Parity, ethnic group and the prevalence of type 2 diabetes: the Coventry Diabetes Study.

The prevalence of Type 2 (non-insulin-dependent diabetes) in relation to parity was compared among South Asian (Asian) and European women during a cross-sectional house-to-house screening programme for diabetes in Foleshill, Coventry, UK. The parity of female residents was ascertained in 8 of the 12 areas visited. These areas contained 2096 European (68 with diabetes diagnosed) and 1148 Asian women (95 with diabetes diagnosed). Crude prevalence of Type 2 diabetes was 3.2% and 14.7% in Europeans aged 30-64 years and > or = 65 years, respectively, and 10.9% and 36.5% in similarly aged Asians, respectively. In those aged 30-64 years, the age and body mass index adjusted prevalence of Type 2 diabetes was highest among nulliparous (Europeans 4.4%, Asians 16.3%) and grand multiparous (parity > or = 5: Europeans 6.3%, Asians 16.5%) women when compared with women who had had 1 or 2 deliveries (Europeans 0.9%, Asians 3.3%, p < 0.001, both ethnic groups). However, parity had no effect among women aged > or = 65 years.     

Prevalence of diabetes in different regional and religious south Asian communities in Coventry.

The prevalence of Type 2 (non-insulin-dependent) diabetes in different South Asian (Asian) communities was compared during the Coventry Diabetes Study, a cross-sectional house to house screening programme for diabetes. Screening was by capillary whole blood glucose measurement with oral glucose tolerance tests when concentrations were greater than or equal to 6.0 mmol l-1 within 2 h of a meal or greater than or equal to 5.0 mmol l-1 2 h or more after a meal and a random 10% of others. Of the 4395 resident Asians, 94% were represented by five communities: Punjabi Sikhs, Punjabi Hindus, Gujerati Moslems, Gujerati Hindus, and Pakistani Moslems. Response to screening was 77-89% and to glucose tolerance test was 59-79%. Differences in anthropometry, socioeconomic circumstances, and migratory patterns were found, but all groups had a higher prevalence of Type 2 diabetes than Europeans. Gujerati Moslems had the highest age-adjusted prevalence (per 1000) of Type 2 diabetes (males: 160 (95% CI 107-228), females: 204 (95% CI 144-283)) when compared with the other Asian groups (males: Punjabi Sikhs 89(72-110), Pakistani Moslems 91(67-120), Gujerati Hindus 84(57-120), Punjabi Hindu 113(74-171); females: Punjabi Sikhs 75(60-94), Pakistani Moslems 103(78-133), Gujerati Hindus 88(62-122), Punjabi Hindu 116(77-174)). That all the Asian groups had a high prevalence of diabetes, in spite of their known dietary, cultural, and socioeconomic differences, suggests that the Asian predisposition to Type 2 diabetes is inherited although environmental factors may be necessary for this to be expressed.     

Knowledge of diabetes in Asians and Europeans with and without diabetes: the Coventry Diabetes Study.

Knowledge about the nature, symptoms, complications, and treatment of diabetes was assessed among United Kingdom Europeans and Asians with and without diabetes during the Coventry Diabetes Study. An open questionnaire was validated for use among Asians and Europeans and a 'Knowledge Index' constructed. The questions were answered by 3814 (87%) of 4395 Asians and 3783 (69%) of 5508 Europeans. Among those with known diabetes, 216 (96%) of 223 Asians and 98 (94%) of 104 Europeans answered the questions. The nature of diabetes was unknown in 30% of Europeans and 44% of Asians with diabetes, and 42% and 67%, respectively, could not name a single complication. Most of those without diabetes were unable to name either a complication (Europeans 66%, Asians 89%) or a single symptom (66% and 83%, respectively). The Knowledge Index was highest in Europeans, increased with increasing educational achievement, and was lowest in non-diabetic subjects without a family history of diabetes. Even those with diabetes had a low Knowledge Index.     

青岛地区20～74岁人群糖尿病患病率调查

目的　了解青岛地区成人糖尿病 (DM )的患病率。　方法　采用分层随机整群抽样方法 ,在 2 0 0 1年 5月～ 2 0 0 2年 6月期间 ,横断面调查青岛地区 2县 5区 2 0～ 74岁居民 14 6 0 6名。除市南区的 2 170名居民直接采用口服 75 g葡萄糖耐量试验 (OGTT)进行筛查外 ,其余各点的 12 4 36名被调查者需先行指血筛查 ,当毛细血管血糖≥ 6 1mmol/L时进行OGTT确定诊断。　结果　青岛地区 2 0～ 74岁人群DM标化的患病率为 5 5 % ,其中 6 4 5 %为新诊断的DM。其中市南区居民DM、糖耐量受损 (IGT)、空腹血糖受损 (IFG)和糖调节受损 (IGR)的标化患病率分别为 9 1%、6 6 %、4 5 %和 11 1%。乡村居民DM的患病率低于城镇居民 (5 0 %比 6 1% ,P <0 0 0 1)。乡村中 ,女性患病率高于男性 (5 7%比 4 0 % ,P <0 0 1)。随着年龄的增加 ,DM的患病率逐渐增加。　结论　青岛地区DM患病率与 1994年及 1996年全国流行病学调查结果相比 ,青岛地区DM的患病率明显升高。随着地区的城市化和人口的老龄化程度进一步增加 ,DM患病率将有更大幅度的升高     

Influence of age on clinical and immunological characteristics of newly diagnosed type 1 diabetic patients

The aim of this study was to analyse the immunological and clinical characteristics of a group of patients at the onset of type 1 diabetes and to determine if these findings are age related. For this purpose, 68 newly diagnosed type 1 diabetes mellitus patients referred to our hospital between 1997 and 1999 were studied; 42 were adults (mean age 24±3.5 years) and 26 children (mean age 6.1±4 years). Autoantibody markers islet cell antibodies, glutamic acid decarboxylase antibodies (GADA) and tyrosine phosphatase antibodies (IA-2A), pancreatic reserve (glucagon test) and HbA_1c were determined. Some clinical characteristics, such as mode of presentation and insulin requirements, were also analysed. Type 1 diabetes mellitus was found to be autoimmune in 83.8% of the patients and idiopathic in 16.2%, without significant differences between adults and children. In the whole autoimmune group, GADA was more prevent in adults and IA-2A more frequent in children. On the other hand, adults showing autoimmune markers developed ketosis more frequently and needed higher insulin doses at diagnosis, while children did not exhibit clinically significant differences associated with the presence or absence of antibodies. In conclusion, in children the presence of autoimmune markers is not related to the mode of presentation or characteristics of type 1 diabetes. In adults, however, the autoimmune group presents with more-severe clinical disease than antibody negative patients. Age at onset seems to be an important parameter in the natural history of type 1 diabetes and must be taken into account in epidemiological or intervention studies. Received: 1 April 2000 / Accepted in revised form: 3 April 2001     

Incidence and Prevalence of Type 1 Diabetes in Children and Adolescents in Benghazi,Libya

The mean annual incidence rates of Type 1 diabetes mellitus in Arab children and adolescents in Benghazi, Libya were assessed as based on prospective registration of patients during the period 1981–1990. Results showed an annual incidence (per 100 000) of 7.0 (6.0–8.2) (males 6.3(5.0–7.9) females 7.8(6.3–9.7)) in 0–14 year olds and 8.8(7.8–10.0) (males 8.3(6.9–10.0), females 9.2(7.7–11.0)) in 0–19 year olds. There were no significant differences between males and females or between season of onset. The commonest age of onset was 15–19 years. Annual variations were significant in the 0–14 years age group (p < 0.001) and non-significant in the 0–19 years age group. In 1981 the age adjusted prevalence rates of Type 1 patients (per 100 000) were 23.5 (17.1–31.5) (males 21.2(13.1–32.3), females 25.9(16.8–38.3)) in 0–14 year olds and 36.2(29.1–45.1) (males 31.4(22.2–43.2), females 41.0(30.2–54.5)) in 0–19 year olds. In 1990 the prevalence rates had increased to 37.3(30.5–45.5) (males 40.7(30.8–53.3), females 33.8 (24.6–45.3)) in 0–14 year olds and 59.5(51.6–58.5) (males 60.3(49.3–73.6), females 58.6 (47.7–72.1)) in 0–19 year olds. Increase in prevalence rates was significant in both sexes and in both age groups (p < 0.001). Increase in prevalence rates in girls in 1981 and in boys in 1990 were not significant. It is concluded that Type 1 diabetes is a common chronic disease of children and adolescents in Benghazi, Libya.     

Metabolic and Clinical Characteristics of South Asians and Europeans in Coventry

A house to house survey in Foleshill, Coventry, compared risk factors for Type 2 diabetes and ischaemic heart disease (IHD) among adult United Kingdom Europeans (n = 5508, 64% screened) and South Asians (n = 4395, 84% screened). Those with a high glucose and a randomized 10% of others had a glucose tolerance test while those with previously diagnosed diabetes (104 Europeans, 223 South Asians) were re-interviewed in more detail. By the age of 29 years, South Asians had higher 2 h glucose 5.4 ± 1.0 vs 4.84 ± 1.2 mmol l^?1, p < 0.005) and insulin (45.6 vs 23.8 mU l^?1, p < 0.001) concentrations and in males, a higher cholesterol concentration (5.1 ± 0.9 vs 4.6 ± 1.2 mmol l^?1, p < 0.05). South Asians with known Type 2 diabetes had an earlier age at diagnosis (48 ± 11 vs 57 ± 14 years, p < 0.001), a lower body mass index in the past (29.0 ± 4.8 vs 32.1 ± 6.9 kg m^?2, p < 0.001) and currently (27.1 ± 3.7 vs 29.1 ± 6.4 kg m^?2, p< 0.001), were more likely to present with acute symptoms, were less likely to attend the hospital clinic (14% vs 31%, p < 0.001), and were less likely to be treated with diet alone (14% vs 21%) or with insulin (9% vs 16%) than Europeans. Glycaemic control was similar in the two ethnic groups. These findings suggest an earlier onset of the disease processes involved in diabetes in South Asians. Important ethnic differences in patterns of care exist that make clinical comparisons difficult.     

Prevalence of retinopathy differs with age at onset of diabetes in a population of patients with Type 1 diabetes.

Aim The VISS study (Vascular complications in South‐east Sweden) investigates prevalence and incidence of vascular complications in a population with Type 1 diabetes, from a well‐defined geographical area and followed from diagnosis with HbA_1c measurement. Method The study population comprised all 440 patients with Type 1 diabetes onset before the age of 36 years, onset during 1983–1987, and at the time of onset living within the counties of Jönköping, Kalmar or Östergötland. Retinopathy was examined with fundus photography 1994–1995, and classified according to a modified Airlie House protocol. Results Fundus photographs from 390 patients were evaluated. In 277 (71%) patients no retinopathy was seen. The prevalence of retinopathy increased from 11% among patients < 5 years old at diabetes onset, to 48% among those 15–19 years old at diabetes onset, and then decreased to 30% for patients 30–35 years old at diabetes onset (P for χ² for linear trend for all ages 0.017, for age at onset 0–19 years P = 0.0003), without corresponding differences in duration or HbA_1c between patients with different onset age. Patients with HbA_1c in the highest quartile (> 8.3% HbA_1c) had a relative risk of 2.4 (95% confidence interval (CI) 1.7–3.2) of having any retinopathy compared with patients with lower HbA_1c, and a relative risk of 7.1 (95% CI 3.0–16.7) of having other forms of retinopathy than microaneurysms. Conclusion In patients with diabetes duration of 6–13 years, the prevalence of retinopathy is clearly related to glycaemic control. Furthermore, the risk of retinopathy varies with different age at onset, independently of differences in duration or glycaemic control. Diabet. Med. 19, 924–931 (2002)     

Residual beta-cell function and spontaneous clinical remission in type 1 diabetes mellitus: the role of puberty

To investigate the role of puberty on spontaneous clinical remission and on secretion of residual C-peptide during the first year of type 1 diabetes mellitus, we studied 77 pre-pubertal, 39 pubertal and 41 post-pubertal type 1 diabetic patients. Spontaneous partial clinical remission (HbA_1c within the normal range and insulin dose less than 0.3 U ⋅ kg^–1 body weight ⋅ day^–1 lasting for at least 10 days) decreased with duration of diabetes: months 3 vs 6 vs 12, respectively 13 vs 7 vs 4% (P<0.025). Remission was higher in post-pubertal than pubertal and pre-pubertal patients: month 6 respectively 20 vs 5 vs 1% (P<0.001). Secretion of C-peptide was significantly lower in pre-pubertal than the other two groups of patients. Basal and stimulated C-peptide secretion were higher in patients in clinical remission than in those who were not: basal value 0.4 (0.26–0.53) vs 0.28 (0.14–0.4) nmol/l (P<0.05); stimulated value 0.63 (0.5–0.95) vs 0.56 (0.31–0.74) nmol/l (P<0.05). Spontaneous remission is less frequent in children and adolescent patients than in adult post-pubertal patients, but different mechanisms may be involved. Low residual insulin secretion seems implicated in children meanwhile low insulin sensitivity could be more important in pubertal patients. Received: 11 April 1997 / Accepted in revised form: 30 April 1998     

Diagnostic criteria for acute‐onset type 1 diabetes mellitus (2012): Report of the Committee of Japan Diabetes Society on the Research of Fulminant and Acute‐onset Type 1 Diabetes Mellitus

Type 1 diabetes is a disease characterized by destruction of pancreatic β‐cells, which leads to absolute deficiency of insulin secretion. Depending on the manner of onset and progression, it is classified as fulminant, acute‐onset or slowly progressive type 1 diabetes. Here, we propose the diagnostic criteria for acute‐onset type 1 diabetes mellitus. Among the patients who develop ketosis or diabetic ketoacidosis within 3 months after the onset of hyperglycemic symptoms and require insulin treatment continuously after the diagnosis of diabetes, those with anti‐islet autoantibodies are diagnosed with ‘acute‐onset type 1 diabetes mellitus (autoimmune)’. In contrast, those whose endogenous insulin secretion is exhausted (fasting serum C‐peptide immunoreactivity <0.6 ng/mL) without verifiable anti‐islet autoantibodies are diagnosed simply with ‘acute‐onset type 1 diabetes mellitus’. Patients should be reevaluated after certain periods in case their statuses of anti‐islet autoantibodies and/or endogenous insulin secretory capacity are unknown.     

Type 1 diabetes in the Maltese Islands

The prevalence of Type 1 diabetes in Malta was estimated by identifying all cases aged less than 32 years by the end of 1987 who had attended the island's principal diabetic clinic. The age-adjusted prevalence rate for 0-19 year olds was 110.3 per 100,000 (girls 126.2 (n = 65), boys 95.3 (n = 52]. The mean annual incidence, during the period 1980-1987, in 0-19 year olds was 13.3 per 100,000 (n = 113, girls 14.1 and boys 12.6). Males developed Type 1 diabetes 2.1 years later than females (13.7 +/- 6.9 (+/- SD) vs 11.6 +/- 6.7 years). The commonest age of onset was 10 to 14 years. The peak period of onset occurred during the cooler months of November to February. The incidence rates are close to those in Nordic countries and indicate that Type 1 diabetes in Malta is underestimated.     

C-peptide measurement in the differentiation of Type 1 (insulin-dependent) and Type 2 (non-insulin-dependent) diabetes mellitus

Summary To determine whether individual subjects with Type 1 (insulin-dependent) diabetes or Type 2 (non-insulin-dependent) diabetes, who are treated with insulin, could be reliably distinguished, C-peptide concentrations and urinary C-peptide excretion were measured in 10 Caucasoids and 10 Pima Indians. All the subjects had developed diabetes before 21 years of age and were receiving insulin treatment. Fasting C-peptide concentrations were significantly higher in the Pima Indians (0.73±0.17 versus 0.02±0.01 nmol/l in Caucasoids; p<0.001), but there were slight overlaps in individual values. Urinary C-peptide excretion, an index of 24-h-insulin excretion, was also higher in the Pima Indian group (27.6±1.85 versus 0.72±0.18 pmol/min in Caucasoids; p<0.001) and there was no overlap in the individual values between the groups. The Pima Indians with early onset diabetes have been previously shown to have Type 2 diabetes, and the Caucasoids with an early onset are most likely to have Type 1 diabetes. These results suggest that distinction between these two major types of diabetes can be made effectively by using C-peptide measurements provided that overt renal disease is absent. This differentiation between insulin-treated patients will be useful for a variety of research applications and possibly in making clinical management decisions.     

The rise and fall of insulin secretion in type 1 diabetes mellitus

An understanding of the natural history of beta cell responses is an essential prerequisite for interventional studies designed to prevent or treat type 1 diabetes. Here we review published data on changes in insulin responses in humans with type 1 diabetes. We also describe a new analysis of C-peptide responses in subjects who are at risk of type 1 diabetes and enrolled in the Diabetes Prevention Trial-1 (DPT-1). C-peptide responses to a mixed meal increase during childhood and through adolescence, but show no significant change during adult life; responses are lower in adults who progress to diabetes than in those who do not. The age-related increase in C-peptide responses may account for the higher levels of C-peptide observed in adults with newly diagnosed type 1 diabetes compared withhose in children and adolescents. Based on these findings, we propose a revised model of the natural history of the disease, in which an age-related increase in functional beta cell responses before the onset of autoimmune beta cell damage is an important determinant of the clinical features of the disease. Electronic Supplementary Material Supplementary material is available for this article at     

Prevalence, risk factors and complications associated with type 2 diabetes in migrant South Asians

It is estimated that type 2 diabetes (T2D) currently affects about 246 million people worldwide, with South Asians, especially Indians, having both the largest number of cases and the fastest growing prevalence. South Asian ethnicity has been identified as a major risk factor for the development of T2D with central adiposity, insulin resistance and an unfavourable lipid profile being identified as predominant signals of alarm. Leading databases, including Web of Science, Medline, PubMed and Science Direct, were consulted and manual searches were conducted for cited references in leading diabetes-related journals. In all, 152 articles were included for the final assessment reported in this review. Genetic predisposition, central adiposity and unfavourable lifestyle, including physical inactivity and an unhealthy diet, were associated with the prevalence of T2D in migrant South Asians. 'Westernization', acculturation, socio-economic factors and lack of knowledge about the disease have also been identified as contributors to the development of T2D in this population. Higher prevalence of T2D in migrant South Asians may not be entirely attributed to genetic predisposition; hence, ethnicity and associated modifiable risk factors need further investigation. Preventive measures and appropriate interventions are currently limited by the lack of ethnic-specific cut-off points for anthropometric and biological markers, as well as by the absence of reliable methods for dietary and physical activity assessment. This article describes the prevalence rate, risk factors and complications associated with T2D in migrant South Asians living in different countries.     

New onset diabetes,type 1 diabetes and COVID-19

Background and aimsNew data has emerged regarding higher risk of coronavirus disease 2019 (COVID-19), and its severity and complications in patients with type 2 diabetes mellitus (T2DM). However, there is a dearth of evidence regarding type 1 diabetes mellitus (T1DM). This article explores the possibility of COVID 19 induced diabetes and highlights a potential bidirectional link between COVID 19 and T1DM.MethodsA literature search was performed with Medline (PubMed), Scopus, and Google Scholar electronic databases till October 2020, using relevant keywords (COVID-19 induced diabetes; COVID-19 and type 1 diabetes; COVID-19 induced DKA; new-onset diabetes after SARS-CoV-2 infection) to extract relevant studies describing relationship between COVID-19 and T1DM.ResultsPast lessons and new data teach us that severe acute respiratory syndrome coronaviruses (SARS-CoV and SARS-CoV-2) can enter islet cells via angiotensin converting enzyme-2 (ACE-2) receptors and cause reversible β-cell damage and transient hyperglycemia. There have been postulations regarding the potential new-onset T1DM triggered by COVID-19. This article reviews the available evidence regarding the impact and interlink between COVID-19 and Τ1DM. We also explore the mechanisms behind the viral etiology of Τ1DM.ConclusionsSARS-CoV-2 can trigger severe diabetic ketoacidosis at presentation in individuals with new-onset diabetes. However, at present, there is no hard evidence that SARS-CoV-2 induces T1DM on it’s own accord. Long term follow-up of children and adults presenting with new-onset diabetes during this pandemic is required to fully understand the type of diabetes induced by COVID-19.     

Increased intestinal permeability precedes clinical onset of type 1 diabetes

Aims/hypothesis Recent observations have shown subclinical intestinal abnormalities in human type 1 diabetes. Whether these are related to the pathogenetic process or secondary to the diabetes remains to be clarified. The aim of this study was to investigate this issue by examining intestinal permeability to sugars in subjects at different stages of type 1 diabetes: preclinical, new-onset and long-term established disease.Methods Eighty-one subjects with islet autoimmunity (18 preclinical, 28 new-onset and 35 long-term type 1 diabetes) and 40 healthy control subjects were investigated by a lactulose-mannitol test, consisting of oral administration of the two sugars and measurement of their urinary excretion.Results All groups of subjects with islet autoimmunity showed an increase in intestinal permeability (p ≤ 0.009 vs controls) to the disaccharide lactulose, indicative of a damaged barrier, but a similar permeability to the monosaccharide mannitol (NS vs controls), indicative of an integral surface mucosa; consequently there was an increase in the lactulose:mannitol excretion ratio (p ≤ 0.025 vs controls).Conclusions/interpretation These findings indicate the presence of a subclinical enteropathy associated with type 1 diabetes that is already detectable before clinical onset of the disease, and suggest that the small intestine is an organ participating in the pathogenetic process of type 1 diabetes.     

Nicotinamide increases C-peptide secretion in patients with recent onset type 1 diabetes

Nicotinamide, a poly-(ADP-ribose) synthetase inhibitor, has been shown in animal models to induce islet B-cell regeneration. An open controlled trial was therefore carried out for 1 year in 36 patients with recent onset (less than 4 weeks symptoms) Type 1 diabetes. Twenty-three patients were treated with nicotinamide (200 mg daily) in addition to insulin, and 13 control patients were treated with insulin alone. Metabolic and immunological variables at entry were similar in the two groups. A significant increase of stimulated plasma C-peptide levels compared to diagnosis was observed only in the nicotinamide treated group (1.4 +/- 0.3 (+/- SE) micrograms l-1 at diagnosis vs 2.4 +/- 0.4 at 6 months, p less than 0.04; and 3.0 +/- 0.5 at 1 year, p less than 0.01). Patients receiving nicotinamide had lower glycosylated haemoglobin levels at 6 months and 1 year compared to the control group (p less than 0.04 and p less than 0.03, respectively) although insulin dose was lower. Small doses of nicotinamide may be successful in improving metabolic control in recent onset Type 1 diabetes, probably by increasing residual islet B-cell function.     

Dysregulated plasma glucagon levels in Japanese young adult type 1 diabetes patients

Currently, the clinical dynamics of glucagon need to be revised based on previous data obtained from conventional glucagon radioimmunoassays. In the present study, we evaluated plasma glucagon levels in type 1 diabetes patients using a newly‐developed sandwich enzyme‐linked immunosorbent assay, and its association with clinical parameters and markers of diabetes complications were statistically assessed. The plasma glucagon level in 77 Japanese type 1 diabetes patients was 28.1 ± 17.7 pg/mL, and comparable with that reported previously for type 2 diabetes patients. However, the values were widely spread and did not correlate with plasma glucose values. Additionally, the average glucagon levels in patients in a hypoglycemic state (glucose level <80 mg/dL) did not increase (21.7 ± 12.2 pg/mL). The average glucagon level of patients experiencing hypoglycemia unawareness was significantly lower. Plasma glucagon levels evaluated using the new enzyme‐linked immunosorbent assay were dysregulated in type 1 diabetes patients in respect to plasma glucose levels, suggesting dysregulation of secretion.