Prospective incidence study of diabetes mellitus in New Zealand children aged 0 to 14 years

Campbell-Stokes, Priscilla; Taylor, B. J.

doi:10.1007/s00125-005-1697-3

Cited by 59 publications

(61 citation statements)

References 20 publications

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“…Previous analyses may have been biased because they only included patients with diabetic nephropathy and because nephropathy may have been misclassified if it was not biopsy proven. Despite an increase of about ϩ3% per year in the incidence of childhood type 1 diabetes in ANZ during the last decades (13,14), the incidence of RRT with associated type 1 diabetes remained stable between 1991 and 2005. The difference in trends between general and ESRD populations may indicate improvements in care of type 1 diabetic patients due to treatment with ACE inhibitors and aggressive glycemic control available since 1980 (15).…”

Section: Multivariate Survival Analysis In the Whole Cohortmentioning

confidence: 99%

Incidences, Treatments, Outcomes, and Sex Effect on Survival in Patients With End-Stage Renal Disease by Diabetes Status in Australia and New Zealand (1991–2005)

2007

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OBJECTIVE -We aimed to update the epidemiology of type 1 and type 2 diabetic patients among the incident end-stage renal disease (ESRD) population in Australia and New Zealand (ANZ) and to determine whether outcome is worse for diabetic women, as described in the general population.RESEARCH DESIGNS AND METHODS -All resident adults of ANZ who began renal replacement therapy (RRT) from 1 April 1991 to 31 December 2005 were included using data from the ANZ Dialysis and Transplant Registry. Incidence rates, RRT, and survival were analyzed. Risk factors for death were assessed using Cox regression.RESULTS -The study included 1,284 type 1 diabetic (4.5%), 8,560 type 2 diabetic (30.0%), and 18,704 nondiabetic (65.5%) patients. The incidence rate of ESRD with type 2 diabetes increased markedly over time (ϩ10.2% annually, P Ͻ 0.0001). In patients aged Ͻ70 years, rates of renal transplantation in type 1 diabetic, type 2 diabetic, and nondiabetic patients were 41.8, 6.5 (P Ͻ 0.0001 vs. other patients), and 40.9% (P ϭ 0.56 vs. type 1 diabetic patients), respectively. Compared with nondiabetic patients, the adjusted hazard ratio (HR) for death was 1.64 (P Ͻ 0.0001) in type 1 diabetes and 1.13 (P Ͻ 0.0001) in type 2 diabetes. Survival rates per 5-year period improved by 6% in type 1 diabetic patients (P ϭ 0.36), by 9% in type 2 diabetic patients (P Ͻ 0.0001), and by 5% in nondiabetic patients (P ϭ 0.001). In type 2 diabetic patients aged Ն60 years, the adjusted HR for death in women versus men was 1.19 (P ϭ 0.0003).CONCLUSIONS -The incidence of ESRD with type 2 diabetes increased markedly. Despite high access to renal transplants, type 1 diabetic patients had a poor prognosis after starting RRT. Survival improved significantly in type 2 diabetic patients during the study period. Older type 2 diabetic women had a worse prognosis than older type 2 diabetic men. Diabetes Care 30:3070-3076, 2007D iabetes is associated with high mortality in the general population (1,2). Worse prognosis has also been reported in diabetic women compared with diabetic men (3,4). End-stage renal disease (ESRD) in patients with type 2 diabetes has increased dramatically worldwide during the last few decades, and diabetes is associated with worse survival among patients undergoing dialysis (5-7).Nevertheless, a study in Denmark showed that the survival rate of patients with ESRD who had type 2 diabetes has improved during the 1990 -2005 period (8). Available studies on patients with ESRD who have type 1 and type 2 diabetes have shortcomings because analyses were limited to patients with diabetic nephropathy (6 -7), did not differentiate the two types of diabetes (9), were short-term (10), or were based on single-center experiences (11).The aim of the present study was to examine the epidemiology and long-term survival of patients with incident ESRD by diabetes status (type 1 diabetes, type 2 diabetes, and no diabetes) in Australia and New Zealand (ANZ) and to determine whether outcomes were different between the sexes among patients with diabetes. RESE...

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Section: Multivariate Survival Analysis In the Whole Cohortmentioning

confidence: 99%

Incidences, Treatments, Outcomes, and Sex Effect on Survival in Patients With End-Stage Renal Disease by Diabetes Status in Australia and New Zealand (1991–2005)

2007

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“…Auckland, the largest city in New Zealand, is the most ethnically diverse, with approximately 11% of people identifying as indigenous Maori, 14% as Pacific and 19% as Asian [20]. By international standards, the incidence of type 1 diabetes in young New Zealanders is moderate at 17.9 per 100,000, with lower rates reported for Maori and Pacific young people than for Europeans [21]. However, Maori and Pacific youth have been shown to have poorer outcomes in several key health areas [22,23].…”

Section: Introductionmentioning

confidence: 99%

“…The 2002 New Zealand National Children's Nutrition Survey (NCNS) identified ethnic and socioeconomic differences in diet and activity that could be expected to affect diabetes control, but did not examine the relationship between ethnicity and socioeconomic factors [24]. Starship Children's Health provides specialist care for all children diagnosed with type 1 diabetes in the Auckland region, with case ascertainment levels of over 95% [21]. The purpose of this study was to examine factors affecting metabolic control in this population of children with type 1 diabetes, and, in particular, whether any effect of ethnicity on HbA 1c is mediated by SES.…”

Section: Introductionmentioning

confidence: 99%

Ethnicity and social deprivation independently influence metabolic control in children with type 1 diabetes

et al. 2008

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Aims/hypothesis This study was performed to evaluate the influence of ethnicity and socioeconomic status (SES) on metabolic control in a population-based cohort of children with type 1 diabetes mellitus, and to evaluate whether any relationship between ethnicity and HbA 1c is mediated by SES. Methods We performed a retrospective review of all patients under age 16 years with type 1 diabetes (n=555) from 1995 to 2005 in the greater Auckland region, New Zealand. Diabetes care variables and HbA 1c values were collected prospectively, during clinic visits. Results The mean population HbA 1c was 8.3±1.3%. Maori and Pacific patients had poorer metabolic control than their European counterparts (9.1% and 9.3% vs 8.1%, p<0.001) and higher rates of moderate to severe hypoglycaemia (31.1 and 24.8 vs 14.9 events/100 patient-years, p=0.03). In multiple linear regression analysis, both ethnicity and SES were independently associated with HbA 1c (p<0.001). Other factors associated with higher HbA 1c level were longer duration of diabetes, higher insulin dose, lower BMI z score and less frequent blood glucose monitoring (p<0.001).Conclusions/interpretation Both ethnicity and SES independently influenced metabolic control in a large, unselected population of children with type 1 diabetes. Irrespective of SES, Maori and Pacific youth with type 1 diabetes were at greater risk of both moderate to severe hypoglycaemia and long-term complications associated with poor metabolic control.

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“…Centers in the United Kingdom, Austria, Germany, and New Zealand report a higher prevalence of obesity in youth with T1DM than in children without diabetes from the representative populations [21][22][23][24]. Knerr et al [22] evaluated anthropometric measurements in a cohort of 9248 pediatric patients with T1DM diagnosed between 1990 and 2003 in Germany and Austria.…”

Section: The Role Of Autoimmunity In T2dmmentioning

confidence: 99%

Type 2 Diabetes in Childhood: Clinical Characteristics and Role of β-Cell Autoimmunity

Badaru

Pihoker

2011

Curr Diab Rep

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The global obesity epidemic has led to dramatic increases in the incidence and prevalence of type 2 diabetes mellitus (T2DM) among youth worldwide. In today's clinical practice it has become increasingly difficult to distinguish type 1 diabetes mellitus (T1DM) from T2DM as many children with T1DM are overweight at diagnosis. Numerous recent publications note a significant proportion of physician-diagnosed T2DM youth with evidence of pancreatic autoimmunity, exemplifying the challenges in distinguishing between T1DM and T2DM. The clinical implications of the phenomenon of antibody positivity in phenotypic T2DM youth, also referred to as "type 1.5 diabetes" (T1.5 DM), "double diabetes," "latent autoimmune diabetes in youth" (LADY), and "hybrid diabetes," are unclear at present. Current and future work should determine if the presence of autoantibodies in phenotypic T2DM youth/children affects clinical course; this will facilitate the development of optimal treatment strategies.

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Prospective incidence study of diabetes mellitus in New Zealand children aged 0 to 14 years

Cited by 59 publications

References 20 publications

Incidences, Treatments, Outcomes, and Sex Effect on Survival in Patients With End-Stage Renal Disease by Diabetes Status in Australia and New Zealand (1991–2005)

Incidences, Treatments, Outcomes, and Sex Effect on Survival in Patients With End-Stage Renal Disease by Diabetes Status in Australia and New Zealand (1991–2005)

Ethnicity and social deprivation independently influence metabolic control in children with type 1 diabetes

Type 2 Diabetes in Childhood: Clinical Characteristics and Role of β-Cell Autoimmunity

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