchewan. The estimated contribution of GDM to the growth in T2DM was highly sensitive to assumptions concerning the post-GDM risk of developing T2DM.Conclusions. GDM may be an important driver for the T2DM epidemic in many subpopulations. Because GDM is a readily identifiable, preventable, and treatable condition, investments in prevention, rapid diagnosis, and evidence-based treatment of GDM in at-risk populations may offer substantial benefit in lowering the T2DM burden over many generations. Model-informed data collection can aid in assessing intervention tradeoffs.The rise of the global epidemic of type 2 diabetes mellitus (T2DM) has been particularly rapid and acute among disadvantaged and indigenous populations.¹ In North America, for example, aboriginal peoples experience rates of diabetes several times higher than that among the general population.² Although research has pointed to the influence of rapid environmental and behavioral changes,² as well as possible genetic contributors,³ recent attention has also been directed at the possible role of diabetic pregnancies (gestational diabetes mellitus [GDM] and pre-existing maternal T2DM) in this epidemic. Previous research conducted among Saskatchewan First Nations people has provided indirect evidence to support a temporal contribution of GDM. Similar to many North American aboriginal peoples, Saskatchewan First Nations people suffer from high rates of GDM,^4–8 with First Nations ethnicity being an independent predictor of GDM and with the magnitude of that risk exhibiting distinctive interactions between obesity and ethnicity.⁵ Among Saskatchewan First Nations people, rates of GDM and overweight or obesity appear to have risen many years prior to widespread appearance of T2DM.⁶ High-birthweight (HBW) rates, a frequent complication of GDM, have increased in Saskatchewan''s predominantly First Nations communities over several decades.^8,9 Similar to patterns seen among other Aboriginal groups,¹⁰ diabetic Saskatchewan First Nations adults are more likely to have been born with HBW than are their nondiabetic counterparts,⁸ and the HBW–T2DM relationship appears to have strengthened over time.⁸ In a reversal of the pattern seen in other Saskatchewan populations, Saskatchewan First Nations women also suffer from significantly higher rates of T2DM than do their male counterparts, with the disparity particularly pronounced in the childbearing years.¹¹GDM is associated with serious health consequences for both mother and offspring. There is substantial evidence suggesting that GDM predisposes women to T2DM,^4,12–15 with approximately 4% to 10% of GDM cases proceeding on to T2DM within the first 9 months after pregnancy.^16–18 Occurrence of GDM during a pregnancy is also a predictor for GDM in future pregnancies,¹⁷ as well as for other conditions such as cardiovascular disease.¹⁹ Finally, because GDM encourages fetal growth,¹⁴ women with GDM are more likely to require caesarean sections and are at greater risk of complications during birth.²⁰For children, the consequences of GDM are of equal or greater severity. GDM significantly elevates the risk of macrosomia and risk of fetal injury during delivery. Children of mothers with GDM also tend to have higher adiposity²⁰ and abnormal glucose tolerance.^21–26 Seminal work carried out in the Pima Indian population showed that the children of women with diabetes during pregnancy had increased rates of obesity^14,27–29 and T2DM^30–33 by adolescence and early adulthood. Observations from Manitoba, where aboriginal children with diabetes were more likely to have experienced a diabetic intrauterine environment,³⁴ support this finding. Some of these effects appear to be independent of birthweight.²⁷ Findings from animal models³⁵ and from sibling studies,²⁹ the absence of influence of paternal diabetes,^36–38 and an apparent dose–response relationship between gestational glycemic control and risk of diabetes in one''s offspring³² suggest that GDM plays a causal role.^29,31,39 Evidence is mixed as to the degree to which infants of glycemically well-controlled mothers with GDM remain at risk.^27,40Although the concept of an intergenerational vicious cycle of diabetic pregnancies leading to progressively increasing rates of T2DM has been demonstrated in animal models³⁵ and is now increasingly cited as a possible contributor to the diabetes epidemic,^14,33,41,42 this effect has been challenging to observe and measure in diverse human populations. This may be in part because GDM was not broadly diagnosed until the 1980s and because of the long delays associated with intergenerational effects. Studies among the Pima have suggested that GDM has played a dominant role in elevating rates of T2DM among that population.³³ Although these findings have been seminal for providing evidence that a vicious cycle is operating and suggest the importance of the subject, they require translation to understand the degree to which GDM contributes to T2DM rates among other populations. This translation process requires addressing a variety of contextual factors that distinguish the populations of interest, such as differences in age-specific fertility rates, birthweights, population-specific risk factors for GDM, weight profiles through life, and differences in health care systems. Establishing the existence and strength of a link between diabetic pregnancies and the epidemic of T2DM is important because it would contribute to our basic understanding of this devastating chronic disease, provide novel opportunities for primary prevention initiatives, and allow for targeted allocation of health care resources. While awaiting more definitive longitudinal studies, there are prospects for leveraging the large body of evidence regarding the linkages between diverse factors that shape the inter- and intragenerational influences of gestational diabetes on population health (e.g., changing fertility patterns, onset and progression of diabetes, macrosomia and overweight, mortality, and weight gain during and outside of pregnancy). Simulation modeling provides an attractive vehicle both for exploring contributions of GDM to the observed rates and changes in diabetes rates by ethnicity and gender and for lending insight into how focused interventions might reduce this burden. To this end, we investigated the contribution of GDM on the historic epidemic of T2DM in Saskatchewan. Saskatchewan offers a valuable opportunity to examine these factors because of the availability of a long and rich sequence of administrative data,⁴³ the systematic series of studies that have already been conducted related to this subject, and the available interdisciplinary expertise.     

新型冠状病毒肺炎疫情对结核病防控的影响及对策

  目的   了解新型冠状病毒肺炎疫情（以下简称新冠肺炎疫情）对湖北省荆州市结核病防控工作的影响。  方法  通过中国疾病预防控制中心结核病信息管理系统,收集2017 — 2021年湖北省荆州市登记诊断为肺结核患者资料。采用SPSS 23.0 软件进行数据的整理和分析。描述近5年肺结核报告发病趋势。通过新冠肺炎疫情强化干预期（2020年1月25日 — 3月27日）、常态化防控期（2020年3月28日 — 5月29日）、对照期（2019年11月29日 — 2020年1月24日）结核报告发病率及病原学阳性率的变化,描述疫情强化干预期、常态化防控期对荆州市结核病防治的影响。  结果  荆州市2017 — 2020年肺结核发病数及发病率呈现逐年下降趋势。2020年疫情强化干预期登记的结核病患者数占比（7.24 %）低于对照期（42.94 %）和常态化防控期（49.72 %）,强化干预期发病数下降明显,病原学阳性率波动明显。  结论   荆州市结核病防治工作向较好的方面发展。新冠肺炎疫情影响了肺结核发现水平下降,病原学阳性率下降。新冠肺炎疫情影响了结核诊治的需求,减少了肺结核患者的发现,在未来可能会出现结核病诊疗服务的需求增多,但严格的疫情防控可减少结核患者发病例数。     

Neighborhood context and incidence of type 1 diabetes: the SEARCH for Diabetes in Youth study

Findings regarding type 1 diabetes mellitus (T1DM) and neighborhood-level characteristics are mixed, with few US studies examining the influence of race/ethnicity. We conducted an ecologic study using SEARCH for Diabetes in Youth Study data to explore the association of neighborhood characteristics and T1DM incidence. 2002-2003 incident cases among youth at four SEARCH centers were included. Residential addresses were geocoded to US Census Tract. Standardized incidence ratios tended to increase with increasing education and median household income. Results from Poisson regression mixed models were similar and stable across race/ethnic groups and population density. Our study suggests a relationship of T1DM incidence with neighborhood-level socioeconomic status, independent of individual-level race/ethnic differences.     

Assessment of the impact of BCG vaccination on tuberculosis incidence in south Asian adult immigrants

Although BCG vaccination is recommended for tuberculin negative adult immigrants, there has hitherto been no evidence of its efficacy in this group. This epidemiological study compares the incidence of tuberculosis in a cohort of South Asian adult immigrants vaccinated on entry to the UK with its incidence in cohorts of immigrants of the same age and origin estimated from the five-yearly national surveys. Results suggest that BCG vaccine may have reduced the incidence of tuberculosis by up to 87.6% (95% confidence interval 55.2% to 98.5%) and support the current recommendation to vaccinate this high-risk group.     

Hepatitis C virus infection in a population with high incidence of type 2 diabetes: impact on diabetes complications

A growing number of reports suggest a connection between hepatitis C virus (HCV) infection and type 2 diabetes (T2D). However, the association of HCV infection with diabetes-related complications has not yet been clarified. The aim of this study was to determine the prevalence of HCV infection in T2D-patients in Kuwait which has a high incidence of type 2 diabetes, and to investigate the association between HCV viremia and diabetes-related complications. A total of 438 patients with T2D (325 Kuwaitis and 113 Egyptians), and 440 control subjects, were enrolled for this study. HCV infection was assessed by testing for serum HCV-specific antibodies, and by detection of HCV RNA. HCV viral load and hemoglobin A1c (HbA1c) levels were assessed in patients with and without diabetes complications. Thirty one (7%) out of 438 T2D-patients had evidence of HCV infection compared to 4 (1%) out of 440 control adults (p<0.0001). The prevalence of HCV infection in Kuwaiti and Egyptian T2D-patients was 3% and 18%, respectively. Most of the HCV sequences detected in T2D patients and control subjects were of genotype 4. The HbA1c levels in T2D-patients with HCV viremia were significantly higher than those in HCV-negative patients. HCV viremia, female sex, age, family history of diabetes were found to be independent risk factors for diabetes complications. The results suggest that T2D-patients in Kuwait have higher prevalence of HCV infection than controls, and that HCV viremia is associated with diabetes-related complications.     

Increased incidence of insulin-dependent diabetes mellitus following an epidemic of Coxsackievirus B5.

In order to address the hypothesis that coxsackievirus B5 is a cause of insulin-dependent diabetes mellitus (IDDM), the incidence of IDDM was examined following an epidemic of coxsackievirus B5 in Jefferson County, Alabama. Incidence estimates were obtained from a registry of IDDM which was maintained in the county since 1979. A total of 266 cases were diagnosed (69 black and 197 white individuals less than 20 years of age) between 1979 and 1988. Significant increases in incidence were observed in both races, corresponding temporally to the epidemic of coxsackievirus B5 which occurred in 1983. The overall incidence in the year beginning July 1983, the month of the first isolation of coxsackievirus B5, was 18.4/100,000 person-years, an excess of 6.7/100,000 person-years over the average annual incidence for the previous 4 years. The increase was greatest in females and among all children aged 10-14 years. This study provides support for the role of coxsackievirus B5 in the multifactorial etiology of IDDM, and suggests a possible basis for the increased incidence of IDDM reported around the world in the early 1980s.     

Trends in the prevalence and incidence of diabetes: non-insulin-dependent diabetes mellitus

The revision of the classification of diabetes mellitus, to differentiate clearly between insulin-dependent (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM), and the provision of unambiguous guidelines for diagnosis (1) constitute important recent developments in diabetes epidemiology. However, our knowledge even of the prevalence of NIDDM remains surprisingly incomplete for many areas of the world. Whilst NIDDM may still be uncommon in rural Africa, prevalence has been reported as approximately 10% in blacks in the United States, indicating a need for more information regarding the prevalence of NIDDM in urban Africa. There is also little information with regard to urban communities in Latin America. The highest prevalence of NIDDM is found in certain indigenous North American and Western Pacific societies. In extreme cases approximately one-third of the adult population now suffers from the disease. NIDDM is also common (prevalence approximately 5%) in Europe and in communities of European origin. Data from the United States suggest that approximately one-fifth of white North Americans can expect to develop NIDDM if they live to the seventh decade of life. Of populations of South-East Asian ethnicity, Indians appear to be the most susceptible. Indian migrants to Fiji, South Africa and South America all demonstrate prevalence of NIDDM of 10% or more. Whilst it was formerly believed that Chinese were rarely affected by NIDDM, recent reports cast some doubt on this. Prevalence of NIDDM in the Western Pacific varies widely. However, with the possible exception of certain Melanesian populations, prevalence is high in all communities which have abandoned their traditional lifestyle.(ABSTRACT TRUNCATED AT 250 WORDS)     

Ageing populations and childhood infections: the potential impact on epidemic patterns and morbidity

BACKGROUND: Population decline, arising from below replacement fertility and possibly giving rise to substantial changes in age distribution, is a feature of many industrialized developed countries; Italy is one of the most notable European examples. The potential influence of this phenomenon on prevalence of chronic non-infectious disease is well known, but little attention to date has been paid to the impact on severe disease due to childhood infections in those cases where control is insufficient to achieve elimination. METHODS: A transmission dynamics model incorporating realistic demography is used to investigate the possible impact of population decline and ageing and suboptimal vaccination uptake on the age distribution of incidence of measles infection and of consequent mortality. Data from Italy is used to parameterize the model. RESULTS: Population ageing in the absence of vaccination is shown to reduce per capita incidence of infection but also to increase average and upper quartile ages at infection. The effect is substantially enhanced by significantly suboptimal vaccination uptake, when disease-induced mortality has, for a period, the potential to exceed that in the absence of vaccination. CONCLUSIONS: Although a substantially increased burden from chronic non-infectious disease has frequently been proposed as a consequence of population decline, there is also potential for an increase in morbidity and mortality from measles and other childhood infectious diseases, particularly where vaccine uptake is substantially below the optimum. Rubella is highlighted as a particular cause for concern. This work also has implications for less-developed countries.     

Trends in the prevalence and incidence of diabetes: insulin-dependent diabetes mellitus in childhood

The results of this international collaboration emphasize the importance of population-based incidence registries which, similarly to cancer research, became an indispensable tool in etiological investigation and health-delivery planning in the area of insulin-dependent diabetes mellitus (IDDM). Future collaboration within the DERI project will help to monitor the geographical and temporal variability of IDDM incidence. This collaborative effort may provide a frame for more detailed international studies of etiology and natural history of the disease, as well as for evaluation of the costs of IDDM and future prevention programmes.     

耐多药结核的流行概况

耐多药结核是目前全球结核病控制工作最主要威胁之一,其治疗失败率高,预后差,有成为不治之症的可能。本文就耐多药结核的耐药机制、流行概况等方面进行阐述,并提出防治原则,以利于最终能有效控制结核病的流行。     

Transmissibility and mortality impact of epidemic and pandemic influenza, with emphasis on the unusually deadly 1951 epidemic

There are important gaps in our current understanding of the influenza virus behavior. In particular, it remains unclear why some inter-pandemic seasons are associated with unusually high mortality impact, sometimes comparable to that of pandemics. Here we compare the epidemiological patterns of the unusually deadly 1951 influenza epidemic (A/H1N1) in England and Wales and Canada with those of surrounding epidemic and pandemic seasons, in terms of overall mortality impact and transmissibility. Based on the statistical and mathematical analysis of vital statistics and morbidity epidemic curves in these two countries, we show that the 1951 epidemic was associated with both higher mortality impact and higher transmissibility than the 1957 and 1968 pandemics. Surprisingly in Liverpool, considered the 'epicenter' of the severe 1951 epidemic, the mortality impact and transmissibility even surpassed the 1918 pandemic.