High Incidence of Childhood Type 1 Diabetes in the Avalon Peninsula, Newfoundland, Canada

Newhook, Leigh Anne; Curtis, Joseph; Hagerty, Donna; Grant, Marie‐Elaine; Paterson, Andrew D.; Crummel, C; Bridger, Tracey; Parfrey, Patrick S.

doi:10.2337/diacare.27.4.885

Cited by 45 publications

(28 citation statements)

References 20 publications

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“…This is in contrast to the reported general population incidence of childhood type 1 diabetes of 0.013-0.040% (41)(42)(43). The development of diabetes was associated with severe disease, marked by central nervous system symptoms, the need for acute dialysis, and mortality.…”

Section: Definition Of Diabetescontrasting

confidence: 66%

Diabetes During Diarrhea-Associated Hemolytic Uremic Syndrome

et al. 2005

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OBJECTIVE -To quantify the incidence of diabetes during the acute phase of diarrheaassociated hemolytic uremic syndrome (DϩHUS) and to identify features associated with its development. RESEARCH DESIGN AND METHODS-A systematic review and meta-analysis of articles assessing diabetes during DϩHUS was conducted. Relevant citations were identified from Medline, Embase, and Institute for Scientific Information Citation Index databases. Bibliographies of relevant articles were hand searched. All articles were independently reviewed for inclusion and data abstraction by two authors.RESULTS -Twenty-one studies from six countries were included. Only 2 studies reported a standard definition of diabetes; 14 defined diabetes as hyperglycemia requiring insulin. The incidence of diabetes during the acute phase of DϩHUS could be quantified in a subset of 1,139 children from 13 studies (1966 -1998, age 0.2-16 years) and ranged from 0 to 15%, with a pooled incidence of 3.2% (95% CI 1.3-5.1, random-effects model, significant heterogeneity among studies, P ϭ 0.007). Children who developed diabetes were more likely to have severe disease (e.g., presence of coma or seizures, need for dialysis) and had higher mortality than those without diabetes. Twenty-three percent of those who developed diabetes acutely died, and 38% of survivors required long-term insulin (median follow-up 12 months). Recurrence of diabetes was possible up to 60 months after initial recovery.CONCLUSIONS -Children with DϩHUS should be observed for diabetes during their acute illness. Consideration should be given to long-term screening of DϩHUS survivors for diabetes. Diabetes Care 28:2556 -2562, 2005H emolytic uremic syndrome (HUS) is characterized by acute hemolytic anemia, thrombocytopenia, and renal failure (1). The incidence of HUS is estimated at 1 per 50,000 person-years for children Ͻ18 years of age (2). Over 90% of childhood cases are associated with diarrhea and gastroenteritis due to Shiga toxin-producing Escherichia coli O157:H7 (3). Also known as "typical" or "primary" HUS, diarrhea-associated HUS (DϩHUS) causes toxin-mediated endothelial cell damage, resulting in thrombotic microangiopathy and intraluminal thrombosis of small vessels, with subsequent tissue ischemia and necrosis (4). Although renal and central nervous system involvement predominate, the pancreas can be affected, causing acute diabetes. Autopsy studies have demonstrated thrombosis of vessels supplying the islets of Langerhans with preservation of the exocrine pancreas (5,6). Although renal complications of HUS have received much attention (7), little is known about the incidence and management of diabetes during DϩHUS. Using techniques described by Stroup et al. (8), this systematic review was conducted to better understand diabetes associated with DϩHUS. RESEARCH DESIGN AND METHODS Research questionsThe primary research questions were as follows. 1) What is the incidence of diabetes during acute DϩHUS? 2) Is diabetes during acute DϩHUS associated with more severe DϩHUS, as defined ...

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Section: Definition Of Diabetescontrasting

confidence: 66%

Diabetes During Diarrhea-Associated Hemolytic Uremic Syndrome

et al. 2005

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“…This gender disparity was also observed in other European countries [4,24,25] and North America [10]. The underlying pathomechanisms explaining this gender difference are still not clear [24].…”

Section: Discussionmentioning

confidence: 67%

“…Northern European countries such as Finland and Sweden, and Canada have the highest incidence rates ranging between 30 and 40 per 100,000 children/adolescents per year [2,3,4,5,6,7]. Incidence rates of countries in Central Europe (with the exception of Sardinia) vary from 8 to 18 per 100,000 children/adolescents per year [2,4,5,8,9,10,11]. The incidence for type 1 diabetes in German children aged 0–14 years was estimated at 13 per 100,000 per year for 1987–1998 and at 15.5 per 100,000 per year for 1999–2003.…”

Section: Introductionmentioning

confidence: 99%

Incidence of Childhood Diabetes in Children Aged Less than 15 Years and Its Clinical and Metabolic Characteristics at the Time of Diagnosis: Data from the Childhood Diabetes Registry of Saxony, Germany

Galler¹,

Stange

Müller

et al. 2010

Horm Res Paediatr

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Aims: The Childhood Diabetes Registry in Saxony, Germany, examined the incidence and metabolic characteristics of childhood diabetes. Methods: In the federal state of Saxony, newly diagnosed cases of diabetes in children and adolescents aged less than 15 years were registered continuously from 1999 until 2008. Family history, date of diagnosis, clinical and laboratory parameters were obtained. Reported cases were ascertained by public health departments as an independent data source and verified using the capture- recapture method. Results: A total of 865 children and adolescents with newly diagnosed diabetes were registered in Saxony. About 96% of them were classified as having type 1 diabetes, 0.6% had type 2 diabetes, 2.4% had maturity-onset diabetes of the young (MODY), and 1.4% had other types of diabetes. The age-standardized incidence rate of type 1 diabetes was estimated at 17.5 per 100,000 children per year. Completeness of ascertainment as calculated by the capture-recapture method amounted to 93.6%. At the time of diagnosis, 27.1% of children with type 1 diabetes had ketoacidosis, 1.5% had a blood pH <7.0, and 1.1% were unconscious. Conclusion: The registry provided data about the incidence rates and clinical presentation of childhood diabetes in a defined German population. We observed higher incidence rates compared to previous surveys.

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“…With the few data available on subSaharan African children, incidence in Tanzania was estimated to be 1.5/ 100,000 (2), and an increase in incidence in Sudan from 9.5/100,000 in 1991 to 10.3/100,000 in 1995 has been reported (3). The prevalence is higher in Western countries (4,5), suggesting the possibility of missed diagnosis in sub-Saharan Africa. In fact, the problem of missed diagnosis of childhood diabetes, although not unique to developing countries (6), is certainly much more common than in developed countries (7).…”

mentioning

confidence: 99%

Survey on Acute and Chronic Complications in Children and Adolescents With Type 1 Diabetes at Muhimbili National Hospital in Dar es Salaam, Tanzania

Majaliwa

Ramaiya

et al. 2007

Diabetes Care

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OBJECTIVE -The purpose of this study was to assess glycemic control and complications of type 1 diabetes in children and adolescents in Tanzania. RESEARCH DESIGN AND METHODS -This demographic and clinical survey in-cluded 99 children aged between 5 and 18 years attending Muhimbili National Hospital Clinic for Diabetes. A structured questionnaire was used for evaluating socioeconomic data and for estimation of the prevalence of acute complications occurring over the last 6 months. The prevalences of retinopathy and diabetic nephropathy were determined by fundus ophthalmoscopy and by microalbuminuria, respectively.RESULTS -All of these children were treated with a conventional insulin regimen. The mean Ϯ SD duration of diabetes was 4.76 Ϯ 3.58 years. Only 1 child (1%) had good glycemic control (A1C Ͻ7.5%), 60 children (60.6%) had moderate glycemic control (A1C 7.5-10%), 14 children (14.1%) had poor glycemic control (A1C Ͼ10 -12.5%), and 24 children (24.2%) had very poor glycemic control (A1C Ͼ12.5%). At onset of diabetes, 75% of children presented with diabetic ketoacidosis (DKA); 89 children (89.80%) had at least one episode of DKA, and 55 children (55.67%) had symptomatic hypoglycemic episodes. Microalbuminuria was present in 29 (29.3%) and retinopathy in 22 (22.68%) children.CONCLUSIONS -Although there are some methodological limitations, this survey highlights the difficulties of achieving good metabolic control and the high prevalence of acute and chronic complications in Tanzanian children with type 1 diabetes. These results clearly show that major efforts are needed to improve quality of care in children with type 1 diabetes in Tanzania. Diabetes Care 30:2187-2192, 2007T ype 1 diabetes is one of the most frequent chronic disease in children and represents a public health challenge globally. Its burden is huge in developing countries owing to the lack of a basic means for reaching reasonable glycemic control. Because of the unavailability of reliable epidemiological data, the natural history of type 1 diabetes, including its complications, is largely unknown (1). With the few data available on subSaharan African children, incidence in Tanzania was estimated to be 1.5/ 100,000 (2), and an increase in incidence in Sudan from 9.5/100,000 in 1991 to 10.3/100,000 in 1995 has been reported (3). The prevalence is higher in Western countries (4,5), suggesting the possibility of missed diagnosis in sub-Saharan Africa. In fact, the problem of missed diagnosis of childhood diabetes, although not unique to developing countries (6), is certainly much more common than in developed countries (7). In a Sudanese study, it was reported that 10% of children were not admitted at the time of diagnosis, being admitted only after they developed diabetic ketoacidosis (DKA) or hypoglycemia (3). This situation contributes to omission of patients in the registry as well as to the possibility of death before diagnosis, especially for those aged Ͻ5 years. In sub-Saharan Africa, most children present with DKA at the time of diagnosis (8,...

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High Incidence of Childhood Type 1 Diabetes in the Avalon Peninsula, Newfoundland, Canada

Cited by 45 publications

References 20 publications

Diabetes During Diarrhea-Associated Hemolytic Uremic Syndrome

Diabetes During Diarrhea-Associated Hemolytic Uremic Syndrome

Incidence of Childhood Diabetes in Children Aged Less than 15 Years and Its Clinical and Metabolic Characteristics at the Time of Diagnosis: Data from the Childhood Diabetes Registry of Saxony, Germany

Survey on Acute and Chronic Complications in Children and Adolescents With Type 1 Diabetes at Muhimbili National Hospital in Dar es Salaam, Tanzania

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