Mortality in patients with childhood-onset type 1 diabetes in Finland, Estonia, and Lithuania: follow-up of nationwide cohorts.

OBJECTIVE: To assess mortality of population-based cohorts of childhood-onset type 1 diabetic patients from the Eastern European countries of Estonia and Lithuania and compare this information with recent data from Finland. RESEARCH DESIGN AND METHODS: Estonian (n = 518) and Finnish (n = 5,156) type 1 diabetic cohorts were diagnosed between 1980 and 1994, and the Lithuanian (n = 698) cohort was diagnosed between 1983 and 1994. The mortality of these cohorts was determined in 1995. Life-table analysis, Cox survival analysis with covariates, and standardized mortality ratios (SMRs) were used. Causes of death were analyzed. RESULTS: Survival after 10 years duration of type 1 diabetes was similar in Estonia (94.3%) and Lithuania (94.0%), but much higher in Finland (99.1%). In the Cox survival analysis with covariates, the country of origin and age at diagnosis were found to be significant predictors of mortality. The SMR for the Estonian cohort was 4.35 (95% CI 2.25-7.61), the highest for the Lithuanian cohort was 7.55 (4.89-11.15), and the lowest for the Finnish cohort was 1.62 (1.10-2.28). The most common cause of death in Estonia and Lithuania was diabetic ketoacidosis (DKA), and in Finland, it was violent causes. No deaths from late complications of diabetes have been documented so far in any of the three countries. CONCLUSIONS: Our results demonstrate a high rate of short-term deaths due to DKA and inferior survival of childhood-onset type 1 diabetic patients in Estonia and Lithuania compared with Finland. In Finland, the survival of childhood-onset type 1 diabetic patients has improved and is only slightly inferior to that of the background population.

Selective or universal diagnostic testing for gestational diabetes mellitus.

OBJECTIVES: To estimate the effect of selective diagnostic testing for gestational diabetes mellitus (GDM): (1) based on evaluation of risk factors; and (2) based on the recommendations of The Fourth Workshop-Conference on GDM. METHODS: A retrospective study was performed of 147 pregnancies complicated by GDM delivered in Kaunas University of Medicine Hospital. The maternal and fetal outcomes and the main risk factors were compared with the same data of a randomly selected 300 women with normal glucose tolerance testing. Logistic regression was used to estimate the odds ratios with 95% confidence interval (CI). RESULTS: The prevalence of all risk factors was significantly higher in the group with GDM, but 29 of these women (23.13%) had no risk factors. Sixteen women (10.9%) with GDM were at low risk and would remain undiagnosed if selective screening would be used. CONCLUSIONS: The recommendations not to test low-risk group women are doubtful and require further examination whereas universal screening of all pregnant women would be justified.

The relationship between the calcaneal bone mineral density and the mental index in post-menopausal females.

OBJECTIVES: The aim of the study was to determine the relationship between the bone mineral density in the calcaneus and the mental index (MI) of the mandible in post-menopausal females, and to evaluate the diagnostic threshold of the index. METHODS: The post-menopausal females aged 50 years and older were examined using panoramic radiography of the mandible for mandibular cortical width measurements at the mental foramen (mental index, MI) determination and DXL Calscan P/N 031000 (Demetech AB, Solna, Sweden) for the examination of calcaneal bone mineral density (BMD). The statistical analysis was performed to determine the tendencies between the data. RESULTS: According to the T-score values of calcaneal BMD, the subjects were distributed into T1, T2 and T3 groups. BMD differences between the groups were statistically significant (p < 0.001). The panoramic radiographic examination of the mandible was performed, MI (mm) was determined and the mean values in the groups were calculated. The differences of MI mean values between the groups were statistically significant (p < 0.001). In the general group, a statistically significant relationship was found between calcaneal BMD, T-score and MI (p < 0.001). In the logistic analysis, the diagnostic threshold of MI was 3 mm (sensitivity 73.5%; specificity 72.6%). CONCLUSIONS: A diagnostic threshold for MI of 3 mm or less is suggested as the appropriate threshold for referral of calcaneal BMD reduction.

Incidence in young adulthood-onset Type 1 diabetes mellitus in Lithuania during 1991-1997. Lithuanian Epidemiology Diabetes Study Group.

Our aim was to determine the incidence of Type 1 diabetes mellitus (T1DM) in the 15-39-yr-old Lithuanian population from 1991 to 1997. A specifically developed communications system with all endocrinologists/diabetologists and general practitioners involved in diabetes care covering 100% of the sample Lithuanian population was the initial data source. Annual reports from regional endocrinologists/diabetologists, death certificates and patients' lists from Diabetes Societies remained as secondary sources for case ascertainment. The annual incidence was calculated per 100,000 persons/yr. The trend in incidence was estimated by fitting the linear regression model with the annual incidence data. The total of 769 new cases (496 males and 273 females) of T1DM were recorded among the 15-39-yr-old population during the period 1 January 1991-31 December 1997. The average age-standardised incidence rate was 7.78 per 100,000 persons/yr [95% Poisson distribution confidence interval (CI) 7.25-8.35] and was slightly higher among males (9.68 per 100,000 persons/yr, 95% CI 8.87-10.57) than among females (5.71 per 100,000, 95% CI 5.07-6.43). Male/female ratio was 1.82 (95% CI 1.69-1.95). Results of the linear regression model showed that the incidence of T1DM in the 15-39-yr-old population had a tendency to increase. The incidence data of T1DM in Lithuania are appropriate to those in Poland and lower than in other countries of the Baltic Sea region.

Time trend of childhood type 1 diabetes incidence in Lithuania and Sweden, 1983-2000.

AIM: To compare the time trend of childhood type 1 diabetes over an 18-y period in Lithuania and Sweden--countries with different incidence levels and different socio-economic conditions. METHODS: Percent average incidence change per year between 1983 and 2000, based on 8031 Swedish and 1100 Lithuanian cases in the age group 0-14 y, was calculated using Poisson regression. RESULTS: Average age- and sex-standardized incidence/100 000/y was 28.9 (95% CI: 28.2-29.5) in Sweden and 7.5 (95% CI: 7.1-8.0) in Lithuania. Between 1983 and 2000, the average increase per year was 2.2% in Sweden (95% CI: 1.7-2.6) and 2.3% in Lithuania (95% CI: 1.1-3.5), but the latter trend depended on an increase during the last few years of the period, and only for girls. In Sweden, incidence increased significantly in all age groups, but more so in the younger groups (3.0%, 2.2% and 1.7% per year in 0-4, 5-9 and 10-14-y age groups, respectively), while in Lithuania a significant increase was found only in the 10-14-y age group (3.0%). In Sweden, a trend towards a younger age at diagnosis was indicated for both boys and girls when comparing 1983-1991 and 1992-2000, whereas in Lithuania, the changes in age distribution over time were small, with an opposite tendency for boys. CONCLUSION: Incidence variability over time differed considerably in the two countries in the region of the Baltic Sea, suggesting a complex effect of environmental risk factors, some of which may be associated with wealth and socio-economic conditions.

Effects of thyroxine as compared with thyroxine plus triiodothyronine in patients with hypothyroidism.

BACKGROUND: Patients with hypothyroidism are usually treated with thyroxine (levothyroxine) only, although both thyroxine and triiodothyronine are secreted by the normal thyroid gland. Whether thyroid secretion of triiodothyronine is physiologically important is unknown. METHODS: We compared the effects of thyroxine alone with those of thyroxine plus triiodothyronine (liothyronine) in 33 patients with hypothyroidism. Each patient was studied for two five-week periods. During one period, the patient received his or her usual dose of thyroxine. During the other, the patient received a regimen in which 50 microg of the usual dose of thyroxine was replaced by 12.5 microg of triiodothyronine. The order in which each patient received the two treatments was randomized. Biochemical, physiologic, and psychological tests were performed at the end of each treatment period. RESULTS: The patients had lower serum free and total thyroxine concentrations and higher serum total triiodothyronine concentrations after treatment with thyroxine plus triiodothyronine than after thyroxine alone, whereas the serum thyrotropin concentrations were similar after both treatments. Among 17 scores on tests of cognitive performance and assessments of mood, 6 were better or closer to normal after treatment with thyroxine plus triiodothyronine. Similarly, among 15 visual-analogue scales used to indicate mood and physical status, the results for 10 were significantly better after treatment with thyroxine plus triiodothyronine. The pulse rate and serum sex hormone-binding globulin concentrations were slightly higher after treatment with thyroxine plus triiodothyronine, but blood pressure, serum lipid concentrations, and the results of neurophysiologic tests were similar after the two treatments. CONCLUSIONS: In patients with hypothyroidism, partial substitution of triiodothyronine for thyroxine may improve mood and neuropsychological function; this finding suggests a specific effect of the triiodothyronine normally secreted by the thyroid gland.

Seasonal variation in the incidence of Type 1 diabetes mellitus during 1983 to 1992 in the countries around the Baltic Sea.

AIM: To examine seasonal patterns of incidence of Type 1 diabetes mellitus incidence in children aged 0-14 years in Finland, Sweden, Estonia, Latvia and Lithuania during 1983-1992 (1987-1992 for Finland). METHODS: The study used a method that models incidence data using combinations of sine waves to model seasonal variation around a possible linear trend. RESULTS: In Finland, a significant pattern was found for combined sexes and age groups 0-9 and 10-14 years. A significant pattern was also confirmed for 10-14 year-old boys. In Sweden, the best model with significant pattern was found separately for boys and girls and age groups 0-9 and 10-14 years, however, a significant pattern was confirmed for older girls only. A seasonal pattern in older boys in Finland and girls in Sweden was characterized by two cycles with decreased incidence in June and November-December. The pattern among younger children (0-9 or 5-9 years) had one cycle with a decreased incidence in May-June. In Estonia, a significant pattern was found for the age group 0-14 years and combined sexes. No significant seasonal patterns were found in Latvia and Lithuania. CONCLUSIONS: The seasonal pattern with two cycles among older children and one cycle only among younger children may indicate different triggers of Type 1 diabetes mellitus for different age groups.