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1.
Womens Health Issues ; 30(3): 191-199, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32340896

RESUMO

BACKGROUND: Diabetes is increasingly prevalent among women of reproductive age, yet little is known about quality of diabetes care for this population at increased risk of diabetes complications and poor maternal and infant health outcomes. Previous studies have identified racial/ethnic disparities in diabetes care, but patterns among women of reproductive age have not been examined. METHODS: This retrospective cohort study analyzed 2016 data from Kaiser Permanente Northern California, a large integrated delivery system. Outcomes were quality of diabetes care measures-glycemic testing, glycemic control, and medication adherence-among women ages 18 to 44 with type 1 or type 2 diabetes (N = 9,923). Poisson regression was used to estimate the association between patient race/ethnicity and each outcome, adjusting for other patient characteristics and health care use. RESULTS: In this cohort, 83% of participants had type 2 diabetes; 31% and 36% of women with type 2 and type 1 diabetes, respectively, had poor glycemic control (hemoglobin A1c of ≥9%), and approximately one-third of women with type 2 diabetes exhibited nonadherence to diabetes medications. Compared with non-Hispanic White women with type 2 diabetes, non-Hispanic Black women (adjusted risk ratio, 1.2; 95% confidence interval, 1.1-1.3) and Hispanic women (adjusted risk ratio, 1.2; 95% confidence interval, 1.1-1.3) were more likely to have poor control. Findings among women with type 1 diabetes were similar. CONCLUSIONS: Our findings indicate opportunities to decrease disparities and improve quality of diabetes care for reproductive-aged women. Elucidating the contributing factors to poor glycemic control and medication adherence in this population, particularly among Black, Hispanic, and Asian women, should be a high research and practice priority.


Assuntos
Prestação Integrada de Cuidados de Saúde/normas , Diabetes Mellitus Tipo 1/etnologia , Diabetes Mellitus Tipo 2/etnologia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde , Adolescente , Adulto , Afro-Americanos/estatística & dados numéricos , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Glicemia , Estudos de Coortes , Grupos Étnicos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hemoglobina A Glicada , Hispano-Americanos/estatística & dados numéricos , Humanos , Adesão à Medicação/etnologia , Prevalência , Estudos Retrospectivos , Risco , Estados Unidos , Adulto Jovem
2.
MMWR Morb Mortal Wkly Rep ; 69(6): 161-165, 2020 Feb 14.
Artigo em Inglês | MEDLINE | ID: mdl-32053581

RESUMO

Diabetes is one of the most common chronic diseases among persons aged <20 years (1). Onset of diabetes in childhood and adolescence is associated with numerous complications, including diabetic kidney disease, retinopathy, and peripheral neuropathy, and has a substantial impact on public health resources (2,3). From 2002 to 2012, type 1 and type 2 diabetes incidence increased 1.4% and 7.1%, respectively, among U.S. youths (4). To assess recent trends in incidence of diabetes in youths (defined for this report as persons aged <20 years), researchers analyzed 2002-2015 data from the SEARCH for Diabetes in Youth Study (SEARCH), a U.S. population-based registry study with clinical sites located in five states. The incidence of both type 1 and type 2 diabetes in U.S. youths continued to rise at constant rates throughout this period. Among all youths, the incidence of type 1 diabetes increased from 19.5 per 100,000 in 2002-2003 to 22.3 in 2014-2015 (annual percent change [APC] = 1.9%). Among persons aged 10-19 years, type 2 diabetes incidence increased from 9.0 per 100,000 in 2002-2003 to 13.8 in 2014-2015 (APC = 4.8%). For both type 1 and type 2 diabetes, the rates of increase were generally higher among racial/ethnic minority populations than those among whites. These findings highlight the need for continued surveillance for diabetes among youths to monitor overall and group-specific trends, identify factors driving these trends, and inform health care planning.


Assuntos
Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Adolescente , Criança , Pré-Escolar , Diabetes Mellitus Tipo 1/etnologia , Diabetes Mellitus Tipo 2/etnologia , Feminino , Humanos , Incidência , Índios Norte-Americanos/estatística & dados numéricos , Lactente , Recém-Nascido , Masculino , Estados Unidos/epidemiologia , Adulto Jovem
3.
N Z Med J ; 133(1510): 35-44, 2020 02 21.
Artigo em Inglês | MEDLINE | ID: mdl-32078599

RESUMO

AIMS: To determine whether glycaemic control and the prevalence of microvascular complications in Waikato children/youth with type 1 diabetes (T1D) has changed since 2003. METHODS: A retrospective review was performed of clinical records of children and youth with T1D who were under the care of the Waikato Paediatric and Young Adult Diabetes Services between March 2016 and March 2017. Comparisons were made to published data from the same service in 2003. RESULTS: Despite a more than two-fold increase in insulin-pump therapy since 2003, glycaemic control was not significantly improved in either children or youth. However, since 2003 there has been a significant reduction in the prevalence of diabetic retinopathy (24.6% vs 6.0%; P=0.003) and nephropathy (6.0% vs 25.4%; P=0.002), while symptomatic diabetic neuropathy remains rare. This reduction occurred despite a significant increase in obesity and hypertension, and no significant difference in the rates of dyslipidaemia or smoking. CONCLUSIONS: There has been a marked reduction in microvascular complications in Waikato youth and young adults with type 1 diabetes, but the reasons for the reduction are not clear given there has been no significant improvements in glycaemic control.


Assuntos
Diabetes Mellitus Tipo 1/complicações , Nefropatias Diabéticas/etnologia , Neuropatias Diabéticas/etnologia , Retinopatia Diabética/etnologia , Grupo com Ancestrais Oceânicos , Adolescente , Biomarcadores/sangue , Glicemia/metabolismo , Criança , Pré-Escolar , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 1/etnologia , Nefropatias Diabéticas/etiologia , Neuropatias Diabéticas/etiologia , Retinopatia Diabética/etiologia , Feminino , Humanos , Hipoglicemiantes/uso terapêutico , Lactente , Recém-Nascido , Masculino , Nova Zelândia/epidemiologia , Prevalência , Estudos Retrospectivos
4.
Seizure ; 71: 318-321, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31525611

RESUMO

PURPOSE: Individuals with type 1 diabetes mellitus (T1D) are at higher risk of epilepsy. T1D is a progressive immune-mediated disease and the etiology of epilepsy remains unknown in most. Glutamic acid decarboxylase (GAD) catalyzes GABA formation. GABA-secreting neurons and pancreatic beta cells are the major cells expressing GAD. METHODS: Cross-sectional study. Patients with T1D from a multiethnic population underwent GADA measurement to investigate possible association between T1D and epilepsy of unknown etiology. RESULTS: T1D patients were analyzed (n = 375). Overall frequency of epilepsy was 5.9% (n = 22). Frequency of epilepsy of unknown etiology was 3.2% (n = 12). Of these, 8 (2.1%) had idiopathic generalized epilepsy (IGE) and 4 (1.1%) MRI-negative temporal lobe epilepsy (TLE). Patients with T1D and epilepsy of unknown etiology did not show differences in GADA frequency (83.3% vs 50%; p = 0.076); however, their titers were higher (106.9 ±â€¯136.5 IU/mL; median 7; IQR 1.65-256 vs 10.2 ±â€¯14.5 IU/ml; median 4.3; IQR 1.9-8.9; p = 0.019) compared to patients without epilepsy. Moreover, epilepsy of unknown etiology was associated with GADA titers ≥ 100 UI/mL [odds ratio (OR) 4.42, 95% CI 2.36-8.66]. CONCLUSION: Epilepsy frequency was elevated in patients with T1D and multiethnic background. Presence of epilepsy of unknown etiology was associated with high titers of GADA in this population with long-standing T1D, which has different ethnic and genetic background compared to previous studies. Further prospective studies are required to identify if GADA presence or its persistence are directly responsible for epilepsy in individuals with T1D.


Assuntos
Autoanticorpos/sangue , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/epidemiologia , Epilepsia/sangue , Epilepsia/epidemiologia , Glutamato Descarboxilase/imunologia , Adulto , Brasil/epidemiologia , Comorbidade , Estudos Transversais , Diabetes Mellitus Tipo 1/etnologia , Epilepsia/etnologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
5.
Am J Med Sci ; 358(2): 121-126, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31331449

RESUMO

BACKGROUND: Multiple studies have addressed ethnic diabetes mellitus (diabetes) care inequalities. But few have assessed whether ethnicity influences patient perceptions of diabetic quality-of-life (QOL). The authors therefore designed a cross-sectional study to quantify the overall QOL associated with diabetes in consecutive white (Caucasian) and black (African-American) participants. MATERIAL AND METHODS: A validated, time tradeoff utility instrument was consecutively administered by interview to 518 white and 92 African-American, adult, diabetic participants in an ambulatory setting. The instrument calculates QOL by quantifying a utility associated with their condition, with utility anchors of 1.00 (perfect health for that condition permanently) and 0.00 (death). Utility acquisition as used herein, first requires asking participants to estimate their theoretical remaining time of life, then subtracting from 1.00 the maximum proportion of their estimated remaining time of life they would be willing to hypothetically trade-if any-to permanently cure their condition (diabetes). Thus, a diabetic participant estimating 20 remaining years of life who will theoretically trade 3 of those years to cure their diabetes, has a diabetes-associated utility of [1.00 - (3/20) =)] 0.85. The closer the utility is to 1.00, the better the QOL associated with a condition, while the closer it is to 0.00, the poorer the associated QOL. RESULTS: The mean diabetes utility (QOL) for the white, diabetic participant cohort was 0.87, while that for the black cohort was 0.86 (P = 0.95). The ethnic cohorts were matched for age (P = 0.70), sex (P = 0.64), level of education (P = 0.29), known years of having diabetes (P = 0.10), insulin use (P = 0.23), type of diabetes (P = 0.27) and the number of associated comorbidities (P = 0.23). There was no difference between the cohorts for the presence and severity of the individual, diabetes-related comorbidities of retinopathy (P = 0.15), nephropathy (P = 0.24), neuropathy (P = 0.52), depression (P = 0.23) and heart disease (P = 0.32). Multiple linear regression integrating both cohorts revealed no effect of ethnicity upon diabetes utility (P = 0.60). CONCLUSIONS: Diabetes-related QOL was similar in matched cohorts of adult white and black participants with diabetes mellitus. This study suggests utilities for diabetes mellitus can be used in economic analyses without adjustment for white and black ethnicity.


Assuntos
Afro-Americanos , Diabetes Mellitus Tipo 1/etnologia , Diabetes Mellitus Tipo 2/etnologia , Grupo com Ancestrais do Continente Europeu , Qualidade de Vida/psicologia , Adulto , Afro-Americanos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Complicações do Diabetes/tratamento farmacológico , Complicações do Diabetes/etnologia , Complicações do Diabetes/psicologia , Diabetes Mellitus Tipo 1/tratamento farmacológico , Diabetes Mellitus Tipo 1/psicologia , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/psicologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Insulina/administração & dosagem , Insulina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Inquéritos e Questionários , Estados Unidos , Adulto Jovem
6.
Gene ; 707: 1-8, 2019 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-31054364

RESUMO

BACKGROUND: Genome-wide association studies have captured a large proportion of genetic variation related to type 1 diabetes mellitus (T1D). However, most of these studies are performed in populations of European ancestry and therefore the disease risk estimations can be inaccurate when extrapolated to other world populations. METHODS: We conducted a case-control study in 1866 individuals from the three major populations of the Republic of Bashkortostan (Russians, Tatars, and Bashkirs) in Russian Federation, using single-locus and multilocus approach to identify genetic predictors of T1D. RESULTS: We found that LTA rs909253 and TNF rs1800629 polymorphisms were associated with T1D in the group of Tatars. Meta-analysis of the association study results in the three ethnic groups has confirmed the association between the T1D risk and LTA rs909253 genetic variant. LTA rs909253 and TNF rs1800629 loci were also featured in combinations most significantly associated with T1D. CONCLUSION: Our findings suggest that LTA rs909253 and TNF rs1800629 polymorphisms are associated with the risk of T1D both independently and in combination with polymorphic markers in other inflammatory genes, and the analysis of multi-allelic combinations provides valuable insight in the study of polygenic traits.


Assuntos
Diabetes Mellitus Tipo 1/genética , Linfotoxina-alfa/genética , Polimorfismo de Nucleotídeo Único , Fator de Necrose Tumoral alfa/genética , Adolescente , Adulto , Bashkiria/etnologia , Estudos de Casos e Controles , Diabetes Mellitus Tipo 1/etnologia , Feminino , Predisposição Genética para Doença/etnologia , Estudo de Associação Genômica Ampla , Humanos , Desequilíbrio de Ligação , Masculino , Pessoa de Meia-Idade , Adulto Jovem
7.
Pediatr Diabetes ; 20(6): 736-742, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31038272

RESUMO

BACKGROUND: Hemoglobin A1c (HbA1c) levels are higher in African-American (AA) individuals compared to Caucasians (EA) even after adjustment for blood glucose levels. To better understand the mechanism of this disparity we examined the relationship of an unstable (labile) form of HbA1c (L-HbA1c) with race and glucose. METHODS: Samples for HbA1c were collected from pediatric patients self-identified as either AA (15F, 12M, age 13.4 ± 3.5 years) or EA (22F, 30M, age 14.6 ± 3.4 years) with type 1 diabetes at the time of a clinic visit. Clinic HbA1c (HbA1c) was performed by immunoassay. L-HbA1c equaled the difference in the HbA1c fraction by dynamic capillary isoelectric focusing before and after incubation in a low pH buffer. A capillary glucose (Clinic-BG) was measured at clinic visit. Mean blood glucose (MBG) was calculated from the last 30 days of the patient's glucose meter data. The influence of race on L-HbA1c was assessed in a multiple variable regression model adjusted for Clinic-BG. RESULTS: The groups were similar for age and duration of diabetes. L-HbA1c was correlated with Clinic-BG, MBG, and HbA1c. The mean levels of L-HbA1c, HbA1c, MBG, but not Clinic-BG were higher in AA patients compared to EA. After adjustment for Clinic-BG, L-HbA1c was still higher in AA (2.8 ± 0.7% AA vs 2.1 ± 0.7% EA, P < .0001). CONCLUSIONS: L-HbA1c is correlated with Clinic-BG. At any given level of Clinic-BG, AA patients have higher levels of L-HbA1c than EA. This preliminary study suggests that early factors prior to the formation of stable HbA1c may contribute to the observed glucose-independent racial disparity.


Assuntos
Afro-Americanos , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/etnologia , Grupo com Ancestrais do Continente Europeu , Hemoglobina A Glicada/metabolismo , Adolescente , Glicemia/metabolismo , Criança , Feminino , Hemoglobina A Glicada/química , Disparidades nos Níveis de Saúde , Humanos , Masculino , Isoformas de Proteínas , Estabilidade Proteica , Estudos Retrospectivos
8.
Eur J Endocrinol ; 181(1): 31-38, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31075760

RESUMO

Objective: With increasing migration to Europe, diabetes diagnosis and treatment of refugees became challenging. To describe the current experience with pediatric refugees in Germany and Austria. Design and Methods: 43,137 patients (<21 years) with type 1 diabetes from the diabetes patient follow-up registry (DPV) were studied and divided by refugee status into patients born in Middle East (n = 365) or Africa (n = 175) and native patients (child and parents born in Germany/Austria; G/A: n = 42,597). Groups were compared using multivariable regression adjusted for age, sex and diabetes duration (SAS 9.4). In refugees the first year after arrival was studied, and for native children the most recent year of care. Results: After adjustment, HbA1c was highest in refugees (1. ME and 2. AFR vs 3. G/A: 72.3 ± 1.0 and 75.0 ± 1.4 vs 66.0 ± 0.1 mmol/mol, 1 vs 3: P < 0.001 and 2 vs 3: P < 0.001) and microalbuminuria (9.9 and 13.6 vs 6.5%, 1 vs 3: P = 0.039 and 2 vs 3: P = 0.002) was more prevalent. African children experienced severe hypoglycemia (17.8 ± 4.3 and 25.4 ± 8.7 vs 11.5 ± 0.3 per 100 patient years, 1 vs 3: P > 0.05 and 2 vs 3: P = 0.045) significantly more often, whereas hypoglycemia with coma (5.1 ± 1.1 and 4.1 ± 1.6 vs 2.6 ± 0.1 per 100 patient years, 1 vs 3: P = 0.006 and 2 vs 3: P > 0.05) and retinopathy (2.1 and n/a vs 0.2%, 1 vs 3: P < 0.001) were significantly more common in children from Middle East compared to natives. Insulin pumps were used in a markedly larger proportion of native patients (7.4 and 13.2 vs 43.0%, 1 vs 3: P < 0.001 and 2 vs 3: P < 0.001). Conclusions: A relevant number of pediatric refugees with type 1 diabetes are treated in German/Austrian diabetes clinics. Refugee children, parents and caregivers are faced with several problems in diabetes therapy and outcome that should be addressed more intensively by pediatric diabetes teams.


Assuntos
Diabetes Mellitus Tipo 1/tratamento farmacológico , Hipoglicemiantes/uso terapêutico , Insulina/uso terapêutico , Refugiados/estatística & dados numéricos , Adolescente , África/etnologia , Áustria , Criança , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/etnologia , Feminino , Alemanha , Hemoglobina A Glicada/análise , Humanos , Masculino , Oriente Médio/etnologia , Análise Multivariada , Sistema de Registros , Análise de Regressão , Resultado do Tratamento
9.
Pediatr Diabetes ; 20(4): 468-473, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30938029

RESUMO

BACKGROUND/OBJECTIVE: Latino patients with type 1 diabetes (T1D) face cultural and language barriers leading to poor outcomes. Shared medical appointments (SMAs) are recognized as effective models of care. Our aim is to develop a culturally sensitive, cost effective SMA program for Latino T1D. SUBJECTS: Spanish speaking Latinos 1 to 20 years with T1D (n = 88) and their families. METHODS: Routine care alternating with SMAs that included group education was provided. Teens, ages >11 received the SMA separate from parents. Younger children were seen together. Hemoglobin A1c (HbA1c), behavioral questionnaires, and use of diabetes technology were measured at baseline and every 3 to 6 months. RESULTS: 57.7% of children and 77.27% of teens completed the 2 years of the Program. There was a significant association between age and change in HbA1c from baseline to year 1 (P = .001) and baseline to year 2 (P = <.0001). For participants <12 years, there was a significant improvement in HbA1c from baseline to year 1 (P = .0146) and from year 1 to year 2 (P = .0069). Participants ≥12 years, had an increase in HbA1c from year 1 to year 2 (P = .0082). Technology use increased significantly from baseline to year 2 for participants <12 years of age (19%-60%, P = .0455) and for participants who were ≥12 years of age (10%-23%, P = .0027). Participants reported a 98% satisfaction rate. CONCLUSIONS: The culturally sensitive SMA proved to be an appreciated, feasible, and effective alternative to care for Latinos with T1D.


Assuntos
Assistência à Saúde Culturalmente Competente/métodos , Diabetes Mellitus Tipo 1/etnologia , Diabetes Mellitus Tipo 1/terapia , Hispano-Americanos , Consultas Médicas Compartilhadas , Adolescente , Adulto , Criança , Pré-Escolar , Barreiras de Comunicação , Assistência à Saúde Culturalmente Competente/organização & administração , Diabetes Mellitus Tipo 1/sangue , Feminino , Hemoglobina A Glicada/análise , Hemoglobina A Glicada/metabolismo , Hispano-Americanos/estatística & dados numéricos , Humanos , Lactente , Masculino , Inovação Organizacional , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Pediatria/métodos , Pediatria/organização & administração , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/organização & administração , Inquéritos e Questionários , Adulto Jovem
10.
Autoimmunity ; 52(2): 95-101, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-31030572

RESUMO

OBJECTIVE: To investigate the association between polymorphisms in PTPN2 (rs1893217 and rs478582) and type 1 diabetes (T1D) risk with different diagnosed age, as well as related clinical characteristics in Chinese Han population. METHODS: A total of 2270 Chinese Han individuals (1023 T1D patients and 1247 healthy controls) were genotyped for rs1893217 and rs478582. And 306 newly diagnosed T1D patients were measured for C-peptide levels based on a standard mixed-meal tolerance test. In addition, 40 healthy controls were analyzed for different T cell subsets by multi-color flow cytometry. RESULTS: Neither rs1893217 nor rs478582 showed any association with T1D risk under an additive model. Stratified analysis for T1D diagnosed age revealed that rs1893217, but not rs478582, was significantly associated with T1D patients diagnosed age ≤18 (OR =0.80, 95% CI: 0.67-0.97, p = 0.02). For those diagnosed age >18, neither of them showed any association. We also found that rs1893217 had a higher positive rate of ZnT8A (CC vs. TT carrier, OR = 2.07, 95% CI: 1.07-4.03, p = 0.026) and IA-2A (CT vs. TT carrier, OR = 1.36, 95% CI: 1.02-1.80, p = 0.038). Furthermore, for rs478582, compared with TT, healthy individuals carrying CC/CT carriers had significantly lower frequency and Helios expression of naive Treg subsets (p = 0.049 and 0.048 respectively), but not secreting or activating Treg subsets. In addition, we did not find any association between these two polymorphisms and residual ß-cell function in newly diagnosed T1D patients. CONCLUSIONS: Our results suggest that rs1893217 may increase the risk of early-onset T1D and affect humoral immunity, while rs478582 may affect Treg subsets.


Assuntos
Diabetes Mellitus Tipo 1 , Modelos Genéticos , Modelos Imunológicos , Polimorfismo Genético , Proteína Tirosina Fosfatase não Receptora Tipo 2 , Linfócitos T Reguladores/imunologia , Adulto , Grupo com Ancestrais do Continente Asiático/etnologia , Grupo com Ancestrais do Continente Asiático/genética , China/etnologia , Diabetes Mellitus Tipo 1/etnologia , Diabetes Mellitus Tipo 1/genética , Diabetes Mellitus Tipo 1/imunologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Proteína Tirosina Fosfatase não Receptora Tipo 2/genética , Proteína Tirosina Fosfatase não Receptora Tipo 2/imunologia
11.
JAMA ; 321(5): 484-492, 2019 02 05.
Artigo em Inglês | MEDLINE | ID: mdl-30721295

RESUMO

Importance: Type 1 diabetes has been associated with cardiovascular disease and late complications such as retinopathy and nephropathy. However, it is unclear whether there is an association between type 1 diabetes and school performance in children. Objective: To compare standardized reading and mathematics test scores of schoolchildren with type 1 diabetes vs those without diabetes. Design, Setting, and Participants: Population-based retrospective cohort study from January 1, 2011, to December 31, 2015 (end date of follow-up), including Danish public schoolchildren attending grades 2, 3, 4, 6, and 8. Test scores were obtained in math (n = 524 764) and reading (n = 1 037 006). Linear regression models compared outcomes with and without adjustment for socioeconomic characteristics. Exposures: Type 1 diabetes. Main Outcomes and Measures: Primary outcomes were pooled test scores in math and reading (range, 1-100). Results: Among 631 620 included public schoolchildren, the mean (SD) age was 10.31 (SD, 2.42) years, and 51% were male; 2031 had a confirmed diagnosis of type 1 diabetes. Overall, the mean combined score in math and reading was 56.11 (SD, 24.93). There were no significant differences in test scores found between children with type 1 diabetes (mean, 56.56) and children without diabetes (mean, 56.11; difference, 0.45 [95% CI, -0.31 to 1.22]). The estimated difference in test scores between children with and without type 1 diabetes from a linear regression model with adjustment for grade, test topic, and year was 0.24 (95% CI, -0.90 to 1.39) and 0.45 (95% CI, -0.58 to 1.49) with additional adjustment for socioeconomic status. Conclusions and Relevance: Among Danish public schoolchildren, there was no significant difference in standardized reading and mathematics test scores of children with type 1 diabetes compared with test scores of children without diabetes.


Assuntos
Diabetes Mellitus Tipo 1/psicologia , Avaliação Educacional , Matemática , Leitura , Adolescente , Estudos de Casos e Controles , Criança , Dinamarca , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/etnologia , Escolaridade , Feminino , Hemoglobina A Glicada/análise , Humanos , Masculino , Estudos Retrospectivos , Fatores Socioeconômicos
12.
Scand J Clin Lab Invest ; 79(1-2): 123-125, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30727763

RESUMO

The GAD65 and IA-2 antibodies (Abs) are biomarkers of the development of type 1 diabetes mellitus (T1DM) in both children and adults. The upper reference limit for the autoantibodies made by the manufacture was established on an adult Chinese population. Here, we established upper reference limits for Northern European adults and children in accordance with the Clinical and Laboratory Standards Institute (CLSI) guidelines. Serum samples from healthy Danish children (0-18 years) and adults (18-70 years) were analysed for GAD65Ab and IA-2Ab using MAGLUMI 800 Chemiluminescence Immunoassay (CLIA). The Kruskal-Wallis test was used for evaluating differences between gender and age groups. No gender or age differences were found for neither GAD65Ab nor IA-2Ab, and a combined upper reference limit for both children and adults could be established. An upper reference limit of 5.1 IU/mL was defined for GAD65Ab and 11.5 U/mL for IA-2Ab. Our results showed a substantial discrepancy with the reference limits established by the manufacturer.


Assuntos
Autoanticorpos/sangue , Glutamato Descarboxilase/antagonistas & inibidores , Imunoensaio/normas , Proteínas Tirosina Fosfatases Classe 8 Semelhantes a Receptores/antagonistas & inibidores , Adolescente , Adulto , Idoso , Biomarcadores/sangue , Criança , Pré-Escolar , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/etnologia , Diabetes Mellitus Tipo 1/imunologia , Europa (Continente) , Grupo com Ancestrais do Continente Europeu , Feminino , Expressão Gênica , Glutamato Descarboxilase/genética , Glutamato Descarboxilase/imunologia , Voluntários Saudáveis , Humanos , Lactente , Recém-Nascido , Luminescência , Masculino , Pessoa de Meia-Idade , Proteínas Tirosina Fosfatases Classe 8 Semelhantes a Receptores/genética , Proteínas Tirosina Fosfatases Classe 8 Semelhantes a Receptores/imunologia , Valores de Referência
13.
Diabetes Care ; 42(3): 406-415, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30659077

RESUMO

OBJECTIVE: Genetic risk scores (GRS) have been developed that differentiate individuals with type 1 diabetes from those with other forms of diabetes and are starting to be used for population screening; however, most studies were conducted in European-ancestry populations. This study identifies novel genetic variants associated with type 1 diabetes risk in African-ancestry participants and develops an African-specific GRS. RESEARCH DESIGN AND METHODS: We generated single nucleotide polymorphism (SNP) data with the ImmunoChip on 1,021 African-ancestry participants with type 1 diabetes and 2,928 control participants. HLA class I and class II alleles were imputed using SNP2HLA. Logistic regression models were used to identify genome-wide significant (P < 5.0 × 10-8) SNPs associated with type 1 diabetes in the African-ancestry samples and validate SNPs associated with risk in known European-ancestry loci (P < 2.79 × 10-5). RESULTS: African-specific (HLA-DQA1*03:01-HLA-DQB1*02:01) and known European-ancestry HLA haplotypes (HLA-DRB1*03:01-HLA-DQA1*05:01-HLA-DQB1*02:01, HLA-DRB1*04:01-HLA-DQA1*03:01-HLA-DQB1*03:02) were significantly associated with type 1 diabetes risk. Among European-ancestry defined non-HLA risk loci, six risk loci were significantly associated with type 1 diabetes in subjects of African ancestry. An African-specific GRS provided strong prediction of type 1 diabetes risk (area under the curve 0.871), performing significantly better than a European-based GRS and two polygenic risk scores in independent discovery and validation cohorts. CONCLUSIONS: Genetic risk of type 1 diabetes includes ancestry-specific, disease-associated variants. The GRS developed here provides improved prediction of type 1 diabetes in African-ancestry subjects and a means to identify groups of individuals who would benefit from immune monitoring for early detection of islet autoimmunity.


Assuntos
Grupo com Ancestrais do Continente Africano/genética , Diabetes Mellitus Tipo 1/etnologia , Diabetes Mellitus Tipo 1/genética , Testes Genéticos , Antígenos HLA-D/genética , Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Alelos , Estudos de Casos e Controles , Grupo com Ancestrais do Continente Europeu/genética , Feminino , Predisposição Genética para Doença , Testes Genéticos/métodos , Testes Genéticos/normas , Estudo de Associação Genômica Ampla , Cadeias alfa de HLA-DQ/genética , Cadeias beta de HLA-DQ/genética , Cadeias HLA-DRB1/genética , Haplótipos , Humanos , Masculino , Polimorfismo de Nucleotídeo Único , Valor Preditivo dos Testes , Projetos de Pesquisa , Fatores de Risco
14.
J Gastroenterol Hepatol ; 34(4): 673-678, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30600564

RESUMO

BACKGROUND AND AIM: The aim of this study was to assess the prevalence and characteristics of celiac disease (CD) in all patients with type 1 diabetes mellitus attending a tertiary adult diabetes clinic in Durban, South Africa. METHODS: This was a cross-sectional observational study that screened 202 patients; of these, 56.4% were African (Black), 31.7% Asian Indian, 4.5% White, and 7.4% mixed race. Demographic data, symptoms, and anthropometry were documented. Blood tests included anti-tissue transglutaminase antibody (tTG), anti-endomysial antibody (EMA), and anti-gliadin antibody (AGA). Endoscopy and duodenal biopsy were performed in patients with celiac antibodies. Diagnosis of CD was based on the modified Marsh classification. RESULTS: Mean age and mean duration of diabetes were 26.4 ± 11.4 and 10.7 ± 9.1 years, respectively. Celiac antibodies were found in 65 (32.2%) patients: EMA 7.4%, tTG immunoglobulin A (IgA) 8.4%, tTG immunoglobulin G 1.9%, AGA IgA 18.3%, and AGA immunoglobulin G 21.8%. Histological evidence of CD was found in 5.9% (n = 12/202): 2.5% were classed as definite CD (Marsh 3) and 3.4% as potential CD (Marsh 1). None of the patients with CD were symptomatic. The sensitivity of AGA IgA, EMA, and tTG IgA antibodies for detecting histologically proven CD was 66.7%, 50.0%, and 41.7%, respectively. CONCLUSION: The prevalence of CD was similar to reports from western countries. No ethnic specific differences were noted. CD was silent in all patients in this study. The sensitivity of EMA and tTG antibodies was poor and merits further evaluation as screening tools for CD in South African patients with type 1 diabetes mellitus.


Assuntos
Doença Celíaca/epidemiologia , Diabetes Mellitus Tipo 1/epidemiologia , Adolescente , Adulto , Biomarcadores/sangue , Doença Celíaca/complicações , Doença Celíaca/diagnóstico , Doença Celíaca/etnologia , Criança , Grupos de Populações Continentais , Estudos Transversais , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/etnologia , Feminino , Proteínas de Ligação ao GTP/imunologia , Gliadina/imunologia , Humanos , Imunoglobulina A/sangue , Imunoglobulina G/sangue , Masculino , Prevalência , África do Sul/epidemiologia , Centros de Atenção Terciária/estatística & dados numéricos , Transglutaminases/imunologia , Adulto Jovem
15.
Ann Epidemiol ; 30: 15-21, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30528324

RESUMO

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.


Assuntos
Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Adolescente , Idoso , Criança , Diabetes Mellitus Tipo 1/etnologia , Diabetes Mellitus Tipo 2/etnologia , Feminino , Humanos , Incidência , Masculino , México/epidemiologia , Vigilância da População , Sistema de Registros , Fatores de Tempo
16.
J Diabetes Sci Technol ; 12(6): 1223-1226, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30079769

RESUMO

Biomedical outcomes for people with diabetes remain suboptimal for many. Psychosocial care in diabetes does not fare any better. "Artificial pancreas" (also known as "closed-loop" and "automated insulin delivery") systems present a promising therapeutic option for people with diabetes (PWD)-simultaneously improving glycemic outcomes, reducing the burden of self-management, and improving health-related quality of life. In recent years there has emerged a growing movement of PWD innovators rallying behind the mantra #WeAreNotWaiting, developing "do-it-yourself artificial pancreas systems (DIY APS)." Self-reported results by DIY APS users show improved metabolic outcomes such as impressive stability of glucose profiles, significant reduction of A1c, and more time within their glycemic target range. However, the benefits remain unclear for the broader population of PWD beyond these highly engaged, highly tech-savvy users willing and able to engage in the demands of building and maintaining their DIY APS. We discuss the challenges faced by key stakeholder groups in terms of potential collaboration and open debate of these challenges.


Assuntos
Glicemia/análise , Cultura , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/tratamento farmacológico , Sistemas de Infusão de Insulina , Insulina/administração & dosagem , Pâncreas Artificial , Automonitorização da Glicemia/instrumentação , Automonitorização da Glicemia/métodos , Automonitorização da Glicemia/psicologia , Diabetes Mellitus Tipo 1/etnologia , Desenho de Equipamento , Equipamentos e Provisões/normas , Equipamentos e Provisões/provisão & distribução , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/etnologia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Sistemas de Infusão de Insulina/normas , Sistemas de Infusão de Insulina/provisão & distribução , Pâncreas Artificial/classificação , Pâncreas Artificial/psicologia , Pâncreas Artificial/provisão & distribução , Reino Unido/epidemiologia , Estados Unidos/epidemiologia
17.
J Cell Mol Med ; 22(9): 4283-4291, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29981194

RESUMO

We carried out this meta-analysis to explore the influence of paraoxonase 1 activity on the susceptibility of diabetes mellitus (DM), diabetic macroangiopathy and diabetic microangiopathy. Relevant studies were identified from PubMed, Web of Science and CNKI without language limitation, following the inclusion and exclusion criteria. Statistical analyses were implemented with the STATA 12.0 statistical software. Thirty-six case-control studies were included in the meta-analyses, in which 35 for the association between paraoxonase 1 activity and DM risk, 8 for diabetic macroangiopathy and 7 for diabetic microangiopathy. Paraoxonase 1 activity was significantly associated with the susceptibility of DM in pooled population (SMD = -1.37, 95% CI = -1.79 ∼ -0.96, P = .000), and Asians (SMD = -2.00, 95% CI = -2.56 ∼ -1.44, P = .000), but not in non-Asians (SMD = -0.44, 95% CI = -0.91 ∼ 0.03, P = .069). However, marked heterogeneity was existed (I2  = 98.10%, P = .000) and subgroup analyses failed to investigate the sources of heterogeneity. Then, meta-regression was performed and found that ethnicity could explain the observed between-study heterogeneity (P = .002). Meanwhile, significant associations were found between paraoxonase 1 activity and diabetic macroangiopathy (SMD = -1.06, 95% CI = -1.63 ∼ -0.48, P = .000) and diabetic microangiopathy (SMD = -0.72, 95% CI = -1.32 ∼ -0.13, P = .018). In conclusion, paraoxonase 1 activity plays important roles in the risk of DM, diabetic macroangiopathy and microangiopathy with ethnicity differences. Further studies with large sample and well design are needed to confirm these results.


Assuntos
Arildialquilfosfatase/genética , Diabetes Mellitus Tipo 1/genética , Diabetes Mellitus Tipo 2/genética , Angiopatias Diabéticas/genética , Predisposição Genética para Doença , Adulto , Grupo com Ancestrais do Continente Asiático , Estudos de Casos e Controles , Criança , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/etnologia , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/etnologia , Angiopatias Diabéticas/diagnóstico , Angiopatias Diabéticas/etnologia , Grupo com Ancestrais do Continente Europeu , Feminino , Expressão Gênica , Humanos , Masculino , Risco
18.
Diabetologia ; 61(10): 2180-2188, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30014265

RESUMO

AIMS/HYPOTHESIS: Wolfram syndrome is a rare, autosomal recessive syndrome characterised by juvenile-onset diabetes and optic atrophy and is caused by bi-allelic mutations in the WFS1 gene. In a recent sequencing study, an individual with juvenile-onset diabetes was observed to be homozygous for a rare missense variant (c.1672C>T, p.R558C) in the WFS1 gene. The aim of this study was to perform the genetic characterisation of this variant and to determine whether it is causal for young-onset diabetes and Wolfram syndrome. METHODS: We analysed the allele frequency of the missense variant in multiple variant databases. We genotyped the variant in 475 individuals with type 1 diabetes and 2237 control individuals of Ashkenazi Jewish ancestry and analysed the phenotypes of homozygotes. We also investigated the association of this variant with risk for type 2 diabetes using genotype and sequence data for type 2 diabetes cases and controls. RESULTS: The missense variant demonstrated an allele frequency of 1.4% in individuals of Ashkenazi Jewish ancestry, 60-fold higher than in other populations. Genotyping of this variant in 475 individuals diagnosed with type 1 diabetes identified eight homozygotes compared with none in 2237 control individuals (genotype relative risk 135.3, p = 3.4 × 10-15). The age at diagnosis of diabetes for these eight individuals (17.8 ± 8.3 years) was several times greater than for typical Wolfram syndrome (5 ± 4 years). Further, optic atrophy was observed in only one of the eight individuals, while another individual had the Wolfram syndrome-relevant phenotype of neurogenic bladder. Analysis of sequence and genotype data in two case-control cohorts of Ashkenazi ancestry demonstrated that this variant is also associated with an increased risk of type 2 diabetes in heterozygotes (OR 1.81, p = 0.004). CONCLUSIONS/INTERPRETATION: We have identified a low-frequency coding variant in the WFS1 gene that is enriched in Ashkenazi Jewish individuals and causes a mild form of Wolfram syndrome characterised by young-onset diabetes and reduced penetrance for optic atrophy. This variant should be considered for genetic testing in individuals of Ashkenazi ancestry diagnosed with young-onset non-autoimmune diabetes and should be included in Ashkenazi carrier screening panels.


Assuntos
Diabetes Mellitus Tipo 2/etnologia , Diabetes Mellitus Tipo 2/genética , Proteínas de Membrana/genética , Mutação de Sentido Incorreto , Síndrome de Wolfram/etnologia , Síndrome de Wolfram/genética , Adolescente , Adulto , Idade de Início , Alelos , Diabetes Mellitus Tipo 1/etnologia , Diabetes Mellitus Tipo 1/genética , Feminino , Frequência do Gene , Variação Genética , Genótipo , Haplótipos , Heterozigoto , Homozigoto , Humanos , Judeus , Masculino , Atrofia Óptica/patologia , Fenótipo , Risco , Adulto Jovem
19.
Gene ; 670: 182-192, 2018 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-29859283

RESUMO

The latest studies in Algeria show that the frequency of type 1 diabetes (T1D) without complications is lower than that with complications and represents a significant burden in terms of cost and treatment. For this reason, we are interested in uncomplicated type1 diabetes and risk factors that are related to polymorphisms of antioxidant enzymes in order to prevent its complications. A total of 260 blood samples of young Algerian adults were examined. The genotypic analysis of Catalase gene (CAT -262C/T, rs1001179) and the superoxide dismutase gene (MnSOD 47C/T, rs4880) was performed by real-time PCR using TaqMan technology. The genotypic distribution of the CAT -262C/T promoter gene's polymorphism showed a significant difference between control and T1D patients for the CC genotype (p = 0.009; OR = 0.30) and for the T allele (p = 0.002; OR = 2.82). In addition, the genotypic distribution of the MnSOD 47C/T gene showed an association with T1D for the CT genotype (p = 0.040; OR = 2.37). Our results revealed that polymorphisms of CAT and MnSOD may be associated with physiopathology causing the onset of T1D. Our data, suggest that the genotypic frequencies of these SNPs appear to be influenced by clinical variables and by the Arab-Berber ethnic origin of the Algerian population.


Assuntos
Catalase/genética , Diabetes Mellitus Tipo 1/etnologia , Diabetes Mellitus Tipo 1/genética , Polimorfismo de Nucleotídeo Único , Superóxido Dismutase/genética , Adulto , Argélia/etnologia , Feminino , Estudos de Associação Genética , Predisposição Genética para Doença , Humanos , Masculino , Regiões Promotoras Genéticas
20.
PLoS One ; 13(6): e0198652, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29924845

RESUMO

The incidence of type-1 Diabetes Mellitus (T1DM) has increased steadily in Kuwait during recent years and it is now considered amongst the high-incidence countries. An interaction between susceptibility genes, immune system mediators and environmental factors predispose susceptible individuals to T1DM. We have determined the prevalence of protein tyrosine phosphatase non-receptor type 22 (PTPN22) gene functional variant (C1858T; R620W, rs2476601), HLA-DQ and DR alleles and three autoantibodies in Kuwaiti children with T1DM to evaluate their impact on genetic predisposition of the disease. This study included 253 Kuwaiti children with T1DM and 214 ethnically matched controls. The genotypes of PTPN22 gene functional variant C1858T (R620W; rs2476601) were detected by PCR-RFLP method and confirmed by DNA sequencing. HLA-DQ and DR alleles were determined by sequence-specific PCR. Three autoantibodies were detected in the T1DM patients using radio-immunoassays. A significant association was detected between the variant genotype of the PTPN22 gene (C1858T, rs2476601) and T1DM in Kuwaiti Arabs. HLA-DQ2 and DQ8 alleles showed a strong association with T1DM. In T1DM patients which carried the variant TT-genotype of the PTPN22 gene, 93% had at least one DQ2 allele and 60% carried either a DQ2 or a DQ8 allele. Amongst the DR alleles, the DR3-DRB5, DR3-3, DR3-4 and DR4-4 showed a strong association with T1DM. Majority of T1DM patients who carried homozygous variant (TT) genotype of the PTPN22 gene had either DR3-DRB5 or DRB3-DRB4 genotypes. In T1DM patients who co-inherited the high risk HLA DQ, DR alleles with the variant genotype of PTPN22 gene, the majority were positive for three autoantibodies. Our data demonstrate that the variant T-allele of the PTPN22 gene along with HLA-DQ2 and DQ8 alleles constitute significant determinants of genetic predisposition of T1DM in Kuwaiti children.


Assuntos
Árabes/genética , Diabetes Mellitus Tipo 1/genética , Antígenos HLA-DQ/genética , Antígenos HLA-DR/genética , Polimorfismo de Nucleotídeo Único , Proteína Tirosina Fosfatase não Receptora Tipo 22/genética , Adolescente , Alelos , Especificidade de Anticorpos , Autoanticorpos/sangue , Criança , Pré-Escolar , Diabetes Mellitus Tipo 1/etnologia , Diabetes Mellitus Tipo 1/imunologia , Feminino , Mutação com Ganho de Função , Genes MHC da Classe II , Predisposição Genética para Doença , Genótipo , Humanos , Lactente , Recém-Nascido , Kuweit/epidemiologia , Masculino
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