Article

Sociodemographic and Clinical Characteristics in Newly Diagnosed Type 1 Diabetes: Rural vs. Urban Perspectives from a Specialized Center in Bangladesh

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Abstract

Type 1 Diabetes Mellitus (T1DM) is a chronic autoimmune disease that primarily aff ects children and adolescents, leading to insulin defi ciency and persistent hyperglycemia. The incidence of T1DM has been rising globally, with signifi cant regional variations. While Europe and North America report the highest rates, Southeast Asia, including Bangladesh, has seen increasing cases. This study aims to compare the sociodemographic and clinical characteristics of newly diagnosed T1DM patients from rural and urban areas of Bangladesh, focusing on factors such as age at diagnosis, family history, and disease presentation. A cross-sectional study was conducted at the Pediatric Diabetes Care and Research Center (PDRC) at BIRDEM Hospital in Dhaka, Bangladesh, from January to December 2019. Retrospective data from 212 newly diagnosed children and adolescents (aged 1-18 years) were analyzed. The study included sociodemographic information (age, sex, residence, family history) and clinical data (DKA at diagnosis, height, weight, fasting blood sugar, HbA1c levels). Most participants (62%) were from rural areas, with a higher proportion from low socioeconomic backgrounds than from urban areas.

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This article describes the epidemiology of type 1 diabetes mellitus (T1D) around the world and across the lifespan. Epidemiologic patterns of T1D by demographic, geographic, biologic, cultural, and other factors in populations are presented to gain insight about the causes, natural history, risks, and complications of T1D. Data from large epidemiologic studies worldwide indicate that the incidence of T1D has been increasing by 2% to 5% worldwide and that the prevalence of T1D is approximately 1 in 300 in the United States by 18 years of age. Research on risk factors for T1D is an active area of research to identify genetic and environmental triggers that could potentially be targeted for intervention. Although significant advances have been made in the clinical care of T1D with resultant improvements in quality of life and clinical outcomes, much more needs to be done to improve care of, and ultimately find a cure for, T1D. Epidemiologic studies have an important ongoing role to investigate the complex causes, clinical care, prevention, and cure of T1D.
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To determine the frequency of medical encounters before diagnosis of diabetes in children in Ontario, Canada; to determine risk factors for diabetic ketoacidosis (DKA). All medical encounters within 4 weeks before date of diagnosis for all new cases of diabetes in children <18 years were identified from April 1994 to March 2000 by use of administrative databases. The main outcome measure was the frequency of medical encounters before diagnosis in children presenting with and without DKA. A total of 3947 new cases of diabetes were identified, 735 (18.6%) with DKA. DKA rates were 39.7% for children < or =3 years and 16.3% for children >3 years (P < .001). During the week before diagnosis, 285 children with DKA (38.8%) and 1104 children with diabetes without DKA (34.4%; P = .026) had at least 1 medical visit. Children with diabetes overall had more medical encounters before diagnosis than control subjects. Children with DKA were less likely to have had relevant laboratory testing before diagnosis than children with diabetes without DKA. Children with diabetes presenting with DKA more frequently had a medical encounter before diagnosis compared with children with diabetes without DKA. These data have important implications for enhancing public and physician awareness of diabetes in children.
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To determine the national incidence of Type 1 diabetes in children aged 0-14 years and examine trends in incidence between 2000 and 2006 by age, sex and calendar year. Case ascertainment was from the Australian National Diabetes Register, a prospective population-based incidence register established in 1999, with two sources of ascertainment: the National Diabetes Services Scheme and the Australasian Paediatric Endocrine Group's state-based registers. Denominator data were from the Australian Bureau of Statistics. There were 6350 new cases of Type 1 diabetes (3323 boys and 3027 girls). Case ascertainment was 97.1% complete using the capture-recapture method. The mean adjusted incidence rate for 2000-2006 was 21.6 per 100,000 person-years [95% confidence interval (CI) 21.0, 22.1], and increased from 19.8 in 2000 to 23.4 per 100,000 in 2006, an average increase of 2.8% (95% CI 1.5, 4.1) per year. Mean incidence for the 7-year period increased with age, and was significantly higher in boys aged 0-4 years and 10-14 years than in girls of the same age. The incidence of Type 1 diabetes among 0-14-year-olds in Australia is very high compared with available data from many other countries. The rate of increase observed globally in the last decade has continued well into this decade in Australia. The rising incidence cannot be explained by changes in genetic susceptibility; there is an urgent need to examine the environmental factors that have contributed to this increase. The findings of this study also have important implications for resource planning.
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Incidence of type 1 diabetes is considered to be low in adults, but no study has been performed in Mediterranean countries. We extended the study base of the registry of the province of Turin, Italy, to subjects aged 30-49 years in the period 1999-2001 to estimate the incidences of type 1 and type 2 diabetes. Diagnosis of type 1 diabetes was based on permanent insulin treatment or a fasting C-peptide level < or =0.20 nmol/l or islet cell (ICA) or GAD (GADA) antibody positivities. We identified 1,135 case subjects with high completeness of ascertainment (99%), giving an incidence rate of 58.0 per 100,000 person-years (95% CI 54.7-61.5). The incidence of type 1 diabetes was 7.3 per 100,000 person-years (6.2-8.6), comparable with the rates in subjects aged 0-14 and 15-29 years (10.3 [9.5-11.2] and 6.8 [6.3-7.4]). Male subjects had a higher risk than female subjects for both type 1 (rate ratio [RR] 1.70 [95% CI 1.21-2.38]) and type 2 (2.10 [1.84-2.40]) diabetes. ICA and/or GADA positivities were found in 16% of the cohort. In logistic regression, variables independently associated with autoimmune diabetes were age 30-39 years (odds ratio [OR] 2.39 [95% CI 1.40-4.07]), fasting C-peptide <0.60 nmol/l (3.09 [1.74-5.5]), and BMI <26 kg/m2 (2.17 [1.22-3.85]). Risk of type 1 diabetes between age 30 and 49 years is similar to that found in the same area between age 15 and 29 years. Further studies are required to allow geographical comparisons of risks of both childhood and adulthood autoimmune diabetes, the latter being probably higher than previously believed.
Lack of access to specialists
  • K J Johnston
  • H Wen
  • Joynt Maddox
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