Childhood diabetes identified in mass urine screening program in Taiwan, 1993–1999

Wei, Jung-Nan; Chuang, Lee‐Ming; Lin, Chau-Ching; Chiang, Chuan-Chi; Lin, Ruey S.; Sung, Fung‐Chang

doi:10.1016/s0168-8227(02)00247-4

Cited by 29 publications

(27 citation statements)

References 25 publications

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“…16 All students from the 1st grade to the 12th grade, aged 6 to 18 years, in the Taiwan Province school system participated in this nationwide survey. Only the children in the 1999 survey were followed up in 2002 for further classification of DM.…”

Section: Methodsmentioning

confidence: 99%

National Surveillance for Type 2 Diabetes Mellitus in Taiwanese Children

Wei

Sung²,

Lin³

et al. 2003

JAMA

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214

169

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Context Despite a disturbing trend of increasing prevalence of type 2 diabetes mellitus (DM) in childhood, little is known about the epidemiology of childhood type 2 DM, especially in the Taiwanese population.Objective To study the rate and risk factors for childhood type 2 DM based on a nationwide screening program in Taiwan.Design, Setting, and Participants Screening in 1999 for type 2 DM using urine and blood testing and confirmed by follow-up telephone survey among schoolchildren aged 6 to 18 years in Taiwan, followed by a nested case-control study conducted in 2002 comparing 137 children with type 2 DM with 1000 randomly selected children without diabetes chosen to represent the age and sex distribution of the whole student population.Main Outcome Measures Rate and identification of risk factors associated with childhood type 2 DM. ResultsThe rate of newly identified diabetes was 9.0 per 100000 for boys and 15.3 per 100000 for girls. Follow-up at 3 years revealed that, of 253 children with newly diagnosed diabetes, 24 (9.5%) had type 1 DM, 137 (54.2%) had type 2 DM, and 22 (8.7%) had secondary diabetes. Compared with children aged 6 to 9 years, the odds ratios (ORs) and 95% confidence intervals (CIs) of type 2 DM increased to 6.59 (3.23-13.4) for those aged 13 to 15 years and to 4.59 (2.07-10.2) for those aged 16 to 18 years. The OR (95% CI) of type 2 DM in children with a body mass index in the 95th percentile or higher (obesity) was 18.8 (9.22-38.5) compared with those with a body mass index in less than the 50th percentile. Other factors significantly associated with type 2 DM were hypercholesterolemia (OR, 1.80; 95% CI, 1.04-3.23), blood pressure greater than the 85th percentile (OR, 1.70; 95% CI, 1.07-2.70), and positive family history of diabetes (OR, 3.95; 95% CI, 2.01-7.78). ConclusionsOur mass screening program showed that type 2 DM is the leading cause of childhood DM in Taiwan. Obesity is a major risk factor for the development of type 2 DM in children.

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Section: Methodsmentioning

confidence: 99%

National Surveillance for Type 2 Diabetes Mellitus in Taiwanese Children

Wei

Sung²,

Lin³

et al. 2003

JAMA

Self Cite

214

169

View full text Add to dashboard Cite

show abstract

“…For the purpose of population screening, which was conducted annually from 1992 to 2000 in Taiwan, we used first morning urine specimen as an initial screening test. Confirmatory test using fasting plasma glucose measurement was done after positive glycosuria for twice in the nationwide surveillance program [13]. Nearly all (97%) of the students were screened by urinalysis.…”

Section: Screening For Diabetes Mellitusmentioning

confidence: 99%

“…The overall average rates of newly identified diabetes from 1993 to 1999 were 8.3 per 100, 000 among boys, and 12.0 per 100 000 among girls. The average rate of new cases increased significantly from sixth grade for boys and fourth grade for girls, with peak rates of 14.7 per 100 000 in eighth grade for boys and 19.0 per 100 000 in sixth grade for girls [13]. In a further study to follow-up those diagnosed of diabetes in 1999 for 3 years, we found that percentage for type 2 diabetes and type 1 diabetes were 54.2% and 9.5%, suggesting that type 2 DM has replaced type 1 DM to be the leading cause of DM in Taiwanese schoolchildren and adolescents [14].…”

Section: Introductionmentioning

confidence: 96%

Type 2 Diabetes and Obesity in Children and Adolescents: Experience from Studies in Taiwanese Population

Chang¹,

Li²,

Wei³

et al. 2006

CDR

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Global prevalence of type 2 diabetes mellitus in children is rising recently, likely due to an increasing rate of childhood obesity. In Taiwan, an annual program of mass screen for diabetes with two-staged design, i.e. diagnosis by fasting plasma glucose when glycosuria was positive in two consecutive urine samples, has been conducted since 1992 for all schoolchildren aged 6 to 18. A recent survey showed that the incidence of type 2 diabetes is 6-fold higher than those of type 1 diabetes. The prevalence of diabetes is elevated during puberty and is higher in girls than in boys. Obesity is the most important risk factor of type 2 diabetes in childhood and adolescence. Besides, genetics, family history, polycystic ovarian syndrome, ethnicity, and puberty are also risk factors of pediatric diabetes. We also briefly discuss the current state of management of obesity and type 2 diabetes, with special emphasis on behavioral and lifestyle modification, the need to create adequate and safe environment, and the psychological as well as family support in children and adolescents. Limited experience of the pharmacological agents in terms of their long-term effect and safety is also discussed.

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“…RESEARCH DESIGN AND METHODS -Subjects comprised 500 randomly selected Taiwanese school students (245 boys and 255 girls) aged 6 -18 years without diabetes, according to the 1997 ADA criteria (23), in a nationwide survey program for diabetes in 1999 (24). Basic demographic data, anthropometric measurement, and fasting venous blood sampling were obtained.…”

mentioning

confidence: 99%

Sex-Related Differences Between Adiponectin and Insulin Resistance in Schoolchildren

et al. 2004

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OBJECTIVE -To study the effect of body composition and adiponectin on insulin resistance and ␤-cell function in schoolchildren during puberty.RESEARCH DESIGN AND METHODS -Plasma adiponectin level and its relationships with insulin sensitivity and ␤-cell function were analyzed in 500 randomly recruited nondiabetic Taiwanese schoolchildren (245 boys and 255 girls) aged 6 -18 years in a national survey program for diabetes in 1999. Insulin resistance and ␤-cell function were evaluated by homeostasis model assessment (HOMA). Plasma adiponectin concentrations were determined with radioimmunoassay.RESULTS -Plasma glucose levels remained stable, whereas insulin resistance increased with a compensatory rise in ␤-cell function during this period. A transient drop of adiponectin level with a trough at 10 -12 years was found in boys but not in girls. This pubertal drop of adiponectin levels in boys coincides with the sharp rise in testosterone concentration. A negative correlation between testosterone levels and adiponectin concentration was also noted in boys (r ϭ Ϫ0.142, P ϭ 0.032). Plasma adiponectin levels correlated inversely with relative body weight, fasting insulin concentrations, and insulin resistance index by HOMA in boys aged 15-18 years and in girls aged 11-14 years. No association was observed between adiponectin levels and ␤-cell function by HOMA.CONCLUSIONS -There is a transient drop in the level of adiponectin during male puberty, correlated with the increase in testosterone level in boys. Plasma adiponectin levels were inversely correlated with obesity and insulin resistance in boys and girls during the pubertal period. Diabetes Care 27:308 -313, 2004T ype 2 diabetes, once considered to be a disease of adults, is now emerging in children and adolescents worldwide (1,2). In adults, both insulin sensitivity and ␤-cell function decline with aging. According to both crosssectional and longitudinal studies (3-5), these abnormalities are always found in the pre-diabetic state during development of type 2 diabetes. However, little is known about the evolution of the insulin resistance and ␤-cell function of children who are "growing" rather than "aging."Although children in their prediabetic state might share common pathogenesis in terms of insulin resistance and ␤-cell deterioration, the etiology of insulin resistance and the pattern of islet compensation under various stimuli for growth and development may differ markedly from those of adults. Much effort for elucidating transient insulin resistance during puberty has focused on sex steroids (6 -8), which, however, fail to explain the restoration of insulin sensitivity after puberty, when sex hormones have achieved and maintain adult levels. On the other hand, the growth hormone/ IGF-1 axis, a chronologically plausible culprit, is still controversial in its insulinantagonizing effects in children of different ages and sexes (9 -11). Given the tight, temporal coupling between growth and reproductive development, some common signals regulating adolescent growth ...

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Childhood diabetes identified in mass urine screening program in Taiwan, 1993–1999

Cited by 29 publications

References 25 publications

National Surveillance for Type 2 Diabetes Mellitus in Taiwanese Children

National Surveillance for Type 2 Diabetes Mellitus in Taiwanese Children

Type 2 Diabetes and Obesity in Children and Adolescents: Experience from Studies in Taiwanese Population

Sex-Related Differences Between Adiponectin and Insulin Resistance in Schoolchildren

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