OBJECTIVE: To investigate and monitor the patterns in incidence of childhood type 1 diabetes worldwide. RESEARCH DESIGN AND METHODS: The incidence of type 1 diabetes (per 100,000 per year) from 1990 to 1994 was determined in children < or =14 years of age from 100 centers in 50 countries. A total of 19,164 cases were diagnosed in study populations totaling 75.1 million children. The annual incidence rates were calculated per 100,000 population. RESULTS: The overall age-adjusted incidence of type 1 diabetes varied from 0.1/100,000 per year in China and Venezuela to 36.8/100,000 per year in Sardinia and 36.5/100,000 per year in Finland. This represents a >350-fold variation in the incidence among the 100 populations worldwide. The global pattern of variation in incidence was evaluated by arbitrarily grouping the populations with a very low (<1/100,000 per year), a low (1-4.99/100,000 per year), an intermediate (5-9.99/100,000 per year), a high (10-19.99/100,000 per year), and a very high (> or =20/100,000 per year) incidence. Of the European populations, 18 of 39 had an intermediate incidence, and the remainder had a high or very high incidence. A very high incidence (> or =20/ 100,000 per year) was found in Sardinia, Finland, Sweden, Norway Portugal, the U.K., Canada, and New Zealand. The lowest incidence (<1/100,000 per year) was found in the populations from China and South America. In most populations, the incidence increased with age and was the highest among children 10-14 years of age. CONCLUSIONS: The range of global variation in the incidence of childhood type 1 diabetes is even larger than previously described. The earlier reported polar-equatorial gradient in the incidence does not seem to be as strong as previously assumed, but the variation seems to follow ethnic and racial distribution in the world population.

OBJECTIVETo assess the proportion of youth with type 1 diabetes under the care of pediatric endocrinologists in the United States meeting targets for HbA1c, blood pressure (BP), BMI, and lipids.RESEARCH DESIGN AND METHODSData were evaluated for 13,316 participants in the T1D Exchange clinic registry younger than 20 years old with type 1 diabetes for ≥1 year.RESULTSAmerican Diabetes Association HbA1c targets of <8.5% for those younger than 6 years, <8.0% for those 6 to younger than 13 years old, and <7.5% for those 13 to younger than 20 years old were met by 64, 43, and 21% of participants, respectively. The majority met targets for BP and lipids, and two-thirds met the BMI goal of <85th percentile.CONCLUSIONSMost children with type 1 diabetes have HbA1c values above target levels. Achieving American Diabetes Association goals remains a significant challenge for the majority of youth in the T1D Exchange registry.

Lee S, Deldin AR, White D, Kim Y, Libman I, Rivera-Vega M, Kuk JL, Sandoval S, Boesch C, Arslanian S. Aerobic exercise but not resistance exercise reduces intrahepatic lipid content and visceral fat and improves insulin sensitivity in obese adolescent girls: a randomized controlled trial. Am J Physiol Endocrinol Metab 305: E1222-E1229, 2013. First published September 17, 2013; doi:10.1152/ajpendo.00285.2013.-It is unclear whether regular exercise alone (no caloric restriction) is a useful strategy to reduce adiposity and obesity-related metabolic risk factors in obese girls. We examined the effects of aerobic (AE) vs. resistance exercise (RE) alone on visceral adipose tissue (VAT), intrahepatic lipid, and insulin sensitivity in obese girls. Forty-four obese adolescent girls (BMI Ն95th percentile, 12-18 yr) with abdominal obesity (waist circumference 106.5 Ϯ 11.1 cm) were randomized to 3 mo of 180 min/wk AE (n ϭ 16) or RE (n ϭ 16) or a nonexercising control group (n ϭ 12). Total fat and VAT were assessed by MRI and intrahepatic lipid by proton magnetic resonance spectroscopy. Intermuscular AT (IMAT) was measured by CT. Insulin sensitivity was evaluated by a 3-h hyperinsulinemic (80 mU·m 2 ·min Ϫ1 ) euglycemic clamp. Compared with controls (0.13 Ϯ 1.10 kg), body weight did not change (P Ͼ 0.1) in the AE (Ϫ1.31 Ϯ 1.43 kg) and RE (Ϫ0.31 Ϯ 1.38 kg) groups. Despite the absence of weight loss, total body fat (%) and IMAT decreased (P Ͻ 0.05) in both exercise groups compared with control. Compared with control, significant (P Ͻ 0.05) reductions in VAT (⌬Ϫ15.68 Ϯ 7.64 cm 2 ) and intrahepatic lipid (⌬Ϫ1.70 Ϯ 0.74%) and improvement in insulin sensitivity (⌬0.92 Ϯ 0.27 mg·kg Ϫ1 ·min Ϫ1 per U/ml) were observed in the AE group but not the RE group. Improvements in insulin sensitivity in the AE group were associated with the reductions in total AT mass (r ϭ Ϫ0.65, P ϭ 0.02). In obese adolescent girls, AE but not RE is effective in reducing liver fat and visceral adiposity and improving insulin sensitivity independent of weight loss or calorie restriction. insulin sensitivity; intrahepatic lipid; visceral fat; exercise; adolescents THE EPIDEMIC RATE OF CHILDHOOD OBESITY is a major health concern in the US, as overweight and obese youth are at increased risk of developing comorbidities such as nonalcoholic fatty liver disease (35), type 2 diabetes (33), and metabolic syndrome (21, 41), once considered diseases of adulthood. Although both diet and physical activity are considered to be the first lines of approach to treat obese youth (9), we recently reported that, in obese adolescent boys, increasing physical activity alone, independent of calorie restriction, is beneficial to reduce total fat, visceral adiposity, and intrahepatic lipid and improves cardiorespiratory fitness (CRF) (22). In obese adolescent girls, the utility of exercise alone as a strategy for reducing obesity-related metabolic risk factors is currently unclear. Given the lower physical activity levels in girls than in boys (14) and the fact that physical activi...

Nearly 70 registries from more than 40 countries have collected and published incidence data of childhood Type 1 (insulin-dependent) diabetes mellitus up to the end of the 1980s. The majority of incidence data comes from regions of high incidence i.e. from Europe and North America. All these published data facilitate the descriptive comparison of incidence and variation of the occurrence of Type 1 diabetes roughly throughout the northern hemisphere. The aim of this paper is to review and compare the most recent epidemiology data on the incidence of Type 1 diabetes among children under the age of 15 years. A clear difference in incidence appeared between northern and southern hemisphere with no countries below the equator having an incidence greater than 15.0 per 100,000. In contrast above the equator the disease is common. Between continents the variation in incidence showed that the lowest incidences were found in Asia, followed by Oceania (Australia and New Zealand), South and North America, and the highest rates were in Europe. The incidence varied from 0.6 per 100,000 in Korea and Mexico to 35.3 per 100,000 in Finland showing prominent worldwide variation in incidence of Type 1 diabetes. The largest intracontinental variation in incidence appeared in Europe, varying from the highest in Finland to the lowest (4.6 per 100,000) in northern Greece. The highest incidence in the world was in northern Europe, but within the continent scale there were some striking exceptions from the overall level of incidence.(ABSTRACT TRUNCATED AT 250 WORDS)

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clinicaltrials.org Identifier: NCT01881828.

OBJECTIVE—The aim of this study was to compare the prevalence of being overweight in black and white children and adolescents at onset of insulin-treated diabetes during two time periods: 1979–1989 (period I) and 1990–1998 (period II). RESEARCH DESIGN AND METHODS—All black children &lt;19 years of age diagnosed with diabetes and treated with insulin at onset admitted to the Children’s Hospital of Pittsburgh between January 1979 and December 1998 were matched with white children by sex, age at onset, and year of diagnosis. Data were obtained from a review of medical records. Overweight was defined as BMI ≥85th percentile for age and sex. Islet cell autoantibodies were measured. RESULTS—The prevalence of being overweight increased from 12.6% (period I) to 36.8% (period II) (P = 0.0003); in whites from 2.9 to 16.6% (P = 0.04) and in blacks from 22 to 55% (P = 0.001); and in the age-group &lt;11 years from 7.3 to 22.2% (P = 0.04) and age 11–18 years from 20 to 50% (P = 0.006). In children with at least one antibody, the prevalence of being overweight increased from 5.1 to 24.4% (P = 0.001). In the multivariate logistic regression, period of diagnosis (period II), race (black), age at onset (≥11 years old), and absence of autoimmunity were associated with being overweight. CONCLUSIONS—At onset of the disease, the prevalence of being overweight has tripled from the 1980s to the 1990s, following the trend in the general population. Weight gain may be an accelerating factor for onset of insulin-treated diabetes and may have contributed to the increased incidence of diabetes in youth seen in some populations.

Our results show poor reproducibility of the OGTT in obese youth, in particular for the 2-h plasma glucose. Obese youth who have discordant OGTT results are more insulin resistant with higher risk of developing type 2 diabetes mellitus, as evidenced by a lower GDI. The implications of this remain to be determined in clinical and research settings.