Increase In Incidence Of Type Research Articles

THU134 Proportion Of Type 2 Diabetes Amongst New Diabetes Diagnosis In Youth Continues To Increase 12 Months After Pandemic Start

Abstract Disclosure: E.E. Bell-Sambataro: None. R.P. Hoffman: None. A. Lahoti: None. Background: Recent studies have shown significant increase in incidence of type 2 diabetes (T2D) in youth in the first 12 months of COVID-19 pandemic likely related to lockdowns, decreased physical activity and increased food consumption, leading to increased weight gain and worsening insulin resistance in at risk adolescents. However, it is unclear if these patterns have persisted beyond the first year of pandemic. We hypothesized that the proportion of T2D amongst youth with new onset diabetes (DM) would decrease to pre pandemic levels after 3/1/2021. Methodology: In this single institution study, youth with new onset DM were identified from the electronic medical record (EMR) database using ICD-10 diagnoses codes. Patients meeting ADA criteria of DM diagnosis were included while patients with diagnosis before 3/1/2018 or after 2/28/2022, age >18 years at diagnosis or DM types other than type 1 diabetes (T1D) or T2D were excluded. Patient characteristics and anthropometric data at DM diagnosis were collected. Frequency of T1D and T2D per year were calculated (Year 1: 3/1/2018-2/28/2019, Year 2: 3/1/2019-2/29/2020, Year 3: 3/1/2020-2/28/2021, Year 4: 3/1/2021-2/28/2022). Descriptive categorical data is reported as frequency and proportion. Chi square, independent sample t tests, and ANOVA were used as appropriate to evaluate differences between years. Results: Frequency of new onset T1D and T2D per year (proportion of T2D among new onset DM), respectively for year 1 was 191 and 63 (24.8%); year 2 was 193 and 45 (18.9%); year 3 was 231 and 109 (32.1%); year 4 was 262 and 130 (33.2%). The increase in proportion of T2D from year 1 to 4 was statistically significant (p <0.001). From year 1 to 4, age at diagnosis and percentage females for both groups and race for T1D patients were not statistically significant. Percentage Blacks amongst all new onset T2D youth increased significantly from 31% in year 1 to 51.3% in year 4 (p< 0.01). BMI z-scores increased significantly in T1D patients from year 1 to 4 (p= 0.008). BMI z-scores in T2D patients decreased significantly between year 2 & 3 (p= 0.002) and rose back between year 3 & 4 (p= 0.005). Conclusions: Our study shows the increase in proportion of T2D patients amongst youth with new onset DM has persisted beyond the first year of COVID-19 pandemic suggesting the increase may not be only due to pandemic era restrictions and lifestyle changes. While prior studies showed higher BMI z-scores at T2D diagnosis compared to pre pandemic period, in our study BMI z-scores for new onset T2D youth decreased significantly in the 1st year of pandemic. This could have been due to swift implementation of telehealth in our community and institution that allowed continued access to healthcare, DM screening and earlier T2D diagnosis. The rapid change in the landscape of pediatric diabetes with growing proportion of T2D is an alarming trend that requires additional studies. Presentation: Thursday, June 15, 2023

SARS-CoV-2 and type 1 diabetes in children in Finland: an observational study

Some epidemiological studies have suggested an increase in incidence of type 1 diabetes during the COVID-19 pandemic, however the mechanism(s) behind such an increase have yet to be identified. In this study we aimed to evaluate the possible role of the SARS-CoV-2 virus in the reported increase in the rate of type 1 diabetes. In this observational cohort study using data from the Finnish Pediatric Diabetes Register (FPDR), we assessed the incidence of type 1 diabetes (number of children with newly diagnosed type 1 diabetes per 100 000 person-years during the pandemic and the reference period) during the first 18 months of the COVID-19 pandemic in children in Finland younger than 15 years old compared with a reference period which included three corresponding pre-pandemic periods also obtained from the FPDR. Children with confirmed monogenic diabetes were excluded. We also compared the phenotype and HLA genotype of the disease between these two cohorts, and analysed the proportion of newly diagnosed people with type 1 diabetes testing positive for SARS-CoV-2 antibodies. 785 children and adolescents in Finland were diagnosed with type 1 diabetes from March 1, 2020, to Aug 31, 2021. In the reference period, which comprised three similar 18-month terms (from March 1, 2014, to Aug 31, 2015; March 1, 2016, to Aug 31, 2017; and March 1, 2018, to Aug 31, 2019) 2096 children and adolescents were diagnosed. The incidence of type 1 diabetes was 61·0 per 100 000 person-years (95% CI 56·8-65·4) among children younger than 15 years old during the pandemic, which was significantly higher than during the reference period (52·3 per 100 000 person-years; 50·1-54·6). The incidence rate ratio adjusted for age and sex for the COVID-19 pandemic was 1·16 (1·06-1·25; p=0·0006) when compared with the reference period. The children diagnosed during the COVID-19 pandemic had more often diabetic ketoacidosis (p<0·001), had a higher HbA1c (p<0·001), and tested more frequently positive for glutamic acid debarboxylase antibodies at diagnosis (p<0·001) than those diagnosed before the pandemic. There were no significant differences in the distribution of HLA genotypes between the two periods. Only five of those diagnosed during the pandemic (0·9%) of 583 tested positive for infection-induced SARS-CoV-2 antibodies. Children and adolescents diagnosed with type 1 diabetes during the pandemic had a more severe disease at diagnosis. The observed increase in type 1 diabetes incidence during the first 18 months could be a consequence of lockdown and physical distancing rather than a direct effect of SARS-CoV-2 infection. Helsinki University Hospital Research Funds, EU Horizon 2020 (Versatile emerging infectious disease observatory project), Academy of Finland, Sigrid Jusélius Foundation, Jane & Aatos Erkko Foundation, and Medicinska understödsföreningen Liv och Hälsa. For the Finnish and Swedish translations of the abstract see Supplementary Materials section.

POS-818 JOURNEY OF A DONOR: A HERMENEUTIC PHENOMENOLOGICAL STUDY

Living kidney donation is considered as the best treatment option for people suffering from end stage renal disease.1The global prevalence of end stage renal disease is quite high and growing rapidly due to improved diagnostic abilities, increase in incidence of type 2 diabetes and several other causes of chronic renal disease. 2 The Transplantation of Human Organ Act (THOA) and rules in India were proclaimed in 1994 and eventually revised in 2008 and 2011 to enhance living kidney donation still there lies a huge void in living kidney donation in INDIA.

IL-25 Treatment Improves Metabolic Syndrome in High-Fat Diet and Genetic Models of Obesity.

IntroductionEndemic obesity is considered the driving force for the dramatic increase in incidence of type 2 diabetes (T2D). There is mounting evidence that chronic, low-grade inflammation driven by Th1/Th17 cells and M1 macrophages, is a critical link between obesity and insulin resistance. IL-25 promotes development of a Th2 immune response and M2 macrophages that counteract the inflammation associated with obesity and T2D.MethodsMice were fed a high-fat diet (HFD) for 16 weeks and then treated with IL-25 or BSA as a control for 21 days. Body weight, blood glucose levels, intraperitoneal glucose tolerance, and gene expression were evaluated in mice treated with BSA or IL-25. Ob/ob mice fed a normal control diet were also treated with BSA or IL-25 and body weight and blood glucose levels were measured. Transepithelial electrical resistance and sodium-linked glucose absorption were determined in muscle-free small intestinal tissue and glucose absorption assessed in vitro in intestinal epithelial and skeletal muscle cell lines.ResultsAdministration of IL-25 to HFD fed mice reversed glucose intolerance, an effect mediated in part by reduction in SGLT-1 activity and Glut2 expression. Importantly, the improved glucose tolerance in HFD mice treated with IL-25 was maintained for several weeks post-treatment indicating long-term changes in glucose metabolism in obese mice. Glucose intolerance was also reversed by IL-25 treatment in genetically obese ob/ob mice without inducing weight loss. In vitro studies demonstrated that glucose absorption was inhibited by IL-25 treatment in the epithelial IPEC-1 cells but increased glucose absorption in the L6 skeletal muscle cells. This supports a direct cell-specific effect of IL-25 on glucose metabolism.ConclusionThese results suggest that the IL-25 pathway may be a useful target for the treatment of metabolic syndrome.

Secular trends in incidence of type 1 and type 2 diabetes in Hong Kong: A retrospective cohort study.

There is very limited data on the time trend of diabetes incidence in Asia. Using population-level data, we report the secular trend of the incidence of type 1 and type 2 diabetes in Hong Kong between 2002 and 2015. The Hong Kong Diabetes Surveillance Database hosts clinical information on people with diabetes receiving care under the Hong Kong Hospital Authority, a statutory body that governs all public hospitals and clinics. Sex-specific incidence rates were standardised to the age structure of the World Health Organization population. Joinpoint regression analysis was used to describe incidence trends. A total of 562,022 cases of incident diabetes (type 1 diabetes [n = 2,426]: mean age at diagnosis is 32.5 years, 48.4% men; type 2 diabetes [n = 559,596]: mean age at diagnosis is 61.8 years, 51.9% men) were included. Among people aged <20 years, incidence of both type 1 and type 2 diabetes increased. For type 1 diabetes, the incidence increased from 3.5 (95% CI 2.2-4.9) to 5.3 (95% CI 3.4-7.1) per 100,000 person-years (average annual percentage change [AAPC] 3.6% [95% CI 0.2-7.1], p < 0.05) in boys and from 4.3 (95% CI 2.7-5.8) to 6.4 (95% CI 4.3-8.4) per 100,000 person-years (AAPC 4.7% [95% CI 1.7-7.7], p < 0.05] in girls; for type 2 diabetes, the incidence increased from 4.6 (95% CI 3.2-6.0) to 7.5 (95% CI 5.5-9.6) per 100,000 person-years (AAPC 5.9% [95% CI 3.4-8.5], p < 0.05) in boys and from 5.9 (95% CI 4.3-7.6) to 8.5 (95% CI 6.2-10.8) per 100,000 person-years (AAPC 4.8% [95% CI 2.7-7.0], p < 0.05) in girls. In people aged 20 to <40 years, incidence of type 1 diabetes remained stable, but incidence of type 2 diabetes increased over time from 75.4 (95% CI 70.1-80.7) to 110.8 (95% CI 104.1-117.5) per 100,000 person-years (AAPC 4.2% [95% CI 3.1-5.3], p < 0.05) in men and from 45.0 (95% CI 41.4-48.6) to 62.1 (95% CI 57.8-66.3) per 100,000 person-years (AAPC 3.3% [95% CI 2.3-4.2], p < 0.05) in women. In people aged 40 to <60 years, incidence of type 2 diabetes increased until 2011/2012 and then flattened. In people aged ≥60 years, incidence was stable in men and declined in women after 2011. No trend was identified in the incidence of type 1 diabetes in people aged ≥20 years. The present study is limited by its reliance on electronic medical records for identification of people with diabetes, which may result in incomplete capture of diabetes cases. The differentiation of type 1 and type 2 diabetes was based on an algorithm subject to potential misclassification. There was an increase in incidence of type 2 diabetes in people aged <40 years and stabilisation in people aged ≥40 years. Incidence of type 1 diabetes continued to climb in people aged <20 years but remained constant in other age groups.

Ketoacidosis at onset of type 1 diabetes in children up to 14 years of age and the changes over a period of 18 years in Saxony, Eastern-Germany: A population based register study.

ObjectiveThe aim of this study was to examine the incidence trends of type 1 diabetes diagnosed with ketoacidosis in Saxony, Germany from 1999 to 2016.MethodsThe population based Childhood Diabetes Registry of Saxony comprising valid data for all children aged 0–14 years diagnosed with type 1 diabetes from1999 to 2016 were used for the analyses. Direct age-standardized incidence rates were calculated and the effects of age, sex, calendar year, home districts and family history of any types of diabetes on the incidence were modelled using Poisson regression. Trend analyses for standard rate ratios of children with moderate and severe diabetic ketoacidosis versus children with type 1 diabetes with non-diabetic ketoacidosis were performed using join point regression.ResultsThe rate of ketoacidosis at the time of the type 1 diabetes diagnosis was high with 35.2% during the entire observation period in Saxony. The Poisson regression analysis indicated a statistically significant increased occurrence of diabetic ketoacidosis for younger age-groups, but no statistically significant differences between boys and girls. The join point trend analyses show that the proportion of severe and moderate ketoacidosis is increasing disproportionally to the increase in incidence of type 1 diabetes over the years.ConclusionDue to the observed increasing incidence of diabetes as well of diabetic ketoacidosis, an educational prevention campaign is needed in Saxony as soon as possible to aid pediatricians, general physicians as well as general public to identify the early signs of type 1 diabetes.

1694-P: A New Developmental Model of Type 1 Diabetes—An Association between Autoimmunity, the Dynamics of Gut Amyloid-Producing E. Coli, and Their Phages

Background: The increase in incidence of type 1 diabetes (T1D) is not solely a result of genetics and environmental factors, but also that of gut microbiota, which play a crucial role in disease onset. Methods: We performed a longitudinal microbiome analysis (Illumina Hiseq2500) in children (0-3 years) with HLA-susceptibility to T1D, using an algorithm focusing on amyloid producing bacteria. This analysis revealed an overlooked association between autoimmunity and the dynamics of gut amyloid-producing E. coli. Results: Our analysis revealed a statistically significant association between the development of autoantibodies in T1D HLA-susceptible children and (i) significantly (p&amp;lt;0.05) high initial (0-12 months of age) abundance of gut amyloid-producing E. coli, (ii) depletion of E. coli prior to seroconversion due to prophage induction, and (iii) triggering of islet autoimmunity and T1D development. Notably, alterations in E. coli abundance were identified only in children who further developed seroconversion and T1D. E. coli depletion was found before the appearance of antibodies, suggesting a role of E. coli in disease onset. Further, our in vitro study revealed a highly immunogenic complex (amyloid curli-DNA composites) released from E. coli biofilms upon prophage induction, which triggered the production of type I IFN through the TLR2/9 stimulation of β-cells and DCs, and autoimmune cascade through the TLR-2-MyD88-NF-kB pathway. Conclusions: Our study suggests that E. coli biofilm-derived highly immunogenic amyloid curly-DNA complexes might be involved in the activation of a pro-diabetic pathway in children who are at a risk of T1D. Besides, amyloid protein producing E. coli and their phages are the factors associated with T1D development that were previously overlooked. Disclosure G. Tetz: None.

Metabolomics and Lipidomics Study of Mouse Models of Type 1 Diabetes Highlights Divergent Metabolism in Purine and Tryptophan Metabolism Prior to Disease Onset.

With the increase in incidence of type 1 diabetes (T1DM), there is an urgent need to understand the early molecular and metabolic alterations that accompany the autoimmune disease. This is not least because in murine models early intervention can prevent the development of disease. We have applied a liquid chromatography (LC-) and gas chromatography (GC-) mass spectrometry (MS) metabolomics and lipidomics analysis of blood plasma and pancreas tissue to follow the progression of disease in three models related to autoimmune diabetes: the nonobese diabetic (NOD) mouse, susceptible to the development of autoimmune diabetes, and the NOD-E (transgenic NOD mice that express the I-E heterodimer of the major histocompatibility complex II) and NOD-severe combined immunodeficiency (SCID) mouse strains, two models protected from the development of diabetes. All three analyses highlighted the metabolic differences between the NOD-SCID mouse and the other two strains, regardless of diabetic status indicating that NOD-SCID mice are poor controls for metabolic changes in NOD mice. By comparing NOD and NOD-E mice, we show the development of T1DM in NOD mice is associated with changes in lipid, purine, and tryptophan metabolism, including an increase in kynurenic acid and a decrease in lysophospholipids, metabolites previously associated with inflammation.

A Review of Association betweenEarly Exposure to Infant-feeding formulas and Type 1 Diabetes among Children

The increasing incidenceof type 1 diabetes among children calls for a thorough understanding of the disease to stem its growth. Early exposure to infant-feeding formulas has been linked with the disease and several mechanisms of action have been proposed. However, it is unclear the exact mechanism by which infant-formulas aid in the pathogenesis of type 1 diabetes. This paper reviewed and articulated several hypotheses proposed as the mechanisms of action of infant formulas in the onset of type 1 diabetes. The Google search engine was used to search for relevant information on the internet from reputable sources such as PubMed, Google Scholar, among others.The majority of the studies reviewed overwhelmingly agreed early exposure to infant-feeding formulas may contribute to the pathogenesis of type 1 diabetes among children. Cow milk, for example, contains bovine insulin, which differs from human insulin with 3 amino acids, and can cause immune reactions in children. Gluten-containing diets such as wheat may cause proportional changes in immune cell populations or modify the cytokine/chemokine pattern towards an inflammatory profile. Concentrated soy-based formulas contain active estrogenic endocrine disruptors. Fruits, berries and roots may be infected with toxic antibiotics, which can start off autoimmunity. Nursing moms are therefore advised to breastfeedtheir babies for a long time before introducing infant-feeding formulas, especially those with a family with a history of diabetes.

Socio-economic Status among Diabetes in Pune

As there is marked increase in incidence of Type 2 Diabetes in India, primarily, due to rapid changes in lifestyles in different socio-cultural and ethnic groups, an anthropological study of 750 diabetic patients was carried out in Western part of India with the help of structured questionnaires, in-depth interviews and statistical calculations. The diagnosis was based on 'WHO criteria from K.E.M, AFMC, Sassoon Hospital, Poona Hospital, Nandadeep Hospital within Pune city. Maximum numbers of patients were Marathas, the Warrior Class followed by Brahmins, Backward Caste, Others. The diabetics though had some sort of formal education but had low awareness about the disease, ignorance about their healthy diet pattern and belonged to Class II category with mixed type of work pattern of both sedentary and non-sedentary. All these might have contributed to deterioration of glucose metabolism coupled with stress, resulted in incidence of Type 2 Diabetes. Hence further studies are required to evaluate the various epidemiological and environmental factors, dietary patterns, socio-cultural and economic status, influencing incidence and distribution of diabetes in different parts of ethnic groups of India.

Socio-economic Status among Diabetes in Pune

As there is marked increase in incidence of Type 2 Diabetes in India, primarily, due to rapid changes in lifestyles in different socio-cultural and ethnic groups, an anthropological study of 750 diabetic patients was carried out in Western part of India with the help of structured questionnaires, in-depth interviews and statistical calculations. The diagnosis was based on 'WHO criteria from K.E.M, AFMC, Sassoon Hospital, Poona Hospital, Nandadeep Hospital within Pune city. Maximum numbers of patients were Marathas, the Warrior Class followed by Brahmins, Backward Caste, Others. The diabetics though had some sort of formal education but had low awareness about the disease, ignorance about their healthy diet pattern and belonged to Class II category with mixed type of work pattern of both sedentary and non-sedentary. All these might have contributed to deterioration of glucose metabolism coupled with stress, resulted in incidence of Type 2 Diabetes. Hence further studies are required to evaluate the various epidemiological and environmental factors, dietary patterns, socio-cultural and economic status, influencing incidence and distribution of diabetes in different parts of ethnic groups of India.

The microbiome as a target for endocrine disruptors: Novel chemicals may disrupt androgen and microbiome-mediated autoimmunity

In non-obese diabetic (NOD) mice, there is a sex-biased increase in female incidence of type 1 diabetes. Recently, the microbiome was found to protect male mice from type 1 diabetes. Transfer of microbiota from adult NOD male mice to pre-pubertal female mice protects against later incidence of sex-biased type 1 diabetes. This protection involves, in part, microbiome-mediated increased testosterone synthesis, which up-regulates the interleukin and interferon pathways. The microbiome-derived signals that mediate this response are unknown, although due to the diversity of chemicals synthesized in the microbiome some are likely to have structures unlike androgens. This suggests that novel synthetic and/or plant-derived chemicals may affect sex-biased autoimmune diseases through disruption of protective signaling networks between the microbiome and its host.

Incidence of type 1 diabetes in Norway among children aged 0–14 years between 1989 and 2012: has the incidence stopped rising? Results from the Norwegian Childhood Diabetes Registry

Our study aimed to describe the incidence of type 1 diabetes in children below 15 years of age in Norway during the period 1989-2012 and to assess the regional variation during 2004-2012. We further set out to estimate the completeness of ascertainment in the Norwegian Childhood Diabetes Registry (NCDR). Incident cases of type 1 diabetes were registered in the NCDR and incidence rates were modelled using Poisson regression. Ascertainment for 2005-2008 was estimated using capture-recapture methodology by using data from the Norwegian Prescription Database (NorPD), a nationwide register established in 2004, which included insulin prescribed and dispensed at pharmacies to individual patients. Population data were obtained from Statistics Norway. Observed incidence rates for 1989-2012 suggested three distinct time segments: in 1989-1996, the average incidence rate was 22.6 per 100,000 person-years (95% CI 21.4, 23.7); in 1996-2004, the average incidence rate was 28.4 per 100,000 person-years (95% CI 27.3, 29.6); and from 2004 to 2012, the average incidence rate per 100,000 person-years was 32.7 (95% CI 31.5, 34.0). After adjustment for age and sex, the estimated change per year was 1.8% for 1989-1996 (95% CI -0.07, 3.6; p = 0.059), 3.4% for 1996-2004 (95% CI 2.2, 4.7; p < 0.0001) and 0.3% for 2004-2012 (95% CI -0.9, 1.6; p = 0.64). The highest incidence was in the age group 10-14 years for both sexes. A significant regional variation in incidence was observed (p < 0.001). Completeness of ascertainment in the NCDR was estimated to be 91%. The previously observed increase in incidence of type 1 diabetes has levelled off and remained essentially constant at 32.7 per 100,000 person-years during 2004-2012. There is a significant variation in type 1 diabetes incidence within Norway.

University screening test at State University of Jakarta

Background Insulin resistance is the greatest risk factor for the development of type 2 diabetes and is perhaps the greatest current health threat to our children. The prevalence of childhood obesity has more than double in the past 15 years in many regions of the world. The marked increase in pediatric obesity in the past decade has resulted in unprecedented increases in incidence of type 2 diabetes mellitus among children and adolescent.

Effects of Thiazide Diuretics on Glucose Metabolism

Previous studies have shown a small but significant increase in incidence of type 2 diabetes in patients with hypertension treated with thiazide

Descriptive epidemiology of type 1 diabetes—is it still in?

This edition of 'Then and now' discusses the valuable contribution made by Onkamo and colleagues to the field of type 1 diabetes epidemiology in their widely cited paper 'Worldwide increase in incidence of type I diabetes-the analysis of the data on published incidence trends', which was published 13 years ago (Diabetologia 1999;42:1395-1403). At the time, this represented the most extensive analysis of global trends in the epidemiology of type 1 diabetes, and covered/included a considerably larger geographical area than previous studies. The data confirmed that there was a worldwide increase in the incidence of childhood diabetes during the second half of the 20th century. Predictions made by the group for the incidence rates in 2010 pointed to large increases, but in retrospect these turned out to be too conservative, particularly among younger children. Whether the increase in incidence among children aged <15 years has started to level off is unknown. Looking to the future, more data on the epidemiology of type 1 diabetes over the whole lifespan are definitely needed. In addition, descriptive epidemiology needs to be complemented with 'aetiological' epidemiology generating information on the causes of the incidence and prevalence trends.

Diabetes Mellitus Increased Mortality Rates More in Gender-Specific than in Nongender-Specific Cancer Patients: A Retrospective Study of 149,491 Patients

Aims. Hyperinsulinemia in overweight status, obesity, and type 2 diabetes mellitus (DM) is often accompanied by cancer. Gender is important in cancer epidemiology, clinical presentation, and response to therapy in different histological types of malignancy. Insufficient information is available concerning gender differences in DM with organ-specific and nonorgan-specific cancers. This study aimed to analyze gender differences in hospitalized cancer patients with or without type 2 DM. Methods. We retrospectively reviewed ten years of patients hospitalized in one institution, enrolling 36,457 female and 50,004 male cancer patients of which 5,992 females and 8,345 males were diagnosed as type 2 DM. Results. Statistically significant increases in incidence of type 2 DM were found in patients of both genders with pancreatic, liver, and urinary tract cancer. Increased incidence of type 2 DM was found in lung and hematologic malignancies in females and prostate cancer in males. Increases in mortality rates of females with type 2 DM (2.98%) were higher than those in males. DM increased mortality rates in gender-specific cancers from 1.91% (uterus, HR: 1.33) to 5.04% (ovary, HR: 1.49). Conclusion. Type 2 DM increased mortality of cancer patients of both genders, with higher increases in gender-specific than in nongender-specific cancers.

Perinatal risk factors for early childhood onset type 1 diabetes in Austria – a population-based study (1989–2005)

To investigate the rapid increase in incidence of type 1 diabetes mellitus (T1DM) in children <5 yr in Austria. Data of children born between 1989 and 2005 (n = 444) from the T1DM children incidence registry were linked with birth certificates (n = 1 407 829). Age of mother, level of education, birth weight, birth length, body mass index, and APGAR score at 10 min were not significant. Boys have about 25% higher risk than girls [hazard ratio = 0.75, 95% confidence interval (CI): 0.62-0.91]. The risk of developing diabetes increases over time significantly (1989-1991 vs. 2001-2005, hazard ratio = 2.86, 95% CI: 2.07-3.94). The linear effect of parity is borderline significant (p = 0.045), with lower risks for second and later born siblings. Marital status is significant [hazard ratio = 0.73, 95% CI: 0.57-0.90)]. Native-born children exhibit twice as high risk as non-native children (hazard ratio = 0.51, 95% CI: 0.37-0.71). Birth weight shows a positive but not significant effect on risk of T1DM. In this very young and rapidly increasing cohort of diabetic children <5 yr of age, no association with birth weight but with year of birth, gestational age, nationality and parity could be observed.

Increasing Ten-Year Burden of Pediatric Type 1 Diabetes Mellitus in Southeastern Wisconsin: Relationship with Body Weight at Diagnosis

Purpose Several studies in Europe have documented the increase in incidence of Type 1 Diabetes Mellitus (T1DM) and the apparent relationship with increase weight at diagnosis. Such data suggests that maintaining a healthy weight throughout childhood may delay the onset of T1DM into adolescents. This is the first study conducted in the Midwest examining this issue. Our objective was to determine if there is an increasing burden of T1DM in specific age cohorts and if increasing body weight is an apparent risk factor for this increase. Methods Retrospective chart review of all 1618 newly diagnosed children and adolescents ( Results An overall, estimated annual incidence, which increased from 18.8 to 40.3/100,000 (p=0.006) over 10 years was observed, with an average yearly cumulative incidence of 2.39%. The increase in incidence was largest in the younger age groups with children ages 0–4, 5–9, and 10–14 having an average yearly increase of 2.4, 2.3, and 3.0% respectively; corresponding to a relative 10-year increase of 25.2, 32.6, and 37.9%, respectively. Age at diagnosis was inversely correlated with weight z-score (p Conclusion The incidence of T1DM increased 2-fold in Southeastern Wisconsin over 10 years. The majority of the increase was in the youngest age groups, which were comparatively the heaviest. Our observations suggest excess weight gain during childhood may be a risk factor for early manifestation of T1DM.

Major increase in Type 1 diabetes—no support for the Accelerator Hypothesis

The Accelerator Hypothesis postulates that the apparent increase in incidence of Type 1 diabetes mellitus (T1DM) is related to an acceleration of disease onset by weight-related insulin resistance. Our diabetes clinic has experienced a major recent increase in newly diagnosed diabetes. The Accelerator Hypothesis predicts that this increase should be associated with younger age and increased body mass at diagnosis, with youngest children having the highest body mass index (BMI). To test the Accelerator Hypothesis in the context of the major increase in T1DM at our centre. Data from all young people diagnosed with T1DM between 1992 and 2003 were reviewed. Height and weight measurements from initial outpatient review were used to calculate BMI. The mean increase in BMI standard deviation score (SDS) is 0.03 per year (P = 0.01). Age at diagnosis has also increased by a mean of 0.11 years annually (P = 0.003). There was no association between BMI SDS and age at diagnosis (P = 0.7). A significant difference in BMI SDS between age-banded subgroups was evident (P = 0.04); however, youngest children had the lowest SDS. Our results do not support increased body mass as an accelerator of diabetes presentation.