An epidemiological study of childhood diabetes affecting two or more siblings

Summary The incidence, prevalence, and ages and dates of onset of diabetes, were studied in 184 families with 2 or more affected children. Results suggested that the siblings of children who developed diabetes before the age of 16 years were 26 times more likely to develop diabetes than other children. Of all siblings surveyed it was estimated that 5.6% became diabetic by the age of 16. The distribution of ages at onset in these siblings was similar to that in the general population, and within sibships, age at onset appeared to be independently determined. An interval of less than a year between the dates of onset in siblings occurred with more than twice the expected frequency, and in most the interval was less than 6 months. These results suggest that age at onset is determined by non-genetic factors and that, in at least some cases, aetiological environmental factors may lead to the development of diabetes within a period of a few months.     

广东城镇居民消化不良的流行病学调查

目的探讨广东地区城镇居民消化不良的流行病学情况。方法采用整群随机抽样方法对广州市及顺德市普通居民３２３４人进行问卷调查，同时问卷调查内科普通门诊１３３０例连续病例及消化专科门诊４７３例连续病例。结果广东地区城镇居民消化不良患病率为１８９２％，消化不良患病率随年龄增长而升高，至５０～５９岁年龄组达到高峰（２７５０％），女性患病率（２０３８％）高于男性（１７３７％）（Ｐ＜００５）。以消化不良为主诉的病人占普通内科门诊的１１０５％，占消化专科门诊的５２８５％。消化不良各亚型的构成比为动力障碍型３７３％，溃疡型２０９％，反流型６７％，非特异型３５１％。消化不良合并肠易激综合征症状占２３６９％，高于无消化不良症状者的６５２％（Ｐ＜０００１）。结论广东地区城镇居民消化不良患病率与国外报道相近。     

Epidemiology of Type I diabetes mellitus in Switzerland: steep rise in incidence in under 5 year old children in the past decade

Aims/hypothesis. In this nationwide prospective study we wanted to verify the trend of increasing diabetes incidence data from our earlier retrospective analysis of the military registry of Swiss men. Subjects and methods. The data collection of newly diagnosed children in Switzerland at an age younger than 15 years started in 1991. The countrywide survey used a small questionnaire which was sent back to the study centre. The questionnaire was anonymous and contained: hospital of diagnosis, initials, sex, birth date, date of diagnosis, residence, country of citizenship, and responsible physician. General data on the population were taken from publications of the Swiss Federal Statistical Office. Results. A total of 941 children below the age of 15 years with newly diagnosed Type I (insulin-dependent) diabetes mellitus were collected (434 girls, 507 boys). The incidence in children aged 0 to 14 years rose significantly between 1991 and 1999 with a yearly average increase of 5.1 %. In the age group 0 to 4 years a more than four-fold increase in incidence from 2.4/100 000 per year to 10.5/100 000 per year (p = 0.0002) was recorded, whereas the age-specific incidence in the 5 to 9-year-old and 10 to 14-year-old children did not change during the data collection period. The incidence was significantly higher in boys than in girls, whereas no difference was found between rural and urban populations. Conclusion/interpretation. The incidence of Type I diabetes is rising in children living in Switzerland but only the youngest age group of under 5 years of age is affected showing a large annual average increase of 23.8 %. [Diabetologia (2001) 44: 286–289] Received: 7 September 2000 and in revised form: 25 October 2000     

A population-based study of the incidence of complications associated with type 2 diabetes in the elderly.

One hundred and eighty-eight known Type 2 diabetic patients aged over 60 years identified by a geographically based survey of a population of 40,076 were followed for a median of 6 years to determine the incidence of various complications. There were 63 deaths and two patients were lost to follow-up. The presence of complications was determined using a structured questionnaire and clinical examination. Incidence rates of ischaemic heart disease, stroke, and peripheral vascular disease (PVD) were 56 (95% CI 41-75), 22 (13-35), and 146 (117-174) 1000-person-years-1 of follow-up, respectively. Rates of stroke and PVD rose significantly with age. Retinopathy occurred at a rate of 60 (42-83) 1000-person-years-1 and cataract at 29 (17-46) 1000-person-years-1 although visual acuity in survivors did not deteriorate overall, probably reflecting the high mortality associated with cataract. The rate of proteinuria (albumin concentration greater than 300 mg l-1) was 19 (9-34) 1000-person-years-1. Incidence rates were unrelated to sex or duration of diabetes. Diabetes is associated with a continuing incidence of complications into old age. Adequate facilities are required to assess and treat the resulting morbidity in a population with an increasing proportion of elderly people.     

Trends in the incidence of childhood diabetes in south Asians and other children in Bradford, UK.

AIMS: To investigate incidence rates and time trends, over 21 years, of Type 1 diabetes in a migrant population of south Asian children in Bradford, UK. METHODS: Children (0-14 years) living in the city of Bradford and diagnosed with Type 1 diabetes were selected from a population-based region-wide register. Between 1978 and 1998, 289 new-onset cases were registered and classified as south Asian (Indian, Pakistani, Bangladeshi) or not, based on their full name using two different computer algorithms and visual inspection. RESULTS: Sixty-six children (22.8%) were designated as south Asian with 223 (77.2%) remaining. The overall age-sex standardized incidence for south Asian and non-south Asian children was 13.0 per 100,000 person years (95% confidence interval 9.9-16.2) and 12.9 (11.2-14.6), respectively. Rates were similar for south Asians at all ages, whereas for the mainly Caucasian children incidence differed significantly by age group (P < 0.001). An average annual increase in incidence of 4.3% (P = 0.001) was seen for all children compared with 6.5% in south Asians (P = 0.002) and 2.4% (P = 0.128) in non-south Asians. CONCLUSIONS: Children in south Asia have a low incidence of Type 1 diabetes but migrants to the UK have similar overall rates to the indigenous population. However, a more steeply rising incidence is seen in the south Asian population, and our data suggest that incidence in this group may eventually outstrip that of the non-south Asians. Genetic factors are unlikely to explain such a rapid change, implying an influence of environmental factors in disease aetiology. The similarity in rates by age group in the south Asian population is notable.     

The incidence of Type 1 (insulin-dependent) diabetes in Toronto

Summary An incidence of 9.0 out of 100,000 children under 19 years of age with Type 1 (insulin-dependent) diabetes was detected in Toronto during a 2 year prospective study. An increased number of cases occurred in the winter months of one of the years but not of the other during the study. The annual incidence was the same in each year. There were slightly more boys than girls but this was not significant. The diabetic children were significantly younger than their non-affected siblings. The incidence of Type 1 diabetes in Toronto is similar to other North American studies.     

Gangliosides in vivo reduce diabetes incidence in non-obese diabetic mice

Summary Non-obese diabetic mice were treated daily with a mixture of ganliosides from day 30 until day 250 of life or until the mice became diabetic. Ganglioside treatment reduced diabetes incidence from 80–90% to 47% and from 20–30% to zero in female and male mice respectively. Gangliosides did not affect the frequency of perivasculitis. It is concluded that gangliosides can reduce diabetes incidence in non-obese diabetic mice.Deceased     

Further evidence for the rising incidence of childhood Type 1 diabetes in Kuwait.

AIMS: To provide age-gender standardized incidence rate, temporal trend and seasonal variation of Type 1 diabetes in Kuwaiti children aged < or = 14 years. METHODS: Data were prospectively collected over a period of 6 years (1992-1997) according to the DiaMond Project protocol using the capture-recapture method of ascertainment. RESULTS: Data ascertainment varied between 90% and 96%. The incidence rate of Type 1 diabetes was 20.1 per 100,000 children 0-14 years (95% confidence interval (CI) 18.0-22.1); age-standardized incidence rate 20.9 (95% CI 18.8-23.0). The incidence rate among boys, 21.1 per 100,000 (95% CI 18.1-24.1) was slightly higher than that among girls, 19.0 per 100,000 (95% CI 16.1-21.8). The age-standardized incidence rate was 21.9 (95% CI 18.9-24.8) in boys, and 19.9 (95 CI 17.1-22.8) in girls. Incidence rates increased with age in both sexes (boys chi(2) for linear trend = 13.5, P < 0.001; and for girls chi(2) = 27.8, P < 0.0001). There was a significant trend towards increase in overall incidence during the 6-year period (chi(2) = 6.210, P = 0.013), and in age group 5-9 (chi(2) = 10.8, P = 0.001). Seasonality was demonstrated overall, in boys and girls (P < 0.001). CONCLUSION: The incidence of Type 1 diabetes in Kuwait is high compared with the neighbouring Arab countries, and it appears to be increasing as in many European populations.     

Unchanged incidence of diabetic nephropathy in Type 1 diabetes: a nation-wide study in Iceland.

AIMS: Diabetic nephropathy is an uncommon cause of end-stage renal disease in Iceland in contrast to most industrialized countries. The aim of this study was to examine the incidence of diabetic nephropathy in Iceland. METHODS: All patients diagnosed with Type 1 diabetes in Iceland before 1992 were studied retrospectively. Patients diagnosed before age 30, who were insulin dependent from the onset, were defined as having Type 1 diabetes. Diabetic nephropathy was defined as persistent proteinuria measured with a dipstick test (Albustix) on three consecutive clinic visits at least 2 months apart. Patients were followed to the end of year 1998, to their last recorded outpatient visit, or until death. The cumulative incidence of diabetic nephropathy was calculated with the Kaplan-Meier method and presented according to the duration of diabetes divided into 5-year intervals. RESULTS: A total of 343 patients with Type 1 diabetes were identified. The mean follow-up period was 20.2 +/- 11.4 (mean +/- sd) years. Only 9.3% of patients were lost to follow-up. Sixty-five patients developed diabetic nephropathy. The cumulative incidence was 22.6% at 20 years and levelled off at 40.3% after approximately 35 years of diabetes duration. No significant changes in cumulative incidence were observed over time. Mean glycated haemoglobin was 8.4% in patients with proteinuria and 7.8% in a group of patients without proteinuria that was matched for age, gender and duration of diabetes (P = 0.04). CONCLUSIONS: The cumulative incidence of diabetic nephropathy in Iceland is comparable with previously reported cumulative incidence rates and has remained unchanged. Glycaemic control was significantly better in patients without proteinuria.     

Predicting the 20-year diabetes incidence rate

BACKGROUND: The long-range prediction from clinical variables of the onset of diabetes is important to patients and clinicians. Our objective was to evaluate the efficacy of various glucose-related clinical measurements in predicting the 20-year risk of developing type 2 diabetes (T2DM) in an elderly population. METHODS: In a prospective study, 672 men and women aged 59-92 years, who were not diabetic in 1980 and were part of a nationwide longitudinal randomized study, were followed-up in 2000-2003. Fasting glucose, 1- and 2-h post-oral glucose tolerance and insulin were measured in 1980 and 2000-2003. RESULTS: A group of 174 (25.9%) survivors had progressed to diabetes during the 20-year follow-up. Fasting glucose values were a good predictor for diabetes. With the 100 mg/dL cut-off of impaired fasting glucose (IFG), a 2-4-times higher predictive sensitivity followed the dramatic increase in IFG prevalence compared to the 110 mg/dL cut-off, but at a cost of reduced specificity and positive predictive value (PPV). By receiver operating curve (ROC) analysis, a 1-h post-load glucose was similar to 2 h and fasting glucose in prediction of the 20-year incidence of diabetes, and classifying correctly the 77, 74 and 73% of the group, respectively. In adjusted logistic regressions, 2.28, 1.78 and 1.69-folds increased the 20-year risk, and were associated with each SD increment of the respective glucose values (p < 0.001). CONCLUSIONS: Although the best population-based strategy for the diagnosis of T2DM would be the combination of fasting glucose followed by post-load glucose, for the purposes of long-term prediction of T2DM risk, fasting glucose is sufficient.     

Prevalence and incidence of diabetes in a Swedish community 1972-1987.

The prevalence and incidence of diabetes mellitus were studied from 1972 to 1987 in Laxå, a rural community with 8500 inhabitants located in mid-Sweden. Data were collected from clinical records at the primary health care centre in Laxå, from departments of internal medicine and paediatrics and from a general practitioner's office in the area. In addition, a case finding procedure involving 85 % of the residents aged 35–79 years was performed in 1983–1987. The age-standardized prevalence of diabetes rose significantly (p < 0.001) from 26 per 1000 in 1972 to 43 per 1000 in 1987. The largest rise in prevalence for males occurred in the age group 45–54 years and for females in the age group 65–74 years. The age-standardized mean annual incidence of diabetes was 3.46 per 1000 population. A small (non-significant) increase in incidence of Type 2 diabetes over time was seen in men which may in part be an effect of the case finding strategy. The overall incidence rates thus appeared to be rather stable while the prevalences tended to increase, probably mainly due to earlier detection of diabetic individuals in recent years, leaving a larger number of patients with a longer duration of diabetes to be cared for in the future.     

Clinical epidemiological analysis of the relationship between pancreatic cancer and diabetes mellitus: Data from a single institution in China

OBJECTIVE: To investigate the relationship between pancreatic cancer (PC) and diabetes mellitus. METHODS: All PC patients diagnosed and treated at Zhongshan hospital from January 1991 to December 2007 were retrospectively analyzed. During this period, 770 non‐digestive tract, non‐neoplastic and non‐hormone‐related patients matched for sex and age were collected as controls. The incidence of diabetes mellitus between the two groups was compared. RESULTS: Between the PC group and the control group, sex and age of the patients were well matched. The incidence of diabetes mellitus was 34.63% in the PC group and 8.83% in the control group (P < 0.001, RR = 5.19). In the PC group there was no correlation between age, sex, site of the cancer, tumor differentiation, lymph node metastasis, TNM staging and the incidence of diabetes mellitus. In this group with diabetes, 74.56% experienced onset within two years of cancer diagnosis. Of the control patients, 57.35% had had diabetes for under 2 years (P = 0.009, RR = 2.18). In the PC group with diabetes, 5.9% had had diabetes for more than 10 years while compared with 8.8% of the controls (P = 0.42). CONCLUSION: Whether diabetes mellitus is a result of or a risk factor for PC is still unclear. The incidence of diabetes mellitus is much higher in the PC patients. The onset of diabetes mellitus in adults might be an alerting factor that could lead to an early diagnosis of pancreatic cancer.     

Ethnic disparities in the association of impaired fasting glucose with the 10-year cumulative incidence of type 2 diabetes

Aims

Evidence of ethnic disparities in the conversion of prediabetes to type 2 diabetes is scarce. We studied the association of impaired fasting glucose (IFG) and fasting plasma glucose (FPG) with the 10-year cumulative incidence of type 2 diabetes in three ethnic groups.

Methods

We analyzed data for 90 South-Asian Surinamese, 190 African-Surinamese, and 176 ethnic Dutch that were collected in the periods 2001–2003 and 2011–2012. We excluded those with type 2 diabetes or missing FPG data. We defined baseline IFG as FPG of 5.7–6.9 mmol/L. We defined type 2 diabetes at follow-up as FPG ≥ 7.0 mmol/L, HbA1c ≥ 48 mmol/mol (6.5%), or self-reported type 2 diabetes.

Results

10-Year cumulative incidences of type 2 diabetes were: South-Asian Surinamese, 18.9%; African-Surinamese, 13.7%; ethnic Dutch, 4.5% (p < 0.05). The adjusted association of baseline IFG and FPG with the 10-year cumulative incidence of type 2 diabetes was stronger for South-Asian Surinamese than for African-Surinamese and ethnic Dutch. The IFG (compared to normoglycaemia) ORs were 11.1 [3.0–40.8] for South-Asian Surinamese, 5.1 [2.0–13.3] for African-Surinamese, and 2.2 [0.5–10.1] for ethnic Dutch.

Conclusions

The 10-year cumulative incidence of type 2 diabetes was higher and associations with baseline IFG and FPG were stronger among South-Asian Surinamese and African-Surinamese than among ethnic Dutch. Our findings confirm the high risk of type 2 diabetes in South-Asians and suggest more rapid conversion in populations of South-Asian origin and (to a lesser extent) African origin than European origin.     

Continuous rise in incidence of childhood Type 1 diabetes in Germany

Aims To assess the incidence and the trend in incidence of Type 1 diabetes (T1DM) in children and adolescents < 15 years of age in Baden‐Württemberg (BW), Germany. Methods BW is Germany's third largest federal state. All 31 paediatric departments in BW and one diabetes centre participated in the study. Case registration was done according to the EURODIAB criteria. The degree of ascertainment was 97.2%. Results From 1987 to 2003, the age‐ and sex‐standardized incidence rate was 14.1/100 000 per year [95% confidence interval (CI) 13.7, 14.6, n = 4017]. The estimated annual increase in incidence was 3.8% (95% CI 1.1, 6.6). Compared with the first years of our registry, the current mean number of new cases of T1DM has doubled (1987–1989, n = 153; 2000–2003, n = 302). Generally, the highest rise in incidence occurred in the youngest age group of 0–4‐year‐old patients (5.8%; 95% CI 2.5, 9.3), followed by the age groups 5–9 (3.4%; 95% CI 0.8, 6.0) and 10–14 (2.7%; 95% CI 0.3, 5.1). Conclusions In Germany, the number of children and adolescents with new‐onset T1DM has been rising at a faster pace than expected. A distinct shift to younger age at onset has been observed in Germany.     

Racial differences in incidence of juvenile-onset Type 1 diabetes: epidemiologic studies in southern California

Summary We have studied the epidemiologic characteristics of insulin-dependent (Type 1) diabetic patients aged 0–19 in a city (San Diego, southern California, USA) characterized by an impressive racial diversity and especially mild and constant climatic conditions. Ascertainment was through retrospective review of medical records in 19 hospitals. For the 3 years 1978–1981 the mean annual incidence of diabetes was 7.3 cases/100,000, with no statistical difference between the sexes. The observed incidence rates in the various ethnic groups was significantly different from expected (p<0.03), with an excess of cases among Caucasians and fewer than expected cases among Mexicans, Blacks and Orientals. There was no identifiable seasonal trend. Some of the clinical char acteristics at diagnosis differed between the sexes: males were slightly older (9.3±5.2 years versus 8.8±3.9 for females), had a shorter duration of diabetes-related symptoms and a higher frequency of infections both at the time of diabetes diagnosis and in preceding months. Females tended to have a higher frequency of Type 1 diabetes in first-degree relatives. This study documents for the first time that, among multiple racial groups living in the same environment, Caucasians are at the highest risk of developing juvenile-onset Type 1 diabetes.