Increase in the incidence of type 1 diabetes mellitus in children in three cities in Poland, 1987-1999.

The aim of this study was to evaluate the trends in the incidence of type 1 diabetes mellitus (DM) in children aged 0-14 years between 1987 and 1999 in three cities in Poland. The study area comprised the provinces of Cracow and Wroclaw and the city of Warsaw. The data were collected prospectively on the basis of the register within the framework of the EURODIAB study up till 1997 and then within the project of the Ministry of Health. During the 13 years of the study period, 766 children (380 girls, 386 boys) with newly diagnosed type 1 DM were identified. The overall age-standardized incidence rates were 8.4/100,000 standardized population/year (95% CI 7.4-9.3) for Cracow province, 6.5/100,000/year (95% CI 5.6-7.4) for Wroclaw province and 7.9/100,000/year (95% CI 6.9-8.8) for Warsaw. A significant trend of increase for children aged 0-14 years was found in the three cities. The analysis of the trend in age subgroups showed a significant increase in incidence in all three age subgroups in Warsaw and Cracow province (0-4 year-old children, p <0.05; 5-9 year-olds, p <0.001 in Cracow province, p <0.05 in Warsaw, and in 10-14 year-olds, p <0.05 in Cracow province, p <0.005 in Warsaw). In the Wroclaw province a significant increase was observed in children aged 0-4 years (p <0.05) and 5-9 years (p <0.001). In children aged 10-14 years the increase was not statistically significant. The results of our study showed that the incidence of type 1 DM in children is rising. A similar phenomenon is occurring in many other countries. The greatest increase of incidence was observed in the 5-9 year-old subgroup of children in Cracow and Wroclaw provinces and in children aged 10-14 years in Warsaw. The incidence rates in excess of 9.0/100,000 per year observed since 1996 have placed Poland in the group of countries with low to medium incidence.

[Risk of incidence of diabetes mellitus in relatives of patients with diabetes type I in retrospective questionnaire study]. / Ryzyko wystepowania cukrzycy u krewnych pacjentów z cukrzyca typu 1 w retrospektywnych badaniach ankietowych.

It is commonly known that there is a higher risk of diabetes type 1 in relatives of patients with diabetes type 1. According to some reports in families of these patients the incidence of diabetes type 2 is also higher. The aim of our study was the evaluation of incidence of diabetes type 1 and 2 in 1st and 2nd degree relatives of patients with diabetes type 1. Our study was conducted in the years 1993-2000 in the Department of Endocrinology for Children and Adolescents in Wroclaw and in the Department of Endocrinology of Jagiellonian University in Cracow among relatives of all the patients in the age of 0-19 years with newly diagnosed diabetes type 1. Special prepared questionnaires were used in which patients were asked about: number of relatives of 1st and 2nd degree, age, sex and diagnosis of diabetes in the relatives. Data from families of 332 patients were obtained. They concerned 4080 relatives. Diabetes occurred in 121 relatives (2.96%). 20 of them were 1st degree relatives and 101--2nd degree relatives. In 31 relatives (0.76%) diabetes type 1 was diagnosed and in 88 relatives (2.16%) diabetes type 2 was diagnosed. Except for one individual (patient's mother) diabetes type 2 occurred in 2nd degree relatives. Diabetes type 1 was diagnosed in 16 1st degree relatives and 15 2nd degree relatives. They were: 1st degree relatives: 9 fathers, 3 brothers, 2 mothers and 2 sisters. 2nd degree relatives: in 8 cases siblings of patient's parents, in 7 grandparents. In families of diabetic children and adolescents relatives with type 1 and type 2 diabetes were observed, with a dominance of relatives with diabetes type 2 in 2nd degree relatives.

[Estimation of IGF-1 and IGFBP-3 concentrations in serum in children with diabetes type 1 and growth disorders]. / Ocena stezenia IGF-1 i IGFBP-3 w surowicy krwi u dzieci chorujacych na cukrzyce typu 1 z zaburzeniami wzrastania.

The relations between diabetes type 1 and growth disturbances have been controversial. The aim of the study was to estimate the IGF-1 and IGFBP-3 levels in the group of children with diabetes type 1 and growth disturbances. The study group consisted of 22 children (10 males and 12 females) aged 11.96+/-3.38, bone aged 10.70+/-3.91, GV SDS < -0.93 below the mean for C. A. IGF-1, IGFBP-3, GH stimulation test, TSH, fT4 and HbA1 were determined. In the studied group positive correlations between: IGF-1 and IGFBP-3; IGF-1 and BMI; BMI and IGFBP-3 were determined. In children with diabetes type 1. The IGF-1 concentration was significantly higher when the sceletal age was delayed above 1 year in comparison with children with delaying of the sceletal age bellow 1 year and it was independent on results of GH stimulation tests.

[ICA incidence in relatives of patients with diabetes type 1]. / Wystepowanie przeciwcial ICA u krewnych pacjentów z cukrzyca typu 1.

Diabetes type 1 is the authoimmunological disease, which develops in persons with genetical predisposition. Typing persons with higher risk of diabetes type 1 is usually based on immunological markers. The ICA are most often determined. The aim of the study was determination of ICA incidence and levels in the group of relatives of patients with diabetes type 1. The studied group consisted of 512 relatives of patients with diabetes type 1. The ICA incidence in 61 relatives was found (11.9%). The incidence and the levels of ICA were similar in both sexes. Majority of males with positive ICA (80%) was younger (0-20), while majority of females with positive ICA (70.97%) was older (21-40 years) (p=0.007). In brothers ICA antibodies were more frequent than in sisters.

[Hamartoma as a reason of precocious puberty in a 15-month old boy]. / Hamartoma jako przyczyna przedwczesnego dojrzewania plciowego u 15-miesiecznego chlopca.

Hamartoma of the hypothalamic region is known as one of the reasons of precocious puberty. The case of a 15-month old boy with hamartoma as a reason of precocious puberty is presented. The GnRH analogues were used in the therapy.

[Primary or tertiary hypothyroidism as a cause of growth disturbances in 13-month old boy?]. / Niedoczynnosc tarczycy czy podwzgórza przyczyna zaburzen wzrastania u 13-miesiecznego chlopca?

UNLABELLED: Due to the screening examination it is possible to diagnose primary hypothyreosis at the very beginning. On the other hand, hypothyreosis may be also caused by insufficient secretion of TSH or TRH. We present a 13-month old boy (A.I.) admitted to our Department because of short stature. The child was from normal pregnancy, birth spontaneous at full term with weight 4400 g, length 56 cm, 10 points in Apgar scale, TSH - 1,87 micro IU/ml in the screening examination. The psychomotor development was normal. At the admission the height was 72 cm (below 3 c), weight - 10,1 kg, body proportions normal, atresic fontanels, 7 teeth. Additional examinations revealed: skeletal age - 3 months, blood cell count normal, biochemical examinations normal except for level of cholesterol (209 mg/dl). We found lack of the GH secretion after clonidine. TSH value was slightly above normal range. The levels of free thyroid hormones, anti-TPO antibodies and thyroid ultrasonography were normal. The TSH level was increased in the stimulation test with TRH. Result of the MR examination of the brain was normal. On the basis of the whole picture tertiary hypothyreosis can not be excluded. The normalisation of thyroid hormone levels and GH in stimulation test with glucagone was obtained after therapy with L-thyroxine. CONCLUSION: In cases of unclear growing disorders the full diagnostics of the hypothalamic-hypophyseal-thyroid axis should be done because of the possibility of regulatory centres insufficiency.

Goiter prevalence in children in Lower and Middle Silesia (Wroclaw--coordinating center).

As a part of the programme concerning iodine deficiency and iodine prophylaxis in Poland, 2518 children of age between 6 and 13 years, living in Lower and Middle Silesia, were studied. The anamnesis was based on a questionnaire answered by parents of the investigated children. The physical examination included measurements of body height and mass, clinical symptoms of thyroid functions as well as size and compactness of the thyroid gland on the basis of WHO classification. Urinary concentration of iodine was measured. The majority of children with goiter were inhabitants of mountainous villages. The goiter was most frequent in the age group 9-10 years. No significant differences in goiter incidence could be found between children consuming and not consuming iodized kitchen salt. The urinary concentration of iodine was low in all children examined. It was concluded that the territory of Lower and Middle Silesia is still a region of moderate endemic goiter. The urinary iodine concentrations is low in children living in Lower and Middle Silesia. The present system of iodine prophylaxis is not adequate and new measures should be urgently introduced.