Rapid increase in the incidence of type 1 diabetes in Polish children from 1989 to 2004, and predictions for 2010 to 2025.

AIMS/HYPOTHESIS: We analysed the temporal changes in the incidence of childhood type 1 diabetes and its demographic determinants in Poland from 1989 to 2004, validating the model with data from 1970 to 1989. We also estimated a predictive model of the trends in childhood diabetes incidence for the near future. METHODS: Children under 15 years with newly diagnosed type 1 diabetes mellitus and drawn from seven regional registries in Poland were ascertained prospectively using the Epidemiology and Prevention of Diabetes study (EURODIAB) criteria. The type 1 diabetes incidence rates (IRs) were analysed in dependency of age, sex, seasonality, geographical region and population density. Time trends in IR were modelled using several approaches. RESULTS: The average incidence, standardised by age and sex, for 1989 to 2004 was 10.2 per 100,000 persons per year and increased from 5.4 to 17.7. No difference was found between boys and girls, or between urban and rural regions. In children above 4 years, IR was significantly higher in the population of northern Poland than in that of the country's southern part, as well as in the autumn-winter season, this finding being independent of child sex. Based on the trend model obtained, almost 1,600 Polish children aged 0 to 14 years are expected to develop type 1 diabetes in 2010, rising to more than 4,800 in 2025. The estimates suggest at least a fourfold increase of IR between 2005 and 2025, with the highest dynamics of this increment in younger children. CONCLUSIONS/INTERPRETATION: These estimates show that Poland will have to face a twofold higher increase in childhood type 1 diabetes than predicted for the whole European population. The dramatic increase could have real downstream effects on Poland's healthcare system.

Late potentials: are they related to cardiovascular complications in children with type 1 diabetes?

INTRODUCTION: The aim of our study was to assess the influence of cardiovascular complications on the occurrence of late ventricular potentials (LP) in children with diabetes mellitus type 1. MATERIALS AND METHODS: 72 children (36 boys and 36 girls), with average course of diabetes type 1 of 6.5+/-2.8 years, were included into the study. Standard physical examination, blood pressure measurements, signal-averaged electrocardiogram (SAECG), autonomic test, 24-h Holter monitoring, and Doppler echo investigations were performed. The control group consisted of 55 sex- and age-matched healthy children. We utilised nonlinear logistic regression analysis to assess the effect of disease duration, albuminuria, insulin demand, cardiac autonomic neuropathy (CAN), heart rate variability (HRV) indices, diabetes complication score, metabolic control, systolic and diastolic blood pressure, left ventricular parameters, and ventricular arrhythmias on LP occurrence. RESULTS: LP was discovered in 12 patients with diabetes and in 1 from the control group (P<.014). Diabetic children with LPs had thicker left ventricular posterior wall (LVPW) and longer diabetes duration time than children without LP (P<.045 and.031, respectively). Nonlinear regression model shows that duration of diabetes, CAN, and LVPW were the strongest independent parameters of LP occurrence (P<.001,.01 and.005, respectively). CONCLUSIONS: Diabetes type 1 is associated not only with increased occurrence of abnormal SAECG but also with LP presence. The disease duration, posterior wall thickness, and CAN are independent predictors of LP appearance in diabetes type 1 children. The presence of cardiovascular complication has no influence on LP occurrence in diabetic children.

Elevated concentrations of homocysteine in children and adolescents with arterial hypertension accompanying Type 1 diabetes.

BACKGROUND: Ischemic heart disease is the primary cause of morbidity and mortality among diabetics, especially those who became ill at a young age. In evaluating the risk of the development of atherosclerotic changes, especially when occurring prematurely, increasing attention is being paid to new, unconventional risk factors. One of many such new factors, and one whose role in the development of atherosclerotic changes currently seems to be beyond dispute, is homocysteine. The purpose of this article is to evaluate the concentration of homocysteine in children and youth with Type 1 diabetes, and to attempt to determine the dependence between homocysteine and the degree of metabolic control, the duration of the illness, the age at onset, the insulin dose, the appearance of complications, and a family history of ischemic heart disease. MATERIAL AND METHODS: Our research involved 103 children and youth (average age 13.3 years) with Type 1 diabetes, with an average duration of illness of 5.3 years. The control group consisted of 44 healthy, non-obese children. The concentration of homocysteine was measured using the AXIS homocystein EIA immunoenzymatic method with a set of reagents from the Bio Rad company. RESULTS: The average homocysteine concentration in the experimental group was 5.6 micromol/L, which did not constitute a significant difference from the control group's 6.1 micromol/l. No statistically significant differences were discovered in the concentration of homocysteine depending on the degree of metabolic control, age at onset, method of insulinotherapy, or family history. A significant increase in the concentration of homocysteine was found in children who had been ill for a long time (more than 10 years): 6.1 micromol/L, as against 5.1 micromol/l in children who had been ill for a shorter period of time, and a significantly higher concentration of Hcy in children with diabetic complications (6.1 vs 5.3 micromol/L) and in children with arterial hypertension. CONCLUSIONS: The significant increase in the concentration of homocysteine in children with Type 1 diabetes and arterial hypertension indicates that this group is particularly exposed to early atherosclerotic changes, independently of metabolic control and the parameters of lipid metabolism, and requires the implementation of treatment aimed at reducing the blood concentration of homocysteine.

The large increase in incidence of Type I diabetes mellitus in Poland.

AIMS/HYPOTHESIS: A rising incidence of Type I (insulin-dependent) diabetes mellitus in different countries in Europe during the last decade has been recently reported. However, in the early 1990s, Poland was reported to have a stable low incidence of this disease. This study aimed to estimate the annual incidence of Type I diabetes in a north-eastern region of Poland (Bialystok region) and investigate if it is associated with age, sex, urban rural differences and the season of disease onset. METHODS: A register of patients with Type I diabetes using two independent sets of data sources was established in 1994 as part of the EURODIAB TIGER programme. The primary data sources were paediatric and internal medicine divisions of the hospitals in the Bialystok province and the secondary were outpatient diabetic clinics in the region. The degree of ascertainment was 98.5 % for the combinated data sources. RESULTS: We found a significant rising trend in the incidence of Type I diabetes in children under 15 years of age (in 1998 the incidence was approximately twice as high as in 1994). Increasing incidence rates were observed in the rural areas but not in urban populations. Seasonal variation in the incidence was also found, with a peak in winter and nadir in summer. CONCLUSIONS/INTERPRETATION: These results show that the north-eastern region of Poland is an area with a moderate rather than a low risk of Type I diabetes. Our observations confirm the important role of environmental and socio-economic factors or both in the pathogenesis of Type I diabetes.

[The epidemiology of type 1 diabetes in children and adolescents in north-east Poland in the period 1988-1999]. / Epidemiologia cukrzycy typu 1 wsród dzieci i mlodziezy w Polsce pólnocno-wschodniej w latach 1988-1999.

AIM: The studies performed in many European countries show the increasing tendency of the incidence of type 1 diabetes in different regions of our continent. The aim of study was the evaluation of incidence of type 1 diabetes in children and adolescents in north-east Poland in the period 1988-1999 and its analysis according to sex, age, place of residence and season of diabetes diagnosis. MATERIAL AND METHODS: Diabetic outpatient clinic and II Department of Pediatrics at Medical Academy in Bialystok take medical care of children and adolescents in north-east macroregion of Poland (administrative border from 1975) with 4% population of Poland. Retrospective study was performed in the period 1.01.1988-31.12.1999. All new cases of diabetes in 0-18 years old children and adolescents were registered. Incidence index of IDDM was expressed by ratio of new diabetes cases to 100 000 age-selected population. The number of population was taken from Demographic Yearbooks 1988-1999 of Central Statistical Office. RESULTS: During twelve-year observation of developmental age population living in north-east Poland diagnosis of diabetes type 1 was established in 421 persons: 221 boys (52.5%) and 200 girls (47.5%). Incidence index for the whole region was 7.33 (4.6-10.1). The analysis of the patient age at the diagnosis revealed rarer occurrence of diabetes in children under 5 years - 53 persons (12.5%). The type 1 diabetes was more often recognized in pubertal period - 188 persons (44.65%). The highest increase in incidence of diabetes was noted in 5-14 years old persons and it reached 17/100,000 in 1999. The analysis of the place of residence showed the increase of diabetes incidence of only in country regions. It was the same in towns. The diabetes manifested itself more often in autumn and winter than in summer period. CONCLUSION: 1) The incidence of type 1 diabetes mellitus in north-east Poland rised significantly from 4.6 in 1988 to 10.1 in 1999. The identification of the etiological factors and prevention of disease may be necessary. 2) The seasonal incidence of type 1 diabetes confirms the real participation of environmental factors in etiopathogenesis of the disease.

[Effectiveness of pre- and postprandial Humalog in adolescents with type 1 diabetes]. / Ocena skutecznosci Humalogu stosowanego przed i po posilku u mlodziezy z cukrzyca typu 1.

UNLABELLED: The aim of the study was to evaluate the glycaemic response to pre- and postprandial Humalog. MATERIAL: The study involved 47 type 1 diabetic adolescents between the ages 12 and 18 (mean 15.5) and the duration of diabetes from 1 to 13 years (mean 5.16). METHODS: All patients received Humalog in intensive therapy during 3-month period: 29 persons just before the meal and 18 immediately after the meal. All patients were injected with basal insulin twice a day (Humulin N). HbA1c values were determined at the beginning and the end of study. Patients' blood glucose levels were measured preprandially and 1 and 2 hours after eating their first bite of breakfast (noted in 1, 6 and 12 week of observation). At the end of observation (after 3 months) the analysis of the blood glucose levels after pre- and postprandial administration of Humalog insulin was performed. Blood samples were obtained at -40, -20, 0, 15, 60, 90, 120, 150 and 180 minute relative to the start of the meal. RESULTS: The mean HbA1c value decreased from 8.01 to 7.63%. The patients' preprandial glucose levels 1 and 2 hours after meal were similar in two groups in each measurement (1, 6, 12 week). The pre- and postprandial glucodynamics were similar in the two groups. The number of mild hypoglycaemic episodes was slightly higher in the group receiving Humalog before meal (0.32 vs. 0.19 episodes/person/day - p<0.05). CONCLUSION: Postprandial Humalog insulin may provide good postprandial glucodynamic control because it is safe, insulin dose can be matched to the actual food intake and it is not associated with an increase in the frequency of hypoglycaemic events. The possibility of the pre- and postprandial Humalog insulin administration improves the quality of life of patients with diabetes.

[IA-2 and anti-GAD antibodies in patients with newly diagnosed type 1 diabetes and their first degree relatives]. / Przeciwciala antylA-2 i antyGAD u pacjentów z nowo rozpoznana cukrzyca typu 1 i ich krewnych 1 stopnia.

Antibodies recognising different pancreatic autoantigens (Abs) are detected many years before the clinical onset of insulin-dependent diabetes mellitus (IDDM). The humoral immune alterations, observed in the susceptible subjects, for example in first degree relatives of IDDM patients, could serve as predictive markers of IDDM development. It has recently been suggested that the predictive value of these humoral markers is associated with the number of the studied antibodies directed against different pancreatic antigens (ICA, GADA, IA-2,A IAA). The aim of the study was the estimation of the prevalence and titre of the antibodies directed against protein tyrosine phosphatase-2 (IA-2) and glutamic acid decarboxylase (GAD) in patients with newly diagnosed diabetes type 1 and their first degree relatives. The investigations were carried out in 52 diabetics (aged 5-25 years) and 136 first degree relatives. IA-2A and GADA were performed by radiobinding assay (RIA) using 2 microliters of serum and recombinant S35-labelled GAD65 and IA-2 antigens. The threshold of Abs detection was > or = 97.5 centile (of healthy schoolchildren). At least one of the antibody marker was detected in 92.7% of newly diagnosed IDDM patients, slightly more frequently observed were GADA (78.8%) than IA-2A (71.2%). The presence of 2 types of antibodies was found in 8.7% of parents and 9.4% of the siblings. The results of our study confirm high sensitivity and specificity of the combined measurement of IA-2A and GADA in recognising of autoimmune alterations in diabetes type 1 development. Taking into consideration small volume of the serum suitable for Abs measurement and possibility of the combined estimation of these Abs it seems that IA-2A and GADA combined measurement could actually serve as a screening marker for the detection of high risk of IDDM subjects also in the Polish population, but studies concerning their predictive value in the general population are suggested.

[Fluorescein angiography in children and adolescents with type I diabetes mellitus]. / Angiografia fluoresceinowa u dzieci i mlodziezy z cukrzyca typu I.

PURPOSE: The evaluation of changes in ophthalmoscopic examination and fluorescein angiography in children and adolescents with insulin dependent diabetes mellitus. MATERIAL AND METHODS: 100 patients with type I diabetes mellitus aged 9.3-21.5 years (15.76 +/- 2.69), with diabetes duration of 1-13.5 years (6.57 +/- 2.52) were examined. RESULTS: Retinal changes in ophthalmoscopic examination were observed in 12 cases. Fluorescein angiography allowed to detect diabetic retinopathy in 29 patients. There was no correlation between the incidence of retinopathy and the age of patients. Vascular abnormalities were related to the duration of diabetes. Retinopathy was not found in children < 10 years of age.

[The evaluation of contrast sensitivity in children and adolescents with insulin-dependent diabetes mellitus]. / Ocena wrazliwosci na kontrast u dzieci i mlodziezy z cukrzyca insulinozalezna.

PURPOSE: The evaluation of contrast sensitivity in children and adolescents with type I diabetes mellitus with and without retinopathy, taking into account metabolic control. MATERIAL AND METHODS: We examined 100 young patients (71 without retinopathy and 29 with background retinopathy on fluorescein angiography) and 60 control non-diabetic subjects matched for age and sex, without visual or systemic symptoms. Contrast sensitivity was measured in spatial frequency of 3, 6, 12 and 18 cycles/degree (c/d). RESULTS: Contrast sensitivity was significantly lower (p < 0.001) in four spatial frequencies in all diabetic patients and in IDDM patients without retinopathy than in control group. Patients with IDDM and retinopathy had abnormal contrast sensitivity at spatial frequency 18 c/d when compared with patients without retinopathy. There was no correlation between contrast sensitivity and HbA1c values. CONCLUSIONS: Contrast sensitivity measurement in children and adolescents with type I diabetes is useful in the evaluation of the nature of early abnormalities in retinal function of diabetics.

[Usefulness of antioxidant vitamin supplementation in children and adolescents with newly diagnosed diabetes mellitus type I]. / Przydatnosc zastosowania witamin antyoksydacyjnych u dzieci i mlodziezy z nowo rozpoznana cukrzyca insulinozalezna.

BACKGROUND: Diabetes type I is caused by immune-mediated destruction of the b-cells. During the immune response macrophages release free oxygen radicals and cytokines which damage DNA. Ascorbic acid, b-carotene, a-tocopherol and nicotinamide act as antioxidants (free radical scavengers). OBJECTIVES: Comparative analysis of diabetes mellitus clinical course in the first year after diagnosis with and without antioxidative vitamin supplementation. MATERIAL AND METHODS: 40 children and adolescents with newly-diagnosed diabetes type I treated with: group A (n=13) n insulin + diet, group B (n=14) n additional vitamins A+E, C, group C (n=13) n additional vitamins A+E, C, PP. RESULTS: The remission was observed in n=13 (92.8%) children in group B, in n=6 (46.1%) in group C and only in 2 (15.4%) in group A after 3-4 months. After 6-7 months the remission was obtained in 10 patients (71.5%) in group B, in 6 (46.1%) - in group C and in 4 (30.8%) - in group A. After one year observation 6 (42.5%) patients in group B had remission, 4 (30.7%) in group C and 2 (15.4%) - in group A. Daily insulin demand was similar after diagnosis, after 3-4 months it was more reduced in group B (x - 0.28 u./kg/d, SD n 0.23) vs. x - 0.40 u./kg/d SD n 0.24 (group C) and vs., x - 0.5 u./kg/d - (group A). The insulin demand was augmented in the following months but all the time it was lower in the group supplemented by vitamins A, E, C. The glycaemic control and the values of lipids, thiobarbituric and reactive substances, group-SH of glutathione and vitamin C were similar in analysed groups in simultaneous periods. CONCLUSIONS: Supplementation with antioxidant vitamins in newly diagnosed diabetes mellitus type I leads to more frequent remissions and reduced insulin demand, particularly in the first months of diabetes duration.

[Epidemiology of diabetes type 1 in the 0 to 29 year-old age group in Northeastern Poland, 1994-1998--prospective observations]. / Epidemiologia cukrzycy typu 1 w populacji 0-29 lat w Polsce pólnocno-wschodniej w latach 1994-1998--obserwacja prospektywna.

It was recently suggested that there is a tendency of the rising incidence of diabetes type 1 in different countries in Europe. In our previous studies we observed the high frequency of ICA among first degree relatives of diabetic subjects, what could suggest a rapid increase in the incidence of diabetes type 1 also in the north-eastern region of Polan. The aim of the study was to estimate the annual incidence of diabetes type 1 in the north-eastern region of Poland and to evaluate the association of the incidence rates with the age, gender, urban-rural differences and the season of the year of the disease onset. The register of new cases of IDDM was established in 1994 using 2 independent data sources. The degree of ascertainment was 98.9% for the combination of both data sources. We observed a rising trend in the incidence from 6.4 in 1994 to 9.9 cases per year per 100,000 in 1998 (p < 0.001). The highest incidence rate increase was recorded in boys aged 5 to 14 years old (16-17 cases per 100,000 in 1997-1998). The rising trend in this incidence was observed in the rural areas, while in urban populations the incidence was unchanged. Seasonal variation in the incidence was also recorded, with a peak in autumn and winter and nadir in summer. Our observations suggest the necessity of the continuation of the studies to identify the diabetogenic environmental factors and to try preventive procedures in the studied population.

[Antibodies to glutamic acid decarboxylase (GADA) as markers of risk for development of insulin-dependent diabetes mellitus]. / Przeciwciala skierowane przeciwko dekarboksylazie kwasu glutaminowego (antyGAD) jako marker ryzyka rozwoju cukrzycy insulinozaleznej.

Autoantibodies to glutamic acid decarboxylase (GADA)-found frequently before the onset of IDDM are an important marker of the autoimmune process of B cells destruction. The aim of the present study was to evaluate the possible relationship between the frequency of GADA and ICA in first degree relatives of subjects with IDDM. The GADA were determined in 238 first degree relatives of IDDM subjects. In 32 of the investigated subjects GADA were measured second time after 12 months and in 24 of them IVGTT was performed to evaluate FPIR and GADA prevalence relationship. The results demonstrate that combination of ICA and GADA antibodies has a high sensitivity and increases the specificity for predicting IDDM in high risk siblings.