Incidence Of Childhood Diabetes Research Articles

Type 1 Diabetes Management in the Hospital Setting.

The incidence of diabetes in children and adolescents has increased during the past decades, with a 1.9% increase per year in type 1 diabetes mellitus (T1DM). Patients with diabetes have a greater risk of hospitalizations compared with those without diabetes. Clear evidence has emerged in the past decade that supports appropriate glycemic control in the hospital setting to improve clinical outcomes and reduce the risk of hospital complications and mortality. Determining the appropriate insulin regimen in patients with T1DM in the hospital depends on the clinical status, type of outpatient insulin regimen (multiple daily injections versus pump therapy), glycemic control before admission, nutritional status, procedures, and enteral versus parenteral nutrition. Due to the complexity of the inpatient management of diabetes, institutions should have an inpatient diabetes management team that includes dietitians, diabetes educators, nurses, pharmacists, social workers, and endocrinologists. The use of inpatient diabetes teams has been demonstrated to be beneficial in the management of patients with T1DM.

The incidence of diabetes in children and adolescents in Austria is still rising!

ZusammenfassungSeit 1989 verfügt Österreich über ein Diabetes-Inzidenz-Register für Kinder unter 15 Jahren. Eine aktuelle Auswertung zeigte, dass die Inzidenz von Typ-1-Diabetes (T1D) wieder steigt und im Jahr 2021 einen Höchststand erreichte. Diese Zusammenfassung gibt einen Überblick über die Entwicklung von Diabetesinzidenzen bei Kindern in Österreich mit besonderem Fokus auf T1D und Typ-2-Diabetes (T2D) sowie deren potenziellen Zusammenhang mit der COVID-19-Pandemie und anderen Einflussfaktoren. Da in den letzten Jahren ein eklatanter Anstieg an diabetischer Ketoazidose bei Diagnosestellung zu verzeichnen war, wird die Bedeutung von Screening, Prävention und Früherkennung im Zusammenhang mit T1D bei Kindern betont.

#185 : Embryos Derived from Prepubertal Hyperglycemic Mice Show Differential Response to Oxygen Tension In Vitro

Background and Aims: Response of preimplantation embryos to varying oxygen tensions, when cultured in vitro, has shown conflicting results. Though physiological or low oxygen culture is gaining popularity in IVF programs, how oxygen tension influences the behavior of embryos derived from pathological conditions is unknown. Since there has been an increasing trend in the incidence of diabetes in children and young adults, this study is aimed to look at the functional ability of embryos derived from experimentally induced hyperglycemic mice at the prepubertal phase of life to varying oxygen tension in vitro. Method: The experimentally induced hyperglycemic state was monitored in the prepubertal phase (3 to 6 weeks), followed by oocyte quality assessment, in vitro maturation potential, mitochondrial status, and spindle integrity analysis. Oocytes were then fertilized and cultured at high/atmospheric ([Formula: see text] 19%) and low/physiological ([Formula: see text]5%) oxygen tension until 96 h in vitro. Embryo quality and developmental progression, blastocyst rate, apoptosis, inner cell mass (ICM) outgrowth proliferation, and expression of Hif1[Formula: see text] were assessed. Results: Prepubertal hyperglycemia did not affect the ovarian reserve significantly; however, the maturation potential (P<0.001), mitochondrial integrity (P<0.01), and meiotic spindle assembly (P<0.05–0.001) in oocytes were altered significantly. Importantly, such oocytes showed better functional ability during the preimplantation phase of development when cultured at low oxygen tension. Hif1[Formula: see text] transcripts in ICM outgrowths were significantly higher (P<0.05) in low oxygen tension compared to atmospheric oxygen tension. Conclusion: Embryo culture in low oxygen tension appears beneficial for embryos derived from hyperglycemic mothers with respect to developmental competence and retaining genetic integrity. ART clinics need to customize their embryo culture strategies based on patient’s physiological and pathological conditions.

Incidence of Diabetes in Children and Adolescents During the COVID-19 Pandemic

There are reports of increasing incidence of pediatric diabetes since the onset of the COVID-19 pandemic. Given the limitations of individual studies that examine this association, it is important to synthesize estimates of changes in incidence rates. To compare the incidence rates of pediatric diabetes during and before the COVID-19 pandemic. In this systematic review and meta-analysis, electronic databases, including Medline, Embase, the Cochrane database, Scopus, and Web of Science, and the gray literature were searched between January 1, 2020, and March 28, 2023, using subject headings and text word terms related to COVID-19, diabetes, and diabetic ketoacidosis (DKA). Studies were independently assessed by 2 reviewers and included if they reported differences in incident diabetes cases during vs before the pandemic in youths younger than 19 years, had a minimum observation period of 12 months during and 12 months before the pandemic, and were published in English. From records that underwent full-text review, 2 reviewers independently abstracted data and assessed the risk of bias. The Meta-analysis of Observational Studies in Epidemiology (MOOSE) reporting guideline was followed. Eligible studies were included in the meta-analysis and analyzed with a common and random-effects analysis. Studies not included in the meta-analysis were summarized descriptively. The primary outcome was change in the incidence rate of pediatric diabetes during vs before the COVID-19 pandemic. The secondary outcome was change in the incidence rate of DKA among youths with new-onset diabetes during the pandemic. Forty-two studies including 102 984 incident diabetes cases were included in the systematic review. The meta-analysis of type 1 diabetes incidence rates included 17 studies of 38 149 youths and showed a higher incidence rate during the first year of the pandemic compared with the prepandemic period (incidence rate ratio [IRR], 1.14; 95% CI, 1.08-1.21). There was an increased incidence of diabetes during months 13 to 24 of the pandemic compared with the prepandemic period (IRR, 1.27; 95% CI, 1.18-1.37). Ten studies (23.8%) reported incident type 2 diabetes cases in both periods. These studies did not report incidence rates, so results were not pooled. Fifteen studies (35.7%) reported DKA incidence and found a higher rate during the pandemic compared with before the pandemic (IRR, 1.26; 95% CI, 1.17-1.36). This study found that incidence rates of type 1 diabetes and DKA at diabetes onset in children and adolescents were higher after the start of the COVID-19 pandemic than before the pandemic. Increased resources and support may be needed for the growing number of children and adolescents with diabetes. Future studies are needed to assess whether this trend persists and may help elucidate possible underlying mechanisms to explain temporal changes.

Type 1 diabetes incidence in children and adolescents during the COVID-19 pandemic in Germany

Aims/hypothesisThe aim of this study was to analyze the incidence of type 1 diabetes in children and adolescents (<20 years of age) during the COVID-19 pandemic (3/2020 to 12/2021) in Germany. MethodsThe present study was based on the IQVIA longitudinal prescription database (LRx), All persons (age ≤ 20 years) with new insulin prescriptions from 2016 to 2021 (index date) were selected and stratified by age group. Weekly (age-specific) data were used to forecast the prescription incidence for the pandemic period based on pre-pandemic data and to explore the relationship between weekly reported age-specific COVID-19 incidences and type 1 diabetes incidence and rate ratios of observed vs. predicted diabetes incidence respectively. ResultsDuring the pre-pandemic period, there was a stable higher insulin prescription incidence during the winter period and a lower insulin prescription incidence during summer. During the pandemic period, there was less seasonal variation in incidence related to the finding that the observed incidence during summer in 2002 and 2021 was 44 % and 65 %, higher, respectively, than the expected incidence based on pre-pandemic year. We did not find any cross-correlations between the COVID-19 incidence and the type 1 diabetes incidence for any age group. Likewise, there were no cross-correlations between the COVID-19 incidence and the incidence rate ratios of observed incidences to predicted incidences. Conclusions/interpretationDuring the COVID-19 pandemic, there was less seasonal variation in the incidence of type 1 diabetes (defined by new insulin prescriptions), with higher observed than expected incidences during summer. We found no evidence that the increase in type 1 diabetes incidence during the COVID-19 pandemic relates to direct effects of COVID-19 pandemic.

Commentary on CDC data showing an increased risk for pediatric diabetes with COVID-19 infection.

Highlights We question certain aspects of the recent Centers for Disease Control and Prevention (CDC) Morbidity and Mortality Weekly Report (January 2022) showing a significant increase in the incidence of diabetes in children after COVID‐19 infection.We are concerned at the source of data being limited to commercial health insurances and lack of factoring race, ethnicity, social determinants of health, body mass index, type of diabetes, and viral variants in the interpretation of these data.

Increase in Type 1 Diabetes Incidence in Children During COVID-19.

According to this study: There was an increase in the incidence of new-onset type 1 diabetes in children during the COVID-19 pandemic.More children had diabetic ketoacidosis at the time of diagnosis.

Worldwide estimates of incidence of type 2 diabetes in children and adolescents in 2021

AimsWe aimed to conduct a systematic review of published studies on the incidence of type 2 diabetes in children and adolescents aged under 20 years and provide worldwide incidence estimates for 2021. MethodsWe used MEDLINE and EMBASE to identify studies reporting type 2 diabetes incidence in children and adolescents published between Jan 2000 and April 2021. We used a negative binomial regression model to develop a prediction equation to estimate incidence rates from country characteristics. We applied the resulting incidence predictions to country population data to estimate numbers of incident cases in children and adolescents by International Diabetes Federation (IDF) region and World Bank income classification group. ResultsWe estimate that there are approximately 41,600 new cases of diagnosed type 2 diabetes among children and adolescents in 2021 worldwide. Around 30% and 40% of the worldwide total incident cases are in IDF Western Pacific region and in World Bank upper-middle-income countries, respectively. The three countries with the highest estimated number of incident cases are China, India, and United States of America. ConclusionsThe number of newly diagnosed type 2 diabetes in children and adolescents is substantial. More reliable data are needed to track the incidence of type 2 diabetes in children and adolescents.

Association of Environmental Exposures and Socioeconomic Status with Presymptomatic Type 1 Diabetes Incidence in Children in Bavaria, Germany

BACKGROUND AND AIM: Increasing incidence of early-onset type 1 diabetes (T1D) has been reported worldwide. Evidence shows that environmental exposures contribute to developing pancreatic islet autoantibodies in individuals with predisposing genes. This study aimed to investigate the effect of environmental exposures and socioeconomic levels on childhood presymptomatic T1D incidence (defined as having at least 2 islet autoantibodies) in Bavaria, Germany. METHODS: Long-term exposure to air pollution (nitrogen dioxide (NO2), Ozone (O3) and particulate matter with a diameter 2.5 μm (PM2.5)) and ambient temperature as well as surrounding greenness and area-level socioeconomic status (SES) were assigned to the residential addresses of 52,636 children (6 years of age) participating in the Fr1da study from 2015 to 2019. Information on demographic characteristics was extracted from self-administered questionnaires. We applied generalized additive models to examine the association of environmental factors and SES with presymptomatic T1D incidence adjusting for sex, age and family history of diabetes. We inspected single as well as multi-exposure models. RESULTS:225 children were diagnosed with presymptomatic T1D. Higher age at the time of diagnosis and having family history of diabetes was related to developing presymptomatic T1D (p0.00). An interquartile range (IQR) increase in O3 was associated with significantly higher odds of developing presymptomatic T1D (IQR: 5.06, Odds ratio (OR): 1.26; 95% confidence interval (CI): 1.08-1.48). One IQR increase in ambient temperature had an inverse association (IQR: 0.92, OR: 0.78, 95% CI: 0.66-0.93). Multi-exposure models indicated similar results, though both effects estimates were slightly shifted to the null. Other exposures were not associated with presymptomatic T1D. CONCLUSIONS:Exposure to higher levels of O3 and low ambient temperature may predispose to T1D development in children. KEYWORDS: Air pollution, Long-term exposure, Ozone, Temperature, Green space, Socio-economic factors

Relationships between emissions of toxic airborne molecules and type 1 diabetes incidence in children: An ecologic study.

BACKGROUNDType 1 diabetes originates from gene-environment interactions, with increasing incidence over time.AIMTo identify correlates of childhood type 1 diabetes in European countries using an ecological approach. Several environmental variables potentially influencing the onset of type 1 diabetes have been previously evaluated. However, the relationships between epidemiologic data and exposure to toxic airborne molecules are scarcely studied.METHODSWe employed an ecological model to explore, in a wide time period (1990-2018), associations between type 1 diabetes incidence in 19 European countries (systematic literature review) and the nationwide production of five widely diffused air pollutants: particulate matter < 10 μm (PM10), nitrogen oxides (NO), non-methane volatile organic compounds (VOCs), sulphur oxide (SO2), and ammonia. RESULTSData confirm a raising incidence of type 1 diabetes in 18 out of 19 explored countries. The average difference (last vs first report, all countries) was +6.9 × 100000/year, with values ranging from -1.4 (Germany) to +16.6 (Sweden) per 100000/year. Although the overall production of pollutants decreased progressively from 1990 to 2018, type 1 diabetes incidence was positively associated with the nationwide emissions of PM10, VOCs, and NO but not with those of SO2 and ammonia. Type 1 diabetes incidence was significantly higher in countries with high emissions than in those with low emissions of PM10 (27.5 ± 2.4 vs 14.6 ± 2.4 × 100000 residents, respectively), VOCs (24.5 ± 4.4 vs 13.2 ± 1.7 × 100000 residents, respectively), and NO (26.6 ± 3 vs 13.4 ± 2.4 × 100000 residents, respectively), but not of SO2 or ammonia. CONCLUSIONEvidence justify further studies to explore better links between long-term air quality and type 1 diabetes onset at the individual level, which should include exposures during pregnancy. In this respect, type 1 diabetes could be, at least in part, a preventable condition. Thus, primary prevention policies acting through a marked abatement of pollutant emissions might attenuate future type 1 diabetes incidence throughout Europe.

High incidence of type 1 diabetes in adolescents and young adults in Eritrea.

Eritrea has no data on type 1 diabetes incidence in children and youth; therefore, a study was undertaken to determine this in persons aged <25years. Data were collected on new type 1 diabetes diagnoses during 2019, from district, provincial and national hospitals. Type 1 diabetes was diagnosed according to standard WHO criteria. No secondary ascertainment source was available. 95% confidence intervals were computed based on approximation to the Poisson distribution, and age and gender effects were analysed with Poisson regression. There were 532 new cases of type 1 diabetes. Mean ± standard deviation (range) age of diagnosis was 16.2±5.7 (1.5-24.9) years, and peak age group was 15-19years (n=200, 37.6%), with mode at 18years. Incidence <15years was 11.5/100,000 individuals [9.9-13.2], with the highest incidence in the 10-14years group (19.0/100,000 [15.5-23.1]). Incidence then peaked in the 15-19years age group (50.2/100,000 [43.5-57.7]) and remained high in the 20-24years group (46.2/100,000 [39.0-54.3]). There was a male:female ratio of 1.37 (p=0.001). Two hundred and thirty-eight (44.7%) presented in diabetic ketoacidosis. Type 1 diabetes incidence in Eritrea is moderate <15years, and high 15-24years. The 15-19 and 20-24years rates appear to be the highest published to date. Given the study was only for oneyear, further confirmatory prospective information will clarify the situation and document trends. Assessment of the type 1 diabetes phenotypes that are occurring in Eritrea is also indicated.

Incidence of diabetes in children and adolescents in Dhaka, Bangladesh

Bangladesh has limited information regarding incidence of type 1 diabetes (T1D) and type 2 diabetes (T2D) in young people. The objective of this study was to measure minimum incidence of T1D and T2D, and record other types of new-onset diabetes in children and adolescents <20 years (y), in Dhaka District, Bangladesh, from 2011-2018. Retrospective study using clinical records from Diabetic Association of Bangladesh clinics. Cases were classified by clinical evaluation. 725 cases were diagnosed. 482 (66.5%) had T1D, 205 (28.3%) T2D, 14 (1.9%) fibrocalculous pancreatic diabetes, and 24 (3.3%) other types. Male:female ratios for T1D/T2D were 1:1.6 (p<0.0001) (T1D) and 1:1.4 (p<0.01) respectively. T1D cases by age-group were 7.3% (0-4y), 19.9% (5-9y), 43.6% (10-14y) and 29.3% (15-19y). Mean±SD ages of onset were 12.3±4.2y (T1D) and 13.1±2.4y (T2D). Annual T1D mean incidences/100,000 were 1.22 [95%CI: 0.85-1.58] (<15y) and 1.25 [0.94-1.57] (<20y), and for T2D 0.52 [0.33-0.73] (<20y). T1D incidence <15y was 1.04 [0.69-1.39] in 2011 and 1.42 [1.04-1.80] in 2018 (p=0.08). T2D incidence rose from 0.22 [0.80-0.36] (2011) to 0.57 [0.36-0.77] (2018), an annualized increase of 12% [8-22%] (p=0.001). Ascertainment was estimated as 95%. T1D was most common, but T2D, FCPD and other forms also occur. T2D incidence increased during the study period.

Going in Early: Hypoxia as a Target for Kidney Disease Prevention in Diabetes?

Diabetic kidney disease (DKD) begins early, which is pertinent to those diagnosed with diabetes during childhood and adolescence. The initiators of DKD are not fully defined, but hypoxia and metabolic abnormalities are important. With growing numbers of young people diagnosed with diabetes and concomitant risk for early mortality, this commentary examines the study by Vinovskis et al. (1) in this issue of Diabetes , which highlights renal hypoxia as an early phenomenon in diabetes associated with risk for DKD. Many diabetologists and nephrologists consider DKD an affliction of late-middle age. Certainly, the proportion of affected individuals with diabetes escalates with age (2), and at least one-third of these will develop DKD, a major risk factor for cardiovascular disease and early mortality (3). Global estimates of people living with diabetes have tripled in the past 20 years (2), topping 463 million individuals, suggesting that 167 million of these already have or will develop DKD. Perhaps less well known is the growing incidence of diabetes in children and adolescents, which is escalating by 3% each year, and at a higher rate in some ethnic groups (2). Another underappreciated fact is that many children and adolescents with diabetes develop complications in early adulthood, placing significant burden on the individual, the family, and society. Data from the International Diabetes Federation suggest that almost half (46.2%) of deaths associated with diabetes among the 20–79 years age-group are in people under the age of 60 years (2). Hence, because the average age of enrolment in phase 3 studies of diabetes-related mortality is 60 years of age, younger individuals who may have benefited from these interventions were excluded. Therefore, undertaking studies to understand and potentially intervene in early complications of diabetes in a much younger cohort than standard is crucial to potentially improving the outcomes of diabetes …

Increased Incidence of Type 1 Diabetes in Children and No Change in the Age of Diagnosis and BMI-SDS at the Onset - is the Accelerator Hypothesis not Working?

Objective:One of the hypothesized reasons for the observed increase in type 1 diabetes incidence in children is weight gain, causing accelerated disease development in predisposed individuals. This so-called accelerator hypothesis is, however, controversial. The aim was to analyze whether, in the ethnically homogeneous population of Lesser Poland, an increase in the number of cases of diabetes among children was associated with younger age and higher body mass index-standard deviation score (BMI-SDS) at the time of diagnosis.Methods:Retrospective data analysis from medical records of all patients <14 years (n=559; 50.6% male), with newly diagnosed type 1 diabetes, in Lesser Poland between 1st January 2006 and 31st December 2017 (11 years).Results:The incidence ratio ranged significantly (p<0.001) from the lowest in 2006 (11.2/100,000/year) to the highest in 2012 (21.9/100,000/year). The mean age of diagnosis was 8.2±3.5 years. There was no trend in decreasing diagnosis age (p=0.43). The mean BMI-SDS was -0.4±1.2. Almost all children (91.6%) presented with BMI-SDS within the normal range at the time of diagnosis, with only 2.7% of cases being obese and 5.7% underweight at the moment of diagnosis. There was no clear trend at all in BMI-SDS over the study period.Conclusion:These results do not corroborate an increase of type 1 incidence in paediatric population being associated with younger age of diagnosis and higher BMI-SDS. This implies that the accelerator hypothesis does not hold true in the study population.

Congenital infections as contributors to the onset of diabetes in children: A longitudinal study in the United States, 2001-2017.

Maternal infections during pregnancy, particularly with rubella virus, were reported to increase the risk of diabetes in children. Widespread vaccination has decreased the number of infants with congenital rubella syndrome in the United States, although it remains a problem in developing countries. Because vaccine hesitancy has recently increased, we investigated the association between congenital infections with subsequent diabetes risk in children in the United States. Using data from a nationwide private health insurer for years 2001-2017, 1 475 587 infants were followed for an average of 3.9 years (maximum 16.5 years). Information was obtained regarding congenital infections (rubella, cytomegalovirus, other congenital infections) and perinatal infections, as well as for the development of diabetes mellitus and diabetic ketoacidosis. There were 781 infants with congenital infections and 73 974 with perinatal infections. Diabetes developed in 3334 children. The odds of developing diabetes for infants with congenital rubella infection were 12-fold greater (P = .013) and, for infants with congenital cytomegalovirus infection, were 4-fold greater (P = .011) than infants without congenital or perinatal infection. Infants with other congenital infections had 3-fold greater odds of developing diabetes (P = .044). Results were similar for diabetes ketoacidosis. Infants with other perinatal infections had 49% greater odds of developing diabetes during the follow-up period (P < .001). Congenital and other perinatal infections are associated with elevated risks of developing diabetes mellitus during childhood. Vaccination for rubella remains an important preventive action to reduce the incidence of diabetes in children.

Trend of type 1 diabetes incidence in children between 2009 and 2019 in Elazig, Turkey.

To assess the incidence of T1D in children aged <15 years in Elazig, Turkey. The data of children who have been registered as child with T1D in the database of pediatric diabetes clinic was analyzed. Childhood census data were acquired from the Turkish Statistical Institute. The incidence rates of T1D were calculated for the whole group as well as separately for age group, gender, year of diagnosis, and place of residence, viz. either urban or rural per 100 000 persons per year. The change of incidence during the 10 year observation period was analyzed. The overall mean incidence of T1D in study period was 16.7/100 000 [95% confidence interval (CI): 14.6-19.0] persons per year. The incidence rates of T1D varied from 10.2 to 24.1/100 000 persons per year, representing 2.4-fold variation between 2009 and 2019. The lowest incidence rate was in children aged 0 to 4 years (9.6/100 000 persons per year; CI: 6.9-12.9). There was no difference in incidence rate between genders, incidence rates was significant higher in urban residents. A significant increasing trend of T1D was detected in the total 10-year observation period; the average annual percent change was 7.8%. Subgroup analysis showed that there was significant increasing trend in boys, urban residents, and children aged 5 to 9 years groups. This study demonstrated increase in T1D incidence of in children in Elazig and highest regional incidence rate of T1D until now in Turkey compared to previous limited data.

Type 1 diabetes incidence in children and adolescents in Mexico: Data from a nation-wide institutional register during 2000–2018

AimsTo describe the annual incidence of type 1 diabetes in children and adolescents insured by the Mexican Institute of Social Security, the main health provider in Mexico, during 2000–2018. MethodsWe conducted a secondary data analyses using the incidence registers from the Epidemiological Surveillance Coordination of the Mexican Institute of Social Security collected during 2000–2018. Incident type 1 diabetes cases (age 19 years old and below) were identified using ICD-10-CM E10 diagnostic codes. Age, sex, and geographical region and seasonal-specific incidence were calculated with their corresponding annual percentage change (APC) as well. ResultsIn the period 2000–2018, the number of incident cases with type 1 diabetes decreased from 3.4 to 2.8 per 100,000 in insured for subjects below 20 years old. We observed an increase in the 2000–2006, followed by a decrease for the 2006–2018 period (APC +16.1 and −8.7 respectively). Females and children <5 years old had a significant decrease in the incidence rate, while inhabitants in Central Mexico showed a significant increase. No difference was found in incidence between seasons. ConclusionsOur study describes significant fluctuations of the incidence of type 1 diabetes during the period 2000–2018, which appeared to correspond to influenza outbreaks, among Mexican children and adolescents.

Promoting the mode of individualized comprehensive management for childhood diabetes

Children diabetes is a rare chronic disease, recent data on the incidence of childhood diabetes show both types of diabetes are increasing worldwide.How to implement individualization on the basis of the principle of comprehensive management of diabetes mellitus, and ultimately make blood sugar achieve optimal control and reduce complications is the goal of treatment.In order to correctly treat and utilize new insulin dosage forms and new blood sugar monitoring technology in children, it is necessary to integrate all aspects of information and make comprehensive decisions.Now, how to realize individualization on the basis of comprehensive management of diabetes mellitus was elaborated. Key words: Diabetes; Child; Comprehensive management; Indvidualization

Prevalence and determinants of abnormal glucose metabolism in urban and rural secondary schools in Cameroon: A cross-sectional study in a sub-Saharan Africa setting

IntroductionThe incidence of Diabetes in children and teenagers increased by 30.2% between 2001 and 2009, with the main cause being an increase in the prevalence of overweight and obesity. Despite its high morbidity and mortality, few studies in Cameroon have focused on the study of abnormal glucose metabolism in schools. MethodologyThis cross-sectional study was carried out in three schools institutions of two health districts selected from a three-stage cluster sampling survey–which consisted of a simple draw without discount for department selection, a simple random survey for the choice of health districts, and finally a simple random survey for the choice of schools institutions. ResultsAmong the 815 participants, the prevalence of impaired fasting glucose and diabetes was 34.1% and 1.8% respectively. Glucose metabolism abnormalities were significantly higher in rural area than in urban areas (40% vs. 31.6%, p=0.016), and were significantly associated with abdominal obesity (p=0.027). Overweight and obesity were significantly higher in rural areas (p=0.0002), as well as abdominal obesity (p=0.0004). ConclusionAbnormalities of glucose metabolism are a major health problem in schools in Cameroon. Thus, it is urgent to develop a health policy involving teachers and parents in the fight against overweight and obesity in schools.

Relationship between fasting plasma glucose and incidence of diabetes in children and adolescents.

To investigate the appropriate fasting plasma glucose threshold by which to define prediabetes in children and adolescents, based on its ability to predict incident paediatric diabetes. In a nationwide survey of diabetes and renal disease conducted between 1992 and 2000 in all school-aged children in Taiwan, those with abnormal results in repeated urine tests received further physical examination and blood tests. Students who had blood tests for at least two time points were selected for the present study (N = 12 119). The incidence of paediatric diabetes, adjusted hazard ratio and predictive power of fasting plasma glucose were analysed. The incidence of paediatric diabetes increased with increasing fasting plasma glucose levels. Groups with fasting plasma glucose >5.6 mmol/l had a higher adjusted hazard ratio. The adjusted hazard ratio of incident diabetes for participants with higher fasting plasma glucose rose continuously when using a higher threshold for fasting plasma glucose. The area under the receiver-operating characteristic curve for fasting plasma glucose was 0.628 for predicting paediatric diabetes. The association between fasting plasma glucose and incident paediatric diabetes and the area under the receiver-operating characteristic curve were similar in boys and girls and were higher in the age group 12-18 years. According to receiver-operating characteristic curve analysis, the optimal thresholds, sensitivity and specificity were 4.75 mmol/l, 65% and 51%, respectively, for those aged 6-11 years and 5.19 mmol/l, 60% and 73%, respectively, for those aged 12-18 years. Fasting plasma glucose is associated with the incidence of paediatric diabetes. The results of the present study can be used as reference data to suggest a cut-off value to define paediatric prediabetes.