Rising incidence of type 1 diabetes mellitus in children and adolescents in Cyprus in 2000-2004

Introduction:  The incidence of type 1 diabetes mellitus (T1DM) has dramatically increased recently in some countries.
Aim:  To ascertain any changes in the incidence of T1DM in our population during the years 1990–2004.
Methodology:  All newly diagnosed cases of T1DM children under the age of 15 yr were registered and relevant information was obtained. Population demographic data based on the most recent census were used for calculations.
Results:  The overall mean annual incidence of T1DM during this 15-yr period was 11.9/100 000 person-years, with a statistically significant increase in the third 5-yr period (14.9/100 000 person-years).
The incidence during the first (1990–1994) and second (1995–1999) 5-yr periods was 10.5/100 000 person-years (p < 0.001). The overall male:female ratio was 0.94. Seasonal distribution for the first and second 5-yr periods revealed a higher incidence during winter and autumn months. Seasonal variation, however, disappears in the third 5-yr period, where no differences were found between the four seasons.
Conclusion:  The incidence of newly diagnosed T1DM cases has increased during 2000–2004. A seasonal variation during the first and second 5-yr periods was no longer observed in the third 5-yr period.     

The incidence of type 1 diabetes mellitus in Greek-Cypriot children and adolescents in 1990-2000

Abstract: Objectives: To ascertain the exact incidence of type 1 diabetes mellitus (DM1) in Greek‐Cypriots under the age of 15 yr, to analyze possible gender differences in the age of onset and to observe any seasonal variation in the manifestation of the disease. Research design and methods: All cases of newly diagnosed DM1 patients under the age of 15 yr from 1990 to 2000 were collected and relevant information was obtained. The data were statistically processed in relation to the population data provided by the Department of Statistics and Research of the Ministry of Finance. Results: The mean annual incidence of DM1 in the Greek population of Cyprus under the age of 15 yr for the period 1990–2000 is 11.32/100 000. There is a trend towards increasing incidence during this period. There is a gender influence on the age of onset: more males develop DM1 before the age of 6 yr and after 13 yr. Moreover, there is a gender difference in the group who manifest DM1 in the age range 5–9 yr, with females having a mean age of onset of 8.1 yr, compared with 7.3 yr for males. There is a statistically significant seasonal variation, but not among preschool subjects who manifest DM1 before the age of 4 yr. Conclusions: DM1 is a common condition in Greek‐Cypriots under the age of 15 yr. The gender difference in the age of onset probably reflects the peripubertal period of each gender. The seasonal variation cannot be solely attributed to weather and temperature changes. This survey covers a 10‐yr period and deals with an adequate number of reported cases; therefore, it could contribute to the international effort to determine the exact pathogenesis of DM1.     

The incidence of hypoglycaemia in children with type 1 diabetes and treated asthma.

AIMS: To investigate whether treatment of coexisting asthma has any effect on the incidence of hypoglycaemia and on glycaemic control in children with type 1 diabetes. METHODS: An observational study of children attending the paediatric diabetes clinics of five hospitals in the North Trent Region. Information on the frequency of hypoglycaemia in the preceding three months, treatment for asthma, and the individual's latest HbA1c, was recorded when they attended for review. RESULTS: Data were collected on 226 children, of whom 27 (12%) had treated asthma. Only 11/27 children with asthma were taking their prescribed inhaled steroids. All used beta agonists at least once a week. There was a reduction of 20% in the incidence of hypoglycaemia in the diabetic children with treated asthma. Of the children with diabetes and treated asthma, 52% reported an episode of hypoglycaemia in the previous three months compared to 72% of those with only diabetes. There was no difference in the proportion of children experiencing nocturnal or severe hypoglycaemia. Although not significant, those with asthma and diabetes also had better overall control (HbA1c 8.8%) compared to those with diabetes alone (HbA1c 9.3%). CONCLUSIONS: Diabetic children with treated asthma have significantly fewer episodes of hypoglycaemia and better glycaemic control compared to children with diabetes alone. This observation needs further investigation but raises an interesting question. Do the drugs used to treat asthma, in particular beta agonists, have the therapeutic potential to reduce hypoglycaemia and facilitate an improvement in glycaemic control?     

Increase in the incidence of type 1 diabetes mellitus in children in three cities in Poland, 1987-1999

The aim of this study was to evaluate the trends in the incidence of type 1 diabetes mellitus (DM) in children aged 0-14 years between 1987 and 1999 in three cities in Poland. The study area comprised the provinces of Cracow and Wroclaw and the city of Warsaw. The data were collected prospectively on the basis of the register within the framework of the EURODIAB study up till 1997 and then within the project of the Ministry of Health. During the 13 years of the study period, 766 children (380 girls, 386 boys) with newly diagnosed type 1 DM were identified. The overall age-standardized incidence rates were 8.4/100,000 standardized population/year (95% CI 7.4-9.3) for Cracow province, 6.5/100,000/year (95% CI 5.6-7.4) for Wroclaw province and 7.9/100,000/year (95% CI 6.9-8.8) for Warsaw. A significant trend of increase for children aged 0-14 years was found in the three cities. The analysis of the trend in age subgroups showed a significant increase in incidence in all three age subgroups in Warsaw and Cracow province (0-4 year-old children, p <0.05; 5-9 year-olds, p <0.001 in Cracow province, p <0.05 in Warsaw, and in 10-14 year-olds, p <0.05 in Cracow province, p <0.005 in Warsaw). In the Wroclaw province a significant increase was observed in children aged 0-4 years (p <0.05) and 5-9 years (p <0.001). In children aged 10-14 years the increase was not statistically significant. The results of our study showed that the incidence of type 1 DM in children is rising. A similar phenomenon is occurring in many other countries. The greatest increase of incidence was observed in the 5-9 year-old subgroup of children in Cracow and Wroclaw provinces and in children aged 10-14 years in Warsaw. The incidence rates in excess of 9.0/100,000 per year observed since 1996 have placed Poland in the group of countries with low to medium incidence.     

The incidence of hypoglycaemia in children with type 1 diabetes and treated asthma

Methods: An observational study of children attending the paediatric diabetes clinics of five hospitals in the North Trent Region. Information on the frequency of hypoglycaemia in the preceding three months, treatment for asthma, and the individual''s latest HbA1c, was recorded when they attended for review. Results: Data were collected on 226 children, of whom 27 (12%) had treated asthma. Only 11/27 children with asthma were taking their prescribed inhaled steroids. All used ß agonists at least once a week. There was a reduction of 20% in the incidence of hypoglycaemia in the diabetic children with treated asthma. Of the children with diabetes and treated asthma, 52% reported an episode of hypoglycaemia in the previous three months compared to 72% of those with only diabetes. There was no difference in the proportion of children experiencing nocturnal or severe hypoglycaemia. Although not significant, those with asthma and diabetes also had better overall control (HbA1c 8.8%) compared to those with diabetes alone (HbA1c 9.3%). Conclusions: Diabetic children with treated asthma have significantly fewer episodes of hypoglycaemia and better glycaemic control compared to children with diabetes alone. This observation needs further investigation but raises an interesting question. Do the drugs used to treat asthma, in particular ß agonists, have the therapeutic potential to reduce hypoglycaemia and facilitate an improvement in glycaemic control?     

Dynamic changes in the trends in incidence of type 1 diabetes in children in Hungary (1978-98)

Abstract: Objective: To determine the recent trends in incidence, to analyze the age and geographic distribution, as well as the seasonal pattern of type 1 diabetes in Hungarian children aged 0–14 yr for the period from 1978 to 1998. Methods: Primary ascertainment of cases was by retrospective (1978–88) and by prospective (1989–98) registration using hospital notifications. The level of ascertainment was estimated by the capture–recapture method. The temporal trend was estimated by fitting Poisson regression models to the yearly incidence data. Roger's test was used to investigate possible seasonal variation in time of diagnosis. Heterogeneity between geographic areas was assessed by Poisson regression. Results: A total of 2616 patients (1214 in the first 11 yr, 1402 in the remaining 10 yr) were identified; the male:female ratio was 0.93. The overall standardized incidence rate was 7.87 (95% CI = 7.57–8.18) per 100 000 person‐yr, the lowest in the youngest (0–4 yr) and highest in the oldest (10–14 yr) age group. There was an increasing trend in incidence with a largest relative annual increase in the youngest age group. Seasonal and regional variations in incidence were also observed. Conclusion: Our 21‐yr study shows dynamic changes in incidence of childhood type 1 diabetes in Hungary, probably reflecting changes in the environment.     

Soluble adhesion molecules in preclinical type 1 diabetes. The Childhood Diabetes in Finland Study Group

We measured the concentrations of the soluble forms of the intercellular adhesion molecule-1 (sICAM-1) and L-selectin in 95 autoantibody-positive siblings of children with type 1 diabetes and 95 sex- and age-matched siblings testing negative for diabetes-associated autoantibodies to assess the possible role of soluble adhesion molecules as markers of progressive ss-cell destruction in preclinical diabetes and their ability to discriminate between those siblings who progress to clinical disease and those who remain nondiabetic. We observed an inverse correlation between age and the levels of both sICAM-1 (r = -0.31, p < 0.001) and sL-selectin (r = -0.27, p < 0.001) in the control siblings but no association with HLA-DR phenotypes. There was no difference in the circulating levels of soluble adhesion molecules between the antibody-positive and negative siblings. Among the antibody-positive siblings, those with at least three autoantibodies had higher sICAM-1 levels (p < 0.01) than those testing positive for only one, and siblings with three autoantibodies or more had higher concentrations of sL-selectin (p < 0.01) than those with two autoantibodies. Siblings with an islet cell antibody level of 20 Juvenile Diabetes Foundation units or more had higher sICAM-1 concentrations than those with a level below 20 (p < 0.001), and those testing positive for antibodies to the protein tyrosine phosphatase-related IA-2 antigen had increased levels of both sICAM-1 (p = 0.03) and sL-selectin (p = 0.02) compared with siblings who tested negative. The antibody-positive siblings who progressed to clinical type 1 diabetes were significantly younger than the nonprogressors (p < 0.001) and had higher levels of sICAM-1 initially (p < 0.001). The difference in sICAM-1 concentrations remained significant (p = 0.03) after age adjustment. Our results indicate that concentrations of soluble adhesion molecules are increased in the autoantibody-positive siblings who have the highest risk of developing clinical diabetes, suggesting that ss-cell destruction is reflected in increased circulating levels of these molecules. This is supported by the observation of elevated sICAM-1 concentrations in the 29 siblings who actually progressed to clinical type 1 diabetes. Peripheral levels of soluble adhesion molecules are not able to discriminate between progressors and nonprogressors, however, due to substantial overlapping between these two groups.     

Time trend of childhood type 1 diabetes incidence in Lithuania and Sweden, 1983-2000

AIM: To compare the time trend of childhood type 1 diabetes over an 18-y period in Lithuania and Sweden--countries with different incidence levels and different socio-economic conditions. METHODS: Percent average incidence change per year between 1983 and 2000, based on 8031 Swedish and 1100 Lithuanian cases in the age group 0-14 y, was calculated using Poisson regression. RESULTS: Average age- and sex-standardized incidence/100 000/y was 28.9 (95% CI: 28.2-29.5) in Sweden and 7.5 (95% CI: 7.1-8.0) in Lithuania. Between 1983 and 2000, the average increase per year was 2.2% in Sweden (95% CI: 1.7-2.6) and 2.3% in Lithuania (95% CI: 1.1-3.5), but the latter trend depended on an increase during the last few years of the period, and only for girls. In Sweden, incidence increased significantly in all age groups, but more so in the younger groups (3.0%, 2.2% and 1.7% per year in 0-4, 5-9 and 10-14-y age groups, respectively), while in Lithuania a significant increase was found only in the 10-14-y age group (3.0%). In Sweden, a trend towards a younger age at diagnosis was indicated for both boys and girls when comparing 1983-1991 and 1992-2000, whereas in Lithuania, the changes in age distribution over time were small, with an opposite tendency for boys. CONCLUSION: Incidence variability over time differed considerably in the two countries in the region of the Baltic Sea, suggesting a complex effect of environmental risk factors, some of which may be associated with wealth and socio-economic conditions.     

The rising incidence of childhood type 1 diabetes in New South Wales, Australia

OBJECTIVES: 1. To determine the incidence of type 1 (insulin dependent) diabetes in children aged 0-14 years who were resident in the state of New South Wales, Australia over the period 1992-1996. 2. To analyse the trends in incidence over the period 1990-1996. METHODS: Primary ascertainment of patients was performed using a prospective incidence register established in 1990. The secondary source of ascertainment was the National Diabetes Supply Scheme, a government subsidised scheme for diabetic supplies. RESULTS: There were 1,230 patients identified over the five-year period. Using the capture-recapture method, ascertainment was estimated to be 99% complete. The lowest incidence occurred in 1992 (16.9 per 10(5) person years) and the highest incidence was in 1995 (21.7 per 10(5)). The crude incidence of IDDM from 1990-1996 was 17.8 per 10(5) and there was a statistically significant rise in the incidence of type 1 diabetes over this period (p=0.0003). The annual incidence has increased on average by 3.2% per year since 1990. CONCLUSION: The incidence of childhood type 1 diabetes in NSW has increased significantly since 1990.     

Marked increase in type 1 diabetes mellitus incidence in children aged 0-14 yr in Victoria, Australia, from 1999 to 2002

OBJECTIVES: The objectives of the study were to (i) determine the incidence of type 1 diabetes mellitus (T1DM) in children aged <15 yr in Victoria, Australia, from 1999 to 2002 and (ii) to analyze trends in incidence over this period. METHODS: Prospective population-based incidence study. The primary source of case ascertainment was from the Australasian Paediatric Endocrine Group (APEG) Victorian diabetes register. The secondary source was the National Diabetes Register (NDR), which ascertains cases from the National Diabetes Service Scheme (NDSS), a Commonwealth government initiative, where patients register to receive diabetes supplies at a subsidized price. MAIN OUTCOME MEASURES: Age-standardized incidence, trends in incidence by age, sex and year, and variation in incidence by region, season, and socioeconomic status. RESULTS: Case ascertainment was 99.1% complete using the capture-recapture method. The mean annual age-standardized incidence was 19.3 per 100 000 person years from 1999 to 2002. On average, incidence increased by 9.3% per year, with a greater relative increase in the 0-4 yr age-group (p = 0.037). No gender bias in incidence was found, but the increase in females was statistically significant (13.6% per year, 95% confidence interval 3.7-24.3). Variation in geographical distribution and seasonal onset of incidence was not statistically significant. CONCLUSIONS: The marked increase in the incidence of T1DM in Victoria is greater than that recently described in other Australia states and developed nations. The etiology of this rise is unclear, while the increased caseload has major implications for diabetes health care providers for current and future resource allocation.     

1997～2000年与1988～1996年北京地区儿童1型糖尿病发病率比较

目的 了解1997年～2000年北京地区儿童1型糖尿病发病翠,与1988～1996年的调查结果进行比较。方法 按照世界卫生组织(WHO)标准的捕获再捕获调查法,通过2个渠道搜集所有1997年1月1日～2000年12月31日新发病的北京地区15岁以下1型糖尿病儿童,按人口统计资料计算发病率,按2000年人口普查公布的结果计算年龄校正的发病率。泊松分布公式计算发病率的可靠性(95％可信限),卡方检验法检验发病率差异的显著性。结果 1997～2000年间,北京地区儿童1型糖尿病的年发病率波动在0．759／10万一1．215／10万之间,平均年发病率为1．014／10万,95％可信限为0．98／10万一1．16／10万。与1988～1996年比较,年粗发病率差异无显著性;按2000年普查资料,以年龄矫正后,发病率分别为o．83／10万和0．86／10万,差异无显著性。年龄比较依然为10～14岁组发病率高(P=0．002)。虽然女性较男性发病率高,但与北京地区前述的报告不同,男女发病率比较差异无显著性。结论1997～2000年北京地区儿童1型糖尿病平均年发病率为1n14／1n百导IORR～1q06正谰杏结果比较未见明显增高。     

Management of intracranial neoplasms in children with neurofibromatosis type 1 and 2. The Children's Cancer Study Group

The association of central nervous system neoplasms in neurofibromatosis is common and children are at particular risk. Recent advances in neurodiagnostic techniques allow for non-invasive detection of these tumors, and often these tumors are found in asymptomatic patients. Due to the diversity of neoplasms, varying grades of malignancy, variable growth patterns, and the occupancy of non-neoplastic hamartomatous lesions, the clinician often has difficulty determining which patient should have a diagnostic biopsy or resection, or if therapy should be started without pathologic confirmation. Following a review of the neuroradiology and more common intracranial tumors, recommendations regarding management are proposed.