Increasing incidence of childhood‐onset type 1 diabetes mellitus among Estonian children in 1999–2006. Time trend analysis 1983–2006

Teeäär T, Liivak N, Heilman K, Kool P, ?or R, Paal M, Einberg Ü, Tillmann V. Increasing incidence of childhood‐onset type 1 diabetes mellitus among Estonian children in 1999–2006. Time trend analysis 1983–2006. Background: The incidence of childhood‐onset type 1 diabetes mellitus (T1DM) among Estonian children under 15 years of age was 10.1 per 100 000 per year in 1983–1990 and 12.2 per 100 000 per year in 1991–1998 with the highest incidence in age‐group 10.0–14.9 years in both periods. From 1983 to 1998, the incidence increased most rapidly in age‐group 0–4.9 years. Objective: To determine the incidence of T1DM among Estonian children in 1999–2006 and to compare the results with the data from 1983 to1998. Subjects and methods: In 1999–2006, population‐based incidence data were collected from two centers where all children with T1DM are seen after the diagnosis. Data for earlier periods were obtained from previously published data. Subjects were divided into three age‐groups: 0–4.9 years, 5.0–9.9 years and 10.0–14.9 years. Results: Between 1999 and 2006, 310 new cases of T1DM were diagnosed in Estonian children aged 0–14.9 years. The age‐standardized incidence rate for that period was 17.2 [95% confidence interval (CI) 13.1–21.2]. The incidence was the highest, 21.2 (95% CI 17.7–25.3) in age‐group 5.0–9.9 years. Over the time period 1983–2006, the incidence of childhood‐onset T1DM in Estonian children under 15 years of age increased annually by an average 3.3% with the most rapid annual increase–9.3%–occurring in the youngest age‐group. Conclusions: The incidence of childhood‐onset T1DM in Estonia continues to rise and the age of onset of the disease becomes younger.     

Health‐related and diabetes‐related quality of life in Japanese children and adolescents with type 1 and type 2 diabetes

Background: The aim of this study was to assess (i) the health‐related quality of life (HR‐QOL) of primary, junior and high school children with type 1 and type 2 diabetes and to compare it with that of healthy school children; and (ii) to compare the diabetes‐related QOL (DR‐QOL) and the QOL of parents of children with diabetes, between type 1 and type 2 diabetes in Japan. Methods: Overall, 471 patients aged 9–18 years (368 with type 1 and 103 with type 2 diabetes) and their parents were involved. QOL was assessed using a self‐administered questionnaire. Results: The total score for HR‐QOL of primary and junior school children with type 1 diabetes was significantly higher than that of those with type 2 diabetes and healthy controls. However, there were no significant differences in high school children. Some subscales regarding HR‐QOL were significantly lower for children with type 2 diabetes than for children with type 1 diabetes or healthy controls. The DR‐QOL of children with type 1 and type 2 diabetes did not significantly differ. The Family Burden and Family Involvement were significantly greater in parents of children with type 1 diabetes. There were significantly positive correlations between HR‐QOL and DR‐QOL in both groups. In type 1 diabetes only, there were significant negative correlations between glycated hemoglobin and some subscales of the HR‐QOL and QOL of parents of children with diabetes, and weak positive correlation between glycated hemoglobin and Family Burden. Conclusions: The HR‐QOL of school children with type 1 diabetes was higher than that of those with type 2 diabetes and healthy school children. The QOL of school children with type 1 diabetes was not impaired.     

Contribution of income to self‐management and health outcomes in pediatric type 1 diabetes

Low income has been established as a risk factor for poorer outcomes in youth with type 1 diabetes; however, the effect of moderate income has not been studied. The purpose of this secondary analysis of baseline data from a multi‐site study was to compare glycemic control, self‐management, and psychosocial outcomes [depression, stress, and quality of life (QOL)] at different income levels in adolescents with type 1 diabetes. Youth (n = 320, mean age = 12.3 + 1.1, 55% female, 64% white, mean A1C = 8.3 ± 1.4) completed established self‐management and psychosocial measures. A1C levels were collected from medical records. Caregivers reported annual family income, categorized as high (>$80K), moderate ($40–80K), or low (<$40K). Youth from high‐income families had significantly lower A1C (mean = 7.9 ± 1.2) than those from the moderate‐income group (8.6 ± 1.7, p < 0.001) or the low‐income group (mean A1C = 8.6 ± 1.5, p = 0.003). Youth from the high‐income group reported significantly better diabetes problem solving and more self‐management goals than those from the moderate‐ or low‐income groups (both p < 0.01). Youth from the high‐income group also reported significantly fewer symptoms of depression, lower levels of perceived stress, and better QOL than those in the moderate or low‐income groups (all p < 0.05). Multivariate linear regression models were used to test psychological and behavioral predictors of A1C and QOL. Parents' education status (p < 0.05) and self‐management activities (p < 0.01) were significant predictors of hemoglobin A1c, while income (p < 0.01) and self‐management activities (p < 0.05) were significant predictors of QOL.