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C C Patterson,
E Gyürüs,
J Rosenbauer,
O Cinek,
A Neu, E Schober,
R C Parslow,
G Joner,
J Svensson,
C Castell, [......],
C Krzisnik,
C Ionescu-Tirgoviste,
I Weets,
M Kocova,
G Stipancic,
M Samardzic,
C E de Beaufort,
A Green,
G G Dahlquist,
G Soltész
[show abstract]
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ABSTRACT: The aim of the study was to describe 20-year incidence trends for childhood type 1 diabetes in 23 EURODIAB centres and compare rates of increase in the first (1989-1998) and second (1999-2008) halves of the period.
All registers operate in geographically defined regions and are based on a clinical diagnosis. Completeness of registration is assessed by capture-recapture methodology. Twenty-three centres in 19 countries registered 49,969 new cases of type 1 diabetes in individuals diagnosed before their 15th birthday during the period studied.
Ascertainment exceeded 90% in most registers. During the 20-year period, all but one register showed statistically significant changes in incidence, with rates universally increasing. When estimated separately for the first and second halves of the period, the median rates of increase were similar: 3.4% per annum and 3.3% per annum, respectively. However, rates of increase differed significantly between the first half and the second half for nine of the 21 registers with adequate coverage of both periods; five registers showed significantly higher rates of increase in the first half, and four significantly higher rates in the second half.
The incidence rate of childhood type 1 diabetes continues to rise across Europe by an average of approximately 3-4% per annum, but the increase is not necessarily uniform, showing periods of less rapid and more rapid increase in incidence in some registers. This pattern of change suggests that important risk exposures differ over time in different European countries. Further time trend analysis and comparison of the patterns in defined regions is warranted.
Diabetologia 05/2012; 55(8):2142-7. · 6.81 Impact Factor
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ABSTRACT: Aim/hypothesis: The aim of our study was to determine the incidence rate of Type I (insulin-dependent) diabetes mellitus in the 15–30 years
age group in a well-defined province in Austria and to compare this with the incidence rate of childhood-onset diabetes mellitus
in the age group 0–15 over a 3-year period.
Methods: Incident cases of Type I diabetes were reported by the local departments of medicine and paediatrics prospectively to the
Austrian Diabetes incidence registry. Completeness of ascertainment was calculated by the capture-recapture method.
Results: The incidence rates per 100 000 person-years for Type I diabetes in the Austrian province of Upper Austria were 8.99 (7.02–11.4,
95 %-CI) for the 0–15 years age group and 7.1 (5.5–9.0, 95 %-CI) for the 15–30 years age group. The estimated completeness
of ascertainment was 93 % (89.0–97.1 %, 95 %-CI) for children and 87 % (84.1–89.9 %, 95 %-CI) for young adults. Sex differences
were evident in young adults, with a 1.6-fold increased risk in males older than 15 years and 2.2-fold increased risk in men
over 20 years of age.
Conclusion/interpretation: Our study shows that the incidence rate of Type I diabetes in Austria after the age of 15 years is similar to the incidence
rate in childhood. An unexplained male predominance in patients older than 20 years could be observed as in several other
countries. [Diabetologia (2001) 44 [Suppl 3]: B 45–B 47]
Diabetologia 04/2012; 44:B45-B47. · 6.81 Impact Factor
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[show abstract]
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ABSTRACT: AimThe aim of the study was to analyse the prevalence of diabetic onset ketoacidosis (DKA) during a period of 20years (1989–2008)
on a population basis in the whole of Austria.
MethodsA prospective population-based incidence study (1989–2008) was performed. The registered data set comprised blood glucose,
pH, ketonuria and clinical symptoms of DKA at manifestation. DKA was defined as pH < 7.3 and severe DKA as pH < 7.1. Time
trends were estimated using linear regression models.
ResultsDuring the study period, 3331 children <15years of age (1,797 boys and 1,534 girls) were registered with newly diagnosed
type 1 diabetes. Of these, 1,238 (37.2%) presented with DKA, 855 (25.7%) had a mild and 383 (11.5%) a severe form, and one
patient died at onset. DKA frequency was negatively associated with age at onset (p < 0.0001). In children <2years the prevalence was 60%, with a higher risk for girls (70% vs 54% for boys, p < 0.05). Despite a significant increase in diabetes incidence in Austria during the observation period from 8.4 to 18.4/100,000
(p < 0.0001), no significant change in the prevalence of DKA at manifestation was observed.
ConclusionsThe overall frequency of DKA in children with newly diagnosed type 1 diabetes in Austria is high and has not changed during
the last 20years despite a clear increase in the manifestation rate. In particular, children less than 2years of age have
a high risk of DKA at onset.
KeywordsAustria-Children-Diabetes manifestation-Diabetic ketoacidosis-Time trend-Type 1 diabetes mellitus
Diabetologia 04/2012; 53(6):1057-1061. · 6.81 Impact Factor
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[show abstract]
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ABSTRACT: Die einfache Verfügbarkeit der Blutzuckermessung im medizinischen Alltag führt nicht selten zur Entdeckung hyperglykämischer
Zustände, deren Wertigkeit für die Zukunft ohne Zusatzuntersuchungen oft nicht zu beurteilen ist. Obwohl die Prävalenz der
Zufalls- und Stresshyperglykämien mit bis zu 4–5% in Abteilungen mit pädiatrischen Notaufnahmen nicht gering ist, scheint
nur ein kleiner Anteil dieser Kinder in der Folge an einem Diabetes zu erkranken oder sich bereits in einem prädiabetischen
Stadium zu befinden. Dennoch können sich sowohl ein Diabetes mellitus Typ1 als auch Typ2 als auch seltenere spezifische
Diabetesformen auf diese Weise präsentieren. Eine differenzialdiagnostische Abklärung ist trotz der niedrigen Prävalenz der
Zufallshyperglykämie sinnvoll, um einerseits schwere Diabetesmanifestationen, wie eine diabetische Ketoazidose, in der Folge
zu verhindern bzw. eine mögliche alternative Therapieform mit Sulfonylharnstoff bei monogenetischen Diabetesformen anzubieten
und den weiteren Verlauf zu prognostizieren.
The ready availability of blood glucose measurement devices in everyday medical life often leads to the incidental discovery
of hyperglycemic events, the long-term significance of which often remains unevaluated in the absence of additional tests.
Although up to 4%–5% of children admitted to pediatric accident and emergency units present with transient hyperglycemia,
only a minority of these subsequently develops diabetes or is already in a prediabetic stage. Both type 1 and type 2 diabetes,
as well as rarer monogenetic forms of diabetes, can present as incidental hyperglycemia. Despite low incidence rates, a differential
diagnostic work-up of incidental hyperglycemia is useful, since it may prevent severe diabetic events such as diabetic ketoacidosis;
moreover, in the case of specific types of monogenetic diabetes, patients can use oral antidiabetic drugs and the further
disease course can be predicted.
SchlüsselwörterZufallshyperglykämie-Stresshyperglykämie-Diabetes mellitus-Kindesalter-Differenzialdiagnose
KeywordsIncidental hyperglycaemia-Stress hyperglycemia-Diabetes mellitus-Childhood-Differential diagnosis
Monatsschrift Kinderheilkunde 04/2012; 158(3):281-289. · 0.27 Impact Factor
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[show abstract]
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ABSTRACT: Der „maturity-onset diabetes of the young“ (MODY) ist eine seltene, aber wichtige Differenzialdiagnose bei Manifestation eines
Diabetes im Kindes- und Jugendalter sowie im frühen Erwachsenenalter. Gemeinsam ist den 10verschiedenen MODY-Formen der monogene
Erbgang mit autosomal-dominant vererbten Mutationen in Genen, die u.a. an der Insulinsekretion beteiligt sind. Von klinischer
Bedeutung sind vor allem der MODY2 (Glukokinase-MODY) und der MODY3 (HNF1A-MODY). Patienten mit MODY2 fallen meist zufällig
mit Hyperglykämien im Rahmen von Laborkontrollen auf, ohne dass Symptome eines Diabetes vorliegen. Eine alleinige diätetische
Therapie ist bei MODY2 meist ausreichend. Bei einem MODY3 besteht in der Regel ein progressiver Verlauf mit Abnahme der
Insulinsekretion. Dies führt zu einer zunehmenden Hyperglykämie. Behandelt wird zunächst mit Sulfonylharnstoffen, später dann
mit Insulin. Die übrigen MODY-Typen sind wesentlich seltener, weisen aber oft eigene Charakteristika auf. Die Diagnose eines
MODY beeinflusst das Management des Diabetes und hat zudem eine wichtige Bedeutung für die genetische Beratung und die Früherkennung
eines Diabetes bei Familienmitgliedern.
Maturity-onset diabetes of the young (MODY) is a rare but important differential diagnosis of diabetes presenting in childhood,
adolescence or young adulthood. Common features of the 10 known MODY forms are autosomal dominant inheritance of mutations
in genes involved, e.g. in the regulation of insulin secretion or β-cell development. The most common forms are MODY2 (glucokinase
MODY) and MODY3 (HNF1A-MODY). Patients with MODY2 initially present with hyperglycemia during an incidental laboratory control
without any clinical symptoms of diabetes and diet alone is usually sufficient for glycemic control. MODY3 is characterized
by progressive hyperglycemia as a result of a decrease in insulin secretion capacity. Most patients are initially successfully
treated with sulphonyl ureas but might later require insulin treatment. The other MODY forms occur much less frequently and
can show specific clinical signs. Diagnosis of MODY has direct impact on the management of diabetes, genetic counselling and
early diagnosing of diabetes in affected family members.
SchlüsselwörterMODY-Diabetes-Glukokinase-Diabetestypen-HNF1A-Monogener Diabetes
KeywordsMODY-Diabetes-Glucokinase-Diabetes types-HNF1A-Monogenic diabetes
Der Diabetologe 04/2012; 6(3):219-230. · 0.25 Impact Factor
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ABSTRACT: To examine change of diagnosis in patients from the German/Austrian multicenter DPV (Diabetes Patienten Verlaufsdokumentation) database initially classified as type 2 diabetes.
Patients aged ≤20 years at onset, diagnosed between 1995 and 2010 were followed for at least 6 months. Chi-square/Wilcoxon tests were performed to compare patient groups according to diabetes type after reclassification.
From 580 study patients, 60 (10.3%) were reclassified, on average 2.4 years after initial diagnosis as follows: 23 (38.3%) as type 1 diabetes; 9 (15%) as maturity onset diabetes of the young (MODY); 20 (33.3%) as "other specific diabetes forms" and 8 (13.3%) as "remission" of type 2 diabetes. Patients reclassified to type 1 were significantly younger (13.5 ± 2.9 versus 14.0 ± 2.6; p=0.027) and more often β-cell antibody positive at disease onset (80.0% versus 31.2%; p=0.002), while patients reclassified as MODY had significantly lower BMI-SDS values than 520 patients with confirmed type 2 diabetes (2.5 ± 1.1 versus 0.9 ± 1.1; p<0.001). The latter were also considerably more obese than patients in "remission" and those reclassified to "other specific diabetes forms".
About 10% of patients in the DPV database, initially diagnosed as type 2 diabetes, were retrospectively reclassified.
Diabetes research and clinical practice 09/2011; 94(3):463-7. · 2.16 Impact Factor
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J Grulich-Henn,
V Wagner,
A Thon, E Schober,
W Marg,
T M Kapellen,
H Haberland,
K Raile,
S Ellard,
S E Flanagan,
A T Hattersley,
R W Holl
[show abstract]
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ABSTRACT: The aim of this study was to elucidate the entities and the frequency of neonatal diabetes mellitus (NDM) in a large representative database for paediatric diabetes patients in Germany and Austria.
Based on the continuous diabetes data acquisition system for prospective surveillance (DPV), which includes 51,587 patients with onset of diabetes before the age of 18 years from 299 centres in Germany and Austria, we searched for patients with onset of diabetes mellitus in the first 6 months of life.
Ninety patients were identified, comprising 0.17% of all paediatric cases in the DPV registry. This represented an incidence of approximately one case in 89,000 live births in Germany. A monogenic basis for NDM was established in 30 subjects (seven UPD6, 10 KCNJ11, seven ABCC8, two FOXP3, two PDX1, one INS, one EIF2AK3). Pancreatic hypoplasia or agenesis was reported in 10 patients and seven subjects were classified as having Type 1 diabetes by their centres. Transient neonatal diabetes (TNDM) accounted for approximately 10% of all cases with NDM. No aetiology was defined in 41 subjects, which may reflect incomplete genetic testing or novel genetic aetiologies.
Based on a large database, we identified a higher rate of NDM in Germany than has been reported previously. Full molecular genetic testing should be performed in all patients diagnosed before 6 months of age.
Diabetic Medicine 06/2010; 27(6):709-12. · 2.90 Impact Factor
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C R Cardwell,
L C Stene,
G Joner,
E A Davis,
O Cinek,
J Rosenbauer,
J Ludvigsson,
C Castell,
J Svensson,
M J Goldacre, [......],
P Pozzilli,
G Brigis,
B Urbonaite,
S Sipetić, E Schober,
C Ionescu-Tirgoviste,
C E de Beaufort,
D Stoyanov,
K Buschard,
C C Patterson
[show abstract]
[hide abstract]
ABSTRACT: We investigated whether children who are heavier at birth have an increased risk of type 1 diabetes.
Relevant studies published before February 2009 were identified from literature searches using MEDLINE, Web of Science and EMBASE. Authors of all studies containing relevant data were contacted and asked to provide individual patient data or conduct pre-specified analyses. Risk estimates of type 1 diabetes by category of birthweight were calculated for each study, before and after adjustment for potential confounders.Meta-analysis techniques were then used to derive combined ORs and investigate heterogeneity between studies.
Data were available for 29 predominantly European studies (five cohort, 24 case-control studies), including 12,807 cases of type 1 diabetes. Overall, studies consistently demonstrated that children with birthweight from 3.5 to 4 kg had an increased risk of diabetes of 6% (OR 1.06 [95% CI 1.01-1.11]; p=0.02) and children with birthweight over 4 kg had an increased risk of 10% (OR 1.10 [95% CI 1.04-1.19]; p=0.003), compared with children weighing 3.0 to 3.5 kg at birth. This corresponded to a linear increase in diabetes risk of 3% per 500 g increase in birthweight (OR 1.03 [95% CI 1.00-1.06]; p=0.03). Adjustments for potential confounders such as gestational age, maternal age, birth order, Caesarean section, breastfeeding and maternal diabetes had little effect on these findings.
Children who are heavier at birth have a significant and consistent, but relatively small increase in risk of type 1 diabetes.
Diabetologia 04/2010; 53(4):641-51. · 6.81 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: The aim of the study was to analyse the prevalence of diabetic onset ketoacidosis (DKA) during a period of 20 years (1989-2008) on a population basis in the whole of Austria.
A prospective population-based incidence study (1989-2008) was performed. The registered data set comprised blood glucose, pH, ketonuria and clinical symptoms of DKA at manifestation. DKA was defined as pH < 7.3 and severe DKA as pH < 7.1. Time trends were estimated using linear regression models.
During the study period, 3331 children <15 years of age (1,797 boys and 1,534 girls) were registered with newly diagnosed type 1 diabetes. Of these, 1,238 (37.2%) presented with DKA, 855 (25.7%) had a mild and 383 (11.5%) a severe form, and one patient died at onset. DKA frequency was negatively associated with age at onset (p < 0.0001). In children <2 years the prevalence was 60%, with a higher risk for girls (70% vs 54% for boys, p < 0.05). Despite a significant increase in diabetes incidence in Austria during the observation period from 8.4 to 18.4/100,000 (p < 0.0001), no significant change in the prevalence of DKA at manifestation was observed.
The overall frequency of DKA in children with newly diagnosed type 1 diabetes in Austria is high and has not changed during the last 20 years despite a clear increase in the manifestation rate. In particular, children less than 2 years of age have a high risk of DKA at onset.
Diabetologia 03/2010; 53(6):1057-61. · 6.81 Impact Factor
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ABSTRACT: Purpose: To evaluate the prevalence and clinical significance of associated oesophageal motor disorders in patients with midoesophageal diverticula. Material and Methods: We retrospectively reviewed videofluoroscopic and, if available, manometric studies of 30 patients with midoesophageal diverticula. The type of diverticulum and the presence and nature of oesophageal motor disorders were assessed. Results: Videofluoroscopy showed that 24 patients had 26 pulsion-type diverticula and 6 patients had 7 traction-type diverticula. Oesophageal motor disorders were demonstrated in 21 of the 24 patients with pulsion-type diverticula and in 3 of the 6 with traction-type diverticula. Nineteen patients had nonspecific motor disorders, 5 had achalasia, and 5 had gastrooesophageal reflux or oesophagitis. Conclusion: Midoesophageal diverticula are most often of the pulsion-type and tend to be associated with an oesophageal motor disorder. Motor disorders are predominantly nonspecific, but achalasia may be encountered as well.
01/2010; 38(1):108-114.
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Diabetic Medicine 10/2009; 26(9):947-8. · 2.90 Impact Factor
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[show abstract]
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ABSTRACT: To analyse and compare clinical characteristics in young patients with maturity-onset diabetes of the young (MODY) and Type 2 diabetes mellitus (T2DM).
We conducted an observational investigation using the DPV-Wiss database containing clinical data on 40 757 diabetic patients < 20 years of age from Germany and Austria.
Three hundred and thirty-nine cases were clinically categorized as MODY (0.83%); 562 patients were diagnosed as T2DM (1.4%). In 20% of cases, the diagnosis of MODY was based on clinical findings only. Of the 272 subjects where genetic testing was available, 3% did not carry mutations in the three examined MODY genes. Glucokinase-MODY was commoner than HNF1A-MODY and HNF4A-MODY. Age at diagnosis was younger in MODY patients. The body mass index of T2DM was significantly higher compared with all MODY subgroups. Macrovascular risk factors such as dyslipidaemia and hypertension were commoner in T2DM, but 23% of MODY patients had dyslipidaemia and 10% hypertension. Glycaemic control was within the therapeutic target (HbA(1c) < 7.5%) in 86% of MODY and 70% of T2DM patients.
The prevalence of MODY in children and adolescents in Germany and Austria is lower than that of T2DM in this age group. Dyslipidaemia and hypertension are less frequent in MODY compared with T2DM patients, but do occur.
Diabetic Medicine 05/2009; 26(5):466-73. · 2.90 Impact Factor
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ABSTRACT: The relationship between metabolic control and cognitive function in adolescents with type 1 diabetes (DM type 1) is not clear. We compared the quality of glycemic control (GC) and cognitive measures in adolescents with DM type 1 to find out if the quality of diabetes management is related to cognitive impairment.
We assessed executive functions (EFs) and other neuropsychological and psychosocial variables in 70 adolescent patients with DM type 1 and 20 age-matched controls. Patients were divided into two groups according to their last hemoglobin A1c (HbA1c): acceptable (HbA1c 5.9-8.0%, mean 6.9%, 36 patients, mean age 14 years) and non-optimal (HbA1c 8.2-11.6%, mean 9.3%, 34 patients, mean age 15.6 years).
We found impaired EFs, mainly problems of concept formation (p=0.038), cognitive flexibility (p=0.011) and anticipation (p=0.000), in the patients with DM type 1. Both groups did not differ in intelligence, most assessed EFs and adjustment to chronic illness (Youth Self-Report; YSR). Younger patients (<15 years) were cognitively less flexible. GC was worse in older patients and in patients with longer duration of the disease. We also found significant differences between patients with diabetes and controls concerning somatic complaints, internalizing problems (Child Behavior Checklist; CBCL) and social activity (CBCL and YSR).
DM type 1 is associated with cognitive deficits in adolescents independent of the quality of metabolic control and the duration of the disease. These deficits are probably related to the disease, especially in patients with early-onset diabetes.
Psychological Medicine 04/2009; 40(1):95-103. · 6.16 Impact Factor
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T. Danne,
T. Battelino,
P. Jarosz-Chobot,
O. Kordonouri,
E. Pánkowska,
J. Ludvigsson, E. Schober,
E. Kaprio,
T. Saukkonen,
M. Nicolino, [......],
U. Zumsteg,
B. Kuhlmann,
C. Aebi,
U. Schumacher,
S. Gschwend,
P. Hindmarsh,
M. Torres,
N. Shehadeh,
M. Phillip,
PedPump Study Group
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ABSTRACT: This large paediatric survey of CSII shows that glycaemic targets can be frequently achieved, particularly in young children, and the incidence of acute complications is low. Adequate substitution of basal and prandial insulin is associated with a better HbA(1c).
Diabetologia. 09/2008; 51(9):1594-1601.
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T Danne,
T Battelino,
P Jarosz-Chobot,
O Kordonouri,
E Pánkowska,
J Ludvigsson, E Schober,
E Kaprio,
T Saukkonen,
M Nicolino, [......],
R Hanas,
U Zumsteg,
B Kuhlmann,
C Aebi,
U Schumacher,
S Gschwend,
P Hindmarsh,
M Torres,
N Shehadeh,
M Phillip
[show abstract]
[hide abstract]
ABSTRACT: To assess the use of paediatric continuous subcutaneous infusion (CSII) under real-life conditions by analysing data recorded for up to 90 days and relating them to outcome.
Pump programming data from patients aged 0-18 years treated with CSII in 30 centres from 16 European countries and Israel were recorded during routine clinical visits. HbA(1c) was measured centrally.
A total of 1,041 patients (age: 11.8 +/- 4.2 years; diabetes duration: 6.0 +/- 3.6 years; average CSII duration: 2.0 +/- 1.3 years; HbA(1c): 8.0 +/- 1.3% [means +/- SD]) participated. Glycaemic control was better in preschool (n = 142; 7.5 +/- 0.9%) and pre-adolescent (6-11 years, n = 321; 7.7 +/- 1.0%) children than in adolescent patients (12-18 years, n = 578; 8.3 +/- 1.4%). There was a significant negative correlation between HbA(1c) and daily bolus number, but not between HbA(1c) and total daily insulin dose. The use of <6.7 daily boluses was a significant predictor of an HbA(1c) level >7.5%. The incidence of severe hypoglycaemia and ketoacidosis was 6.63 and 6.26 events per 100 patient-years, respectively.
This large paediatric survey of CSII shows that glycaemic targets can be frequently achieved, particularly in young children, and the incidence of acute complications is low. Adequate substitution of basal and prandial insulin is associated with a better HbA(1c).
Diabetologia 08/2008; 51(9):1594-601. · 6.81 Impact Factor
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C R Cardwell,
L C Stene,
G Joner,
O Cinek,
J Svensson,
M J Goldacre,
R C Parslow,
P Pozzilli,
G Brigis,
D Stoyanov,
B Urbonaite,
S Sipetić, E Schober,
C Ionescu-Tirgoviste,
G Devoti,
C E de Beaufort,
K Buschard,
C C Patterson
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study was to investigate the evidence of an increased risk of childhood-onset type 1 diabetes in children born by Caesarean section by systematically reviewing the published literature and performing a meta-analysis with adjustment for recognised confounders.
After MEDLINE, Web of Science and EMBASE searches, crude ORs and 95% CIs for type 1 diabetes in children born by Caesarean section were calculated from the data reported in each study. Authors were contacted to facilitate adjustments for potential confounders, either by supplying raw data or calculating adjusted estimates. Meta-analysis techniques were then used to derive combined ORs and to investigate heterogeneity between studies.
Twenty studies were identified. Overall, there was a significant increase in the risk of type 1 diabetes in children born by Caesarean section (OR 1.23, 95% CI 1.15-1.32, p < 0.001). There was little evidence of heterogeneity between studies (p = 0.54). Seventeen authors provided raw data or adjusted estimates to facilitate adjustments for potential confounders. In these studies, there was evidence of an increase in diabetes risk with greater birthweight, shorter gestation and greater maternal age. The increased risk of type 1 diabetes after Caesarean section was little altered after adjustment for gestational age, birth weight, maternal age, birth order, breast-feeding and maternal diabetes (adjusted OR 1.19, 95% CI 1.04-1.36, p = 0.01).
This analysis demonstrates a 20% increase in the risk of childhood-onset type 1 diabetes after Caesarean section delivery that cannot be explained by known confounders.
Diabetologia 05/2008; 51(5):726-35. · 6.81 Impact Factor
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C C Patterson,
G Dahlquist,
V Harjutsalo,
G Joner,
R G Feltbower,
J Svensson, E Schober,
E Gyürüs,
C Castell,
B Urbonaité,
J Rosenbauer,
V Iotova,
A V Thorsson,
G Soltész
[show abstract]
[hide abstract]
ABSTRACT: The aims of this study were to provide a contemporary picture of mortality and causes of death in Europe following a diagnosis of type 1 diabetes made before the 15th birthday, and to examine excess mortality by country for possible links to incidence level or national prosperity.
Thirteen population-based EURODIAB registers in 12 countries followed-up 28,887 children diagnosed since 1989, either by record linkage to population registers or through contact with doctors providing care.
There were 141 deaths in the cohort during 219,061 person-years of follow-up compared with 69.1 deaths expected from national mortality rates, a standardised mortality ratio (SMR) of 2.0 (95% CI 1.7-2.4). The SMR varied from 0 to 4.7 between countries, but showed little relationship with the country's incidence rate or gross domestic product (US$ per capita). The SMR did not change significantly with attained age, calendar period or time since diagnosis. The female SMR (2.7; 95% CI 2.0-3.5) was greater than the male SMR (1.8; 95% CI 1.4-2.2), although absolute numbers of excess deaths were similar in the two sexes. One-third of deaths were classified as directly attributable to diabetes (many with mention of ketoacidosis) and half were unrelated to diabetes. There was a non-significant excess of accidental/violent deaths (48 observed vs 40.7 expected; SMR 1.2; 95% CI 0.9-1.6) but little excess in suicides (11 observed, 10.2 expected; SMR 1.1; 95% CI 0.5-1.9).
Before the onset of late complications, significant excess mortality existed following the diagnosis of type 1 diabetes in childhood, even in recent years. Variation between countries in this excess could not be explained.
Diabetologia 01/2008; 50(12):2439-42. · 6.81 Impact Factor
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Journal of pediatric endocrinology & metabolism: JPEM 12/2006; 19(11):1359-62. · 0.88 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: The objective of the study was to analyse prevalence of overweight and obesity among migrant girls in Vienna, Austria, starting at the age of 6 years up to the age of 15 years.
In a longitudinal study, the prevalence of overweight and obesity among migrant girls from Turkey and former Yugoslavia was documented and compared with that among Austrian girls in Vienna.
Medical investigation of medical school authority in Viennese schools.
Seven hundred and ninety girls of low socio-economic status were included in the study.
Anthropometric data were collected at the age of 6, 10 and 15 years. Body mass was estimated by means of the body mass index (BMI), and percentile curves were used for determining the weight status.
Stature, body weight, BMI, weight status.
The prevalence of overweight and obesity was significantly higher among migrant girls at all age groups. The highest percentage of overweight was found among 10-year-old girls from Yugoslavia (nearly 35%) and the lowest percentage of overweight was exhibited in 6-year-old Austrian girls (20%). Being overweight or obese at the age of 6 years increased the risk of being overweight at 10 and 15 years significantly (P < 0.001). Among migrants, this risk was significantly higher than among Austrian girls (P < 0.001). Only 64.8% of Austrian girls, who were overweight/obese at the age of 6 years, were still classified as overweight at the age of 15 years. Among migrant girls, who were overweight at the age of 6 years, 72.0% (Turkish girls) and 78.3% (Yugoslavian girls) remained overweight until the age of 15 years.
Especially girls from former Yugoslavia but also Turkish girls exhibited high rates of overweight and obesity. Prevention should start as early as possible since overweight tends to persist from childhood into adolescence.
BJOG An International Journal of Obstetrics & Gynaecology 10/2006; 113(10):1188-94. · 3.41 Impact Factor
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[show abstract]
[hide abstract]
ABSTRACT: Children with type 1 diabetes mellitus (DM1) are more prone to developing thyroid autoimmunity (TAI); TAI also occurs more frequently in patients with celiac disease (CD).
To determine whether TAI occurs more frequently in children with coexisting DM1 and CD compared to children with DM1 only, and whether the clinical course of DM1 is influenced by concomitant TAI.
We performed a multicenter retrospective case-control study comparing data from 84 diabetic children with CD (group 1) to 167 diabetic children without CD (group 2), matched by age at DM1 onset, duration of DM1 and center. Markers of TAI, thyroid function and HbA1c were recorded. The TAI follow-up lasted 4.9 +/- 2.8 years.
TAI was diagnosed in 13% of children in group 1 and 19% of children in group 2 (ns). Diabetes control was not influenced by TAI in either group.
Occurrence of TAI in diabetic children is not related to coexisting CD. TAI does not lead to worsening of metabolic control in children with DM1.
Journal of pediatric endocrinology & metabolism: JPEM 05/2006; 19(4):517-22. · 0.88 Impact Factor
