Lower Incidence Of Type Research Articles

Rising Rates of All Types of Diabetes in South Asian and Non-South Asian Children and Young People Aged 0–29 Years in West Yorkshire, U.K., 1991–2006

OBJECTIVETo investigate incidence trends of all diabetes types in all children and young people and in the south Asian subpopulation.RESEARCH DESIGN AND METHODSAnnual incidence per 100,000 and time trends (1991–2006) were analyzed for 2,889 individuals aged 0–29 years diagnosed with diabetes while resident in West Yorkshire, U.K.RESULTSDiagnoses comprised type 1 (83%), type 2 (12%), maturity-onset diabetes of the young (0.7%), “J”-type/other (0.1%), and uncertain/unclassified (4%). There was a lower incidence of type 1 and a threefold excess of type 2 in south Asians compared with non-south Asians. Type 1 incidence leveled out and type 2 increased after the first south Asian case of type 2 was diagnosed in 1999. Type 2 and unclassified diabetes incidence rose in all population subgroups.CONCLUSIONSThe burden of diabetes increased over time for both ethnic groups, with a significant excess of type 2 diabetes in south Asians. The rising incidence of type 1 diabetes in south Asians attenuated as type 2 diabetes increased after 1999.

Dietary patterns are associated with lower incidence of type 2 diabetes in middle-aged women: the Shanghai Women's Health Study

Data linking risk of type 2 diabetes (T2D) and dietary patterns in Chinese populations are scarce. A population-based prospective study of 64,191 middle-aged women in urban Shanghai, China, who were free of T2D and other chronic diseases at study recruitment, was conducted. Dietary intake, physical activity and anthropometric measurements were assessed through in-person interviews. Dietary patterns were assessed by using K-means cluster analysis. Cox regression model was used to evaluate the association of dietary patterns with the risk of T2D. We identified three dietary clusters in this population. Cluster 1 (56.3%; N = 36,159) had the highest intake of staples, cluster 2 (40.4%: N = 25,948) had the highest intake of dairy milk, and cluster 3 (2.9%; N = 1843) had the highest energy intake. Participants in cluster 2 had lower prevalence of obesity, central obesity and hypertension at baseline. Using cluster 1 as the reference, participants in cluster 2 had a lower incidence of T2D after 6.9 years of follow-up [relative risk (RR) 0.78; 95% confidence interval (CI) 0.71-0.86]. The RR for the incidence of T2D for cluster 3 compared with cluster 1 was 1.05 (95% CI 0.81-1.35). The association was not modified by age category, body mass index category, waist-to-hip ratio category or exercise participation. We identified and characterized dietary patterns in middle-aged Chinese women by using cluster analysis. We identified a dietary pattern low in staple foods and high in dairy milk, which was associated with lower risk of T2D. Study of dietary patterns will help elucidate links between diet and disease, and contribute to the development of healthy eating guidelines for health promotion.

Neighborhood Resources for Physical Activity and Healthy Foods and Incidence of Type 2 Diabetes Mellitus

Despite increasing interest in the extent to which features of residential environments contribute to incidence of type 2 diabetes mellitus, no multisite prospective studies have investigated this question. We hypothesized that neighborhood resources supporting physical activity and healthy diets are associated with a lower incidence of type 2 diabetes. Person-level data came from 3 sites of the Multi-Ethnic Study of Atherosclerosis, a population-based, prospective study of adults aged 45 to 84 years at baseline. Neighborhood data were derived from a population-based residential survey. Type 2 diabetes was defined as a fasting glucose level of 126 mg/dL or higher (> or =7 mmol/L) or taking insulin or oral hypoglycemic agents. We estimated the hazard ratio of type 2 diabetes incidence associated with neighborhood (US Census tract) resources. Among 2285 participants, 233 new type 2 diabetes cases occurred during a median of 5 follow-up years. Better neighborhood resources, determined by a combined score for physical activity and healthy foods, were associated with a 38% lower incidence of type 2 diabetes (hazard ratio corresponding to a difference between the 90th and 10th percentiles for resource distribution, 0.62; 95% confidence interval, 0.43-0.88 adjusted for age, sex, family history of diabetes, race/ethnicity, income, assets, educational level, alcohol use, and smoking status). The association remained statistically significant after further adjustment for individual dietary factors, physical activity level, and body mass index. Better neighborhood resources were associated with lower incidence of type 2 diabetes, which suggests that improving environmental features may be a viable population-level strategy for addressing this disease.

Diabetic Ketoacidosis in Peruvian Patients with Type 2 Diabetes Mellitus

ObjectiveTo describe the clinical and laboratory characteristics of diabetic ketoacidosis (DKA) in adult Peruvian patients with type 2 diabetes mellitus. MethodsIn this cross-sectional analysis, we reviewed clinical charts of type 2 diabetic patients with DKA admitted to Cayetano Heredia Hospital between 2001 and 2005 for data on demographics, previous treatment, previous hospital admissions for DKA, family history of diabetes, precipitating factors, hospital course, mortality, and insulin use 3 and 6 months after the index DKA episode. Patients older than 18 years who had confirmed DKA were included. Patients with type 1 diabetes mellitus were excluded. ResultsWe report on 53 patients with DKA for whom complete clinical and laboratory data were available. Of the 53 patients, 39 (74%) were men; mean age (± SD) was 45 ± 12 years; and 22 (42%) had no previous diagnosis of type 2 diabetes. The following mean (± SD) laboratory values were obtained at DKA diagnosis: glucose, 457 ± 170 mg/dL; pH, 7.15 ± 0.14; bicarbonate, 7.73 ± 6 mEq/L; and anion gap, 24.45 ± 7.44 mEq/L. Of the 53 DKA episodes, 35 (66%) were severe (arterial pH <7.0 and/or serum bicarbonate <10 mEq/L). The following precipitating factors were discerned: discontinuation of treatment in 21 (40%), infections in 16 (30%), intercurrent illness in 3 (6%), and no identifiable cause in 13 (25%). Mortality rate was 0%. Three and 6 months after the index DKA episode, insulin was used by 65% and 56% of patients, respectively. ConclusionIn countries with a low incidence of type 1 diabetes, DKA is frequently reported in patients with type 2 diabetes. In this study, 42% of patients had new-onset disease. Most DKA episodes were severe and were related to infection or noncompliance with treatment. (Endocr Pract. 2008;14:442-446)

A low incidence of Type 1 diabetes between 1977 and 2001 in south‐eastern Sweden in areas with high population density and which are more deprived

To explore how socioeconomic factors and population density may contribute to the geographical variation of incidence of Type 1 diabetes in children in south-eastern Sweden. All children diagnosed with Type 1 diabetes in south-eastern Sweden during 1977-2001 were defined geographically to their place of residence and were allocated x and y coordinates in the national grid. The population at risk and socioeconomic data were aggregated in 82,000 200-m squares and geocoded likewise. A socioeconomic index was calculated using a signed chi(2) method. Rural-urban gradients were defined by overlay analysis in a geographic information system. The incidence during the past 25 years has been rising steadily, particularly in the last 6 years. The incidence was highest in areas with a high proportion of small families, of families with a high family income and better education, and this was found both at the time of diagnosis and at the time of birth. In the rural-urban analysis, the lowest incidence was found in the urban area with > 20,000 inhabitants, where there was also a higher frequency of deprivation. Our findings indicate that geographical variations in incidence rates of Type 1 diabetes in children are associated with socioeconomic factors and population density, although other contributing factors remain to be explained.

Moderate Drinking Might Improve Fasting Glucose in People with Diabetes

Moderate drinking is associated with a lower incidence of type 2 diabetes, but whether moderate drinking affects glycemic control has not been

Occurrence of enterovirus RNA in serum of children with newly diagnosed type 1 diabetes and islet cell autoantibody-positive subjects in a population with a low incidence of type 1 diabetes

Background: The penetrance of type 1 diabetes mellitus (T1DM) in a genetically susceptible population is largely determined by environmental influences amongst which the human enteroviruses are prominent putative factors.Aim/hypothesis: The aim of this study was to determine the occurrence of enterovirus RNA in serum of children with type 1 diabetes at onset and ICA-positive subjects in a population with low incidence of type 1 diabetes and high circulation of enteroviruses.Subjects and methods: Serum samples were collected from children with newly diagnosed type 1 diabetes (n = 34); islet autoantibody-positive (n = 32) and -negative (n = 31) first-degree relatives of type 1 diabetic patients; and control subjects (n = 194). Enteroviral RNA was assessed using a highly sensitive reverse transcriptase-polymerase chain reaction method.Results: The frequency of positive signals corresponding to enteroviral sequence amplifications were higher in newly diagnosed T1DM children (9/34, 26.5%) and islet autoantibody-positive first-degree relatives (5/32, 15.6%) than in their corresponding matched controls (2/68, 2.9%, p = 0.0007 and 0/64, 0.0%, p = 0.0033, respectively). The presence of enteroviral RNA appeared to be associated with severe diabetic ketoacidosis at onset (pH < 7.1, p = 0.0328) and high ICA titres ( ≥ 20 JDF units, p < 0.05).Conclusions: Despite there is a high circulation of enteroviruses and a low type 1 diabetes incidence in the Cuban population, the presence of enteroviral RNA is associated with type 1 diabetes and β-cell autoimmunity and is similar to European countries in which this scenario is reversed.

Soluble thrombomodulin as a predictor of type 2 diabetes: results from the MONICA/KORA Augsburg case–cohort study, 1984–1998

Previous studies have shown an inverse association between soluble thrombomodulin (sTM) and incident CHD, but there is a lack of data on the association between sTM and type 2 diabetes. Since CHD and type 2 diabetes share many risk factors, the aim of this study was to assess whether elevated sTM levels are associated with a lower incidence of type 2 diabetes. A case-cohort study was performed in initially healthy middle-aged men and women based on data from the Monitoring of Trends and Determinants in Cardiovascular Disease/Cooperative Health Research in the Region of Augsburg (MONICA/KORA) studies conducted between 1984 and 1998. Levels of sTM were measured with an ELISA in serum samples from 138 men and 86 women who developed type 2 diabetes during follow-up (cases) and 534 men and 446 women who did not develop type 2 diabetes (non-cases). An inverse association was found between sTM and type 2 diabetes risk after multivariable adjustment for diabetes risk factors, including several other markers of inflammation and endothelial dysfunction. Markers of inflammation and endothelial dysfunction were particularly strong confounders of the observed association. In the fully adjusted model, a 1 SD increase in sTM was associated with a 27% decrease in the risk of type 2 diabetes (hazard ratio=0.73, 95% CI 0.58-0.91) in the total study population. We did not observe significant risk differences between men and women. These data suggest that, in initially healthy middle-aged men and women, levels of sTM are inversely associated with the risk of type 2 diabetes.

Type 2 Endoleaks after Abdominal Aortic Aneurysm Stent Grafting with Systematic Mesenteric and Lumbar Coil Embolization

We evaluated the results of our policy of systematic coil embolization of the inferior mesenteric artery (IMA) and/or lumbar arteries (LAs) prior to endovascular abdominal aortic aneurysm (AAA) repair (EVAR). We retrospectively reviewed all patients undergoing EVAR over a 4-year period at one hospital. Results were analyzed using uni- and multivariate analyses. Fifty-five male patients with an average age of 71 years were evaluated. Follow-up averaged 15 +/- 13 months. The IMA was either coiled or occluded in 30 cases. One or more LAs were coiled in 29 patients. An average of 1.3 LAs per patients were coiled (range 0-6). There were no immediate or late complications from coiling. At last follow-up, 14 AAAs showed no change in diameter, one increased by 2 mm, and the remainder (n = 40) decreased by 7.5 +/- 6 mm in maximal diameter. Only five (9%) type 2 endoleaks were detected during follow-up. Three were associated with AAA size increase. Four of the five were treated with additional coiling, with good results. By logistic regression, neither endoleak occurrence nor AAA shrinkage correlated with LA or IMA coiling. However, by multivariate analysis, completeness of lumbar coiling correlated negatively with aneurysm shrinkage (p = 0.04) and IMA coiling correlated positively with aneurysm shrinkage (p = 0.04). Coil embolization of the IMA and/or LAs prior to EVAR can be safely accomplished in a large number of cases and is associated with a low incidence of type 2 endoleaks. We cannot at present demonstrate a benefit to LA embolization in terms of endoleak prevention or AAA shrinkage. However, IMA embolization may be of benefit in terms of AAA shrinkage.

The Association ofCTLA4Polymorphism with Type 1 Diabetes Is Concentrated in Patients Complicated with Autoimmune Thyroid Disease: A Multicenter Collaborative Study in Japan

Transracial studies are a powerful tool for genetic association studies of multifactorial diseases, such as type 1 diabetes. The low incidence of type 1 diabetes in Asian countries, however, makes it difficult to perform large-scale studies in Asia. To overcome this, we have assembled a multicenter study group in Japan and studied the association of CTLA4 polymorphisms with type 1 diabetes relative to autoimmune thyroid disease (AITD) phenotypes. Subjects included a total of 1837 samples, including 1114 cases (769 with type 1 diabetes and 345 with AITD) and 723 control subjects. The +6230G>A and +49G>A polymorphisms of CTLA4 as well as HLA-DRB1 and -DQB1 were genotyped. The +6230G>A polymorphism was significantly associated with type 1 diabetes complicated with AITD (odds ratio, 1.54; P = 0.027) and with AITD alone (odds ratio, 1.31; P = 0.045) but not with type 1 diabetes without AITD. The association with type 1 diabetes positive for autoantibodies to both pancreatic islets and thyroid was particularly strong (odds ratio, 1.87; P = 0.001). Type 1 diabetic patients with the disease-associated GG genotype were characterized by a significantly higher frequency of AITD (P = 0.013), of positivity for both AITD and antiislet autoantibody (P = 0.00086), and of high-risk HLA genotypes (P = 0.034). Given the high frequency of AITD in patients with type 1 diabetes, these data suggest the possibility that the association of CTLA4 with type 1 diabetes in previous studies may have been secondary to AITD, suggesting the importance of subclassification of type 1 diabetes relative to AITD in genetic studies.

Low Incidence of Type 1 Diabetes in Iran

There is a worldwide increase in the incidence of type 1 diabetes (1–3). This increase, in conjunction with the lack of complete concordance in monozygotic twin pairs, points to the importance of environmental factors (3). Useful clues about these environmental factors may be obtained by studying geographical variation in incidence in relation to the characteristics of different countries. There is a paucity of information regarding type 1 diabetes in Iran. It was the purpose of this study to provide some baseline data regarding this disease in Iran. The surveyed area was the southern province of Fars in the 5-year time period between 21 March 1991 and 20 March 1996. The region, which had a population of 3,800,000 in 1996, covers an area of 133,000 km2 and is the largest province in southern Iran. Of the whole Iranian population, 10% live in southern Iran and 64% are residents of Fars. ### Primary ascertainment procedure In a prospective study from 21 March 1991 to 20 March 1996, all type 1 diabetic patients with age at onset of disease <30 years were selected from diabetic patients of endocrine and diabetes clinics and university hospitals of southern Iran. The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus criteria (4) were used in the assessment of the diagnosis …

Coffee consumption and incidence of impaired fasting glucose, impaired glucose tolerance, and type 2 diabetes: the Hoorn Study

Coffee contains several substances that may affect glucose metabolism. The aim of this study was to evaluate the relationship between habitual coffee consumption and the incidence of IFG, IGT and type 2 diabetes. We used cross-sectional and prospective data from the population-based Hoorn Study, which included Dutch men and women aged 50-74 years. An OGTT was performed at baseline and after a mean follow-up period of 6.4 years. Associations were adjusted for potential confounders including BMI, cigarette smoking, physical activity, alcohol consumption and dietary factors. At baseline, a 5 cup per day higher coffee consumption was significantly associated with lower fasting insulin concentrations (-5.6%, 95% CI -9.3 to -1.6%) and 2-h glucose concentrations (-8.8%, 95% CI -11.8 to -5.6%), but was not associated with lower fasting glucose concentrations (-0.8%, 95% CI -2.1 to 0.6%). In the prospective analyses, the odds ratio (OR) for IGT was 0.59 (95% CI 0.36-0.97) for 3-4 cups per day, 0.46 (95% CI 0.26-0.81) for 5-6 cups per day, and 0.37 (95% CI 0.16-0.84) for 7 or more cups per day, as compared with the corresponding values for the consumption of 2 or fewer cups of coffee per day (p=0.001 for trend). Higher coffee consumption also tended to be associated with a lower incidence of type 2 diabetes (OR 0.69, CI 0.31-1.51 for >/=7 vs </=2 cups per day, p=0.09 for trend), but was not associated with the incidence of IFG (OR 1.35, CI 0.80-2.27 for >/=7 vs </=2 cups per day, p=0.49 for trend). Our findings indicate that habitual coffee consumption can reduce the risk of IGT, and affects post-load rather than fasting glucose metabolism.

Trends in the incidence of childhood diabetes in south Asians and other children in Bradford, UK.

To investigate incidence rates and time trends, over 21 years, of Type 1 diabetes in a migrant population of south Asian children in Bradford, UK. Children (0-14 years) living in the city of Bradford and diagnosed with Type 1 diabetes were selected from a population-based region-wide register. Between 1978 and 1998, 289 new-onset cases were registered and classified as south Asian (Indian, Pakistani, Bangladeshi) or not, based on their full name using two different computer algorithms and visual inspection. Sixty-six children (22.8%) were designated as south Asian with 223 (77.2%) remaining. The overall age-sex standardized incidence for south Asian and non-south Asian children was 13.0 per 100,000 person years (95% confidence interval 9.9-16.2) and 12.9 (11.2-14.6), respectively. Rates were similar for south Asians at all ages, whereas for the mainly Caucasian children incidence differed significantly by age group (P < 0.001). An average annual increase in incidence of 4.3% (P = 0.001) was seen for all children compared with 6.5% in south Asians (P = 0.002) and 2.4% (P = 0.128) in non-south Asians. Children in south Asia have a low incidence of Type 1 diabetes but migrants to the UK have similar overall rates to the indigenous population. However, a more steeply rising incidence is seen in the south Asian population, and our data suggest that incidence in this group may eventually outstrip that of the non-south Asians. Genetic factors are unlikely to explain such a rapid change, implying an influence of environmental factors in disease aetiology. The similarity in rates by age group in the south Asian population is notable.

Sequence Analysis of Tnf as a Candidate for Idd16

Linkage analysis and congenic mapping have localized 18 loci ( Idd1-18 ) that contribute to the development of autoimmune type 1 diabetes in the nonobese diabetic (NOD) mouse. By using a congenic NOD strain which possesses recombinant MHC from a closely related CTS strain, a susceptible region ( Idd16 ) was mapped to the segment adjacent to, but distinct from class II A and E genes ( Idd1 ). The tumor necrosis factor f gene ( Tnf ), which is located within the Idd16 region, has been suspected to be a candidate gene for type 1 diabetes in the NOD mouse. Although the protein-coding region in Tnf has been sequenced in the NOD mouse and its related strains, the complete upstream region (approximately 1400 u bp, including the 5'-untranslated region) has not yet been studied. To study the possible contribution of the transcriptional regulation of Tnf to susceptibility to type 1 diabetes, we determined the complete nucleotide sequences of the NOD strain and its related strain, CTS, in comparison with the non-diabetic control strain, C57BL/6. The nucleotide sequence of the 5'-upstream region in the NOD mouse was identical to that in the C57BL/6 mouse, but different from that in the CTS mouse. In particular, a C to A substitution at position 3408 in the CTS mouse creates a new GATA family binding site, which may be responsible for the lower incidence of type 1 diabetes in the NOD. CTS-H-2 congenic strain despite the presence of the same class II MHC.

Effects of exercise on glucose homeostasis in Type 2 diabetes mellitus.

This review has evaluated the effectiveness of physical activity in the treatment and prevention of Type 2 diabetes mellitus (DM). The available literature was reviewed through a computerized search (MEDLINE, 1966--2000) to classify studies examining the influence of physical activity on the treatment and prevention of Type 2 DM. Additional studies were reviewed through ancestral searches from their bibliographies. It is not possible at the present time to discern from the available literature whether a dose-response relationship exists between exercise volume or intensity and improvements in glucose control in Type 2 DM. Large-scale, prospective studies indicate that higher levels of physical activity are clearly associated with a lower incidence of Type 2 DM. However, no randomized controlled trials have been conducted to address the dose-response effect of exercise or physical activity on diabetes treatment or prevention. It is uncertain whether there is a dose-response effect of exercise on improved glucose control in Type 2 DM. There does appear to be, however, a limited amount of evidence suggesting that increasing levels of physical activity contribute to better diabetes prevention. Clearly, additional studies are needed to determine the influence of physical activity on the treatment and prevention of Type 2 DM.

Genetic susceptibility factors of Type 1 diabetes in Asians.

Type 1 diabetes is a multifactorial disease in which the insulin producing beta-cells of the pancreas are destroyed by the immune system, a process determined by the activity of major histocompatibility complex (MHC)-restricted T lymphocytes. Progress has been made in elucidating genetic factors involved in Type 1 diabetes in Caucasians, with less data available from Asia. For Asians, the human MHC locus (HLA region), especially the class II region, is the major susceptibility interval. The role of IDDM2, the insulin locus, has been questioned in Asia. In contrast to Caucasians, Asian populations have a very low incidence of Type 1 diabetes (0.4-1.1 cases/year/100 000 individuals). This low incidence rate in the Asian population may be related to the population frequency distribution of susceptible Type 1 diabetes genes, especially of HLA. The overall risk for Type 1 diabetes from HLA DR and DQ is determined by polymorphic residues (alleles) and particular combinations of alleles (haplotypes and genotypes) in a given individual. In Asians, it is very common that a protective DR4 allele is associated with susceptible DQ alleles while neutral/protective DQ alleles are associated with the susceptible DR4 alleles. Our analyses indicate that the counterbalancing between susceptible DRB1 and protective DQB1, and vice versa, is a factor that may contribute to the low incidence of diabetes in Asians. We find that identical HLA DRB1-DQB1 haplotypes of Asians and Caucasians have similar transmission to diabetic children and similar associations with diabetes. Moreover, the association with diabetes and transmission to a diabetic offspring of DR4 haplotypes varies depending on the haplotype borne on the homologous chromosome. This might contribute not only to the synergistic effect of DR3/4, but also to the susceptibility influence of DQB1*0401 haplotypes confined to DR4/X. High-risk DR4 subtypes were predominant in DR4/X, whereas protective DR4 subtypes were observed mainly in the DR3/4 genotype. Since in Asians DQB1*0401 is in linkage disequilibrium (LD) with DRB1*0405, we find more DRB1*0405-DQB1*0401 haplotypes in patients with DR4/X than in patients with DR3/4, suggesting that the contribution of the DRB1 locus may be greater in DR4/X than in DR3/4 genotypes. Several genome scans suggested additional susceptibility intervals and provided supporting evidence for several previously reported linkages. Other studies focused on the confirmation of linkage using multipoint sib-pair analyses with densely spaced markers and multiethnic collection of families. Although significant and consistent linkage evidence was reported for the susceptibility intervals IDDM12 (on 2q33) even in Asia, evidence for most other intervals varies in different data sets. LD mapping has become an increasingly important tool for both confirmation and fine-mapping of susceptibility intervals, as well as identification of etiological mutations. The examination of large and ethnically varied data sets including those of Asia has allowed identification of haplotypes that differ only at a single codon in a single locus. As more data become available, the study of pairs of haplotypes which differ at a single polymorphic site, but have different effects on disease susceptibility, should allow more precise definition of the polymorphisms involved in the disease process.

Enterovirus antibodies in relation to islet cell antibodies in two populations with high and low incidence of type 1 diabetes.

Enterovirus antibodies in relation to islet cell antibodies in two populations with high and low incidence of type 1 diabetes.

Molecular epidemiology of adhesin and hemolysin virulence factors among uropathogenic Escherichia coli

The pap, prs, pil, and hly operons of the pyelonephritic Escherichia coli isolate J96 code for the expression of P, F, and type 1 adhesins and the production of hemolysin, respectively; the afaI operon of the pyelonephritic E. coli KS52 encodes an X adhesin. Using different segments of these operons as probes, colony hybridizations were performed on 97 E. coli urinary tract and 40 fecal clinical isolates to determine (i) the presence in the infecting bacteria of nucleotide sequences related to virulence operons, and (ii) the phenotypic properties associated with such sequences. Coexpression of P and F adhesins encoded by pap-related sequences was detected more frequently among isolates from patients with pyelonephritis (32 of 49, 65%) than among those with cystitis (11 of 48, 23%; P less than 0.0001) or from fecal specimens (6 of 40, 15%; P less than 0.0001). Therefore, the expression of both adhesins appears to be critical in the colonization of the upper urinary tract. In contrast, afaI-related sequences were detected significantly more frequently among isolates from patients with cystitis, suggesting that this class of X adhesin may have a role in lower urinary tract infections. Urinary tract isolates differed from fecal isolates by a low incidence of type 1 adhesin expression among pil probe-positive isolates. hly-related sequences were only detected in pap probe-positive isolates. The frequency of hemolysin production among pap probe-positive isolates was not associated with a particular pattern of infection. The distribution of these virulence factors was similar in the presence or absence of reflux, indicating that structural abnormalities of the urinary tract did not facilitate colonization by adhesin-negative isolates.

Low incidence of Type I diabetes in Israeli children of all ethnic groups

A retrospective study of the entire population of Israel revealed 392 newly diagnosed Type I diabetics aged 0-20 for the period 1975-1980. The mean annual age specific incidence of Type I (insulin-dependent) diabetes mellitus was 3.8 per 105 for the age group 0-14 yrs and 4.2 per 105 for the age group 0-20 yrs. The incidence among the Jews of Ashkenazi origin was 658 × 105 and that for Jews of non-Ashkenazi origin was 4.3 × 105 , whereas that for the Arabs was 1.2 × 105 . The overall incidence is lower than that reported for similar populations in most European countries, the USA, Canada and New Zealand, similar to that reported for Arabs in Kuwait and higher only than that found in Japan. The highest proportion of patients was registered between ages 10-14 yrs and the lowest at 0-4. In the young age group there was a preponderance of females differing (p=0.05) from the ratio over age 5 which was almost 1. Out of 294 patients for whom month of onset could be established, 170 had their onset from November to March and 124 from April to October. The relative importance of environmental and genetic factors in the interpopulation differences in incidence of Type I diabetes remains to be established.

Bacteriophage typing of strains of Mycobacterium tuberculosis from Nepal

One hundred strains of Mycobacterium tuberculosis isolated from cases of pulmonary tuberculosis in Nepalese villagers were typed with the World Health Organization set of bacteriophages. The number of strains in the 3 major phage types A, I, and B were 19, 53, and 28 respectively. This distribution is significantly different from those described in other geographical regions. In particular there was a relatively low incidence of type A strains and, in common with South India, there was a high proportion of type I strains. All the strains in this study were resistant to 5-Furan-2 carbonic acid hydrazine and 34 were highly resistant to isoniazid. Representative strains of the 3 phage types, including 4 isoniazid-resistant type I strains, did not differ in their virulence in the guinea pig; thus the type I strains found in Nepal may not be of the same origin as those of this phage type from India which are usually attenuated in the guinea pig. This study provides further evidence for the existence of geographical differences in the types of tubercle bacilli.