A life-course approach to early-onset of diabetes mellitus: Probable contribution of collective violence in Mexico.

Type 2 diabetes mellitus (T2DM) is a growing health problem among the pediatric population in the world, and particularly in Mexico. Official data in Mexico reported that during the period from 2003 to 2013 there was an increase in the cumulative incidence among older adolescents between 2010 and 2012, which decreased to the usual measures in 2013. All these variations occurred in a period in which collective violence permeated all levels of Mexican society. It can be argued that there might be a relationship between the two phenomena. This is an ecologic analytical study of trends over time comprising older adolescents (15-19 year olds). T2DM cumulative incidence and mortality rates attributable to violent death (VD) were standardized by direct method according to the World Health Organization. Data were sourced from nationwide official reports. Time series analysis was performed with ARIMA models and significant predictors. The disease ecology analysis was done using cluster analysis. Using significant predictors with ARIMA models, we found that the male VD mortality rates series could forecast 63.1% of the temporal variability of the cumulative incidence of T2DM series. Geographically, states with higher rates of violence also showed a higher incidence of T2DM. These data suggest that collective violence may make some contribution to the early onset of T2DM among adolescents, particularly in those regions most affected by violence. These findings can be conducive to opening new lines of research to explore the relationship between variables at the individual level and the clinical implications.

Variation in incidence of type 2 diabetes mellitus: time series of Mexican adolescents.

PURPOSE: To study temporal changes in the cumulative incidence (CI) of type 2 diabetes mellitus during early and late adolescence from 2003 to 2013. METHODS: This was an ecologic, analytical study of trends over time. Data were weekly reports of new cases (General Directorate of Epidemiology). Specific CI was calculated and standardized by age using the direct method (WHO). Autoregressive Integrated Moving Average models offering a better fit to the observed series were calculated and controlled by intentional screening. Structural break point analysis was performed. RESULTS: The CI was lower in younger adolescents than in older adolescents. In early adolescence, the incidence was similar in both sexes and stable over time [Autoregressive Integrated Moving Average female: (2,0,2)(0,0,0), male: (1,0,1)(0,0,0); P < .001], whereas in late adolescence, the female incidence was higher than the male incidence and showed a linear increase [female: (1,1,2)(1,0,0), male: (1,0,1)(0,0,0); P < .001)]. The female series showed two structural break points, in 2010 and 2012. The male early adolescent series showed one break point in 2011. CONCLUSIONS: Although there was an increase in the CI of type 2 diabetes mellitus during the study period, only the female late adolescence series showed an epidemiologically significant linear trend. There was also a brief, limited rise between 2010 and 2012 that affected all adolescents. This suggests that the disease may be triggered by specific events.