Increasing body mass index at diagnosis of diabetes in young adult people during 1983-1999 in the Diabetes Incidence Study in Sweden (DISS).

Objective. To study trends in body mass index (BMI) at diagnosis of diabetes in all young Swedish adults in the age range of 15-34 years registered in a nation-based registry. Design. The BMI was assessed at diagnosis in diabetic patients 15-34 years of age at diagnosis, for a period of 17 years (1983-1999). Islet cell antibodies (ICA) were measured during three periods (1987-1988, 1992-1993 and 1998-1999). Setting. A nationwide study (Diabetes Incidence Study in Sweden). Subjects. A total of 4727 type 1 and 1083 type 2 diabetic patients. Main outcome measures. Incidence-year specific BMI adjusted for age, gender and time of diagnosis (month). Results. Body mass index at diagnosis increased significantly both in type 1 (21.4 ± 3.6 to 22.5 ± 4.0; P < 0.0001) and in type 2 (27.4 ± 6.8 to 32.0 ± 6.0; P < 0.0001) diabetic patients, also when adjusted for age, gender and month of diagnosis. A similar significant increase in BMI was found in type 1 diabetic patients and in type 2 diabetic patients in the periods 1987-1988, 1992-1993 and 1998-1999; years when ICA were assessed and considered in the classification of diabetes. Despite this increase in BMI, there was no increase in the incidence of diabetes in young-adult people in Sweden. Conclusion. Body mass index at diagnosis of diabetes in subjects 15-34 years of age has substantially increased during 1983-1999 in Sweden when adjusted for age, gender and month of diagnosis

The Diabetes Incidence Study in Sweden (DISS): Ascertainment, risk factors, and problems with classification

The Diabetes Incidence Study in Sweden (DISS) registers diabetes in young adults aged 15-34 years in Sweden. This thesis aims to validate the ascertainment, methods in the classification of diabetes, and putative etiological factors such as family background, psychological stress, and BMI, that may affect the incidence of diabetes in young adults, in the DISS registry. The capture-recapture method was used in the evaluation of ascertainment, whereas C-peptide and islet antibodies (islet cell antibodies ?ICA? and glutamic acid decarboxylase antibodies ?GADA?) were used in the classification of diabetes. In a case-control study 1992-1993, autoimmune Type 1 diabetic patients were compared with controls. Body mass index (BMI) was calculated from weight and height in the registration forms 1983-1999. Level of ascertainment in the DISS registry was 0.86 for Type 1 diabetes. Clinical characteristics at diagnosis or C-peptide values 2.5-3 years after diagnosis did not clarify whether the type of diabetes was of autoimmune (Type 1 diabetes) origin or not. Six years after diagnosis of diabetes in the 1987-1988 cohort, 72% of patients at diagnosis considered to have Type 2 or unclassifiable diabetes, were insulin-treated and ICA or GADA at diagnosis were present in 74% of this group of patients compared with only 12% in those still non-insulin treated. The positive predictive values for later insulin treatment were for ICA and GADA 100%, for ICA alone 98%, and for GADA alone 95%. In the case-control study, heredity for diabetes (OR 2.6) and a positive association of being born of Swedish mothers were associated with a development of diabetes. Major stress factors, however, were not associated with the development of diabetes. In addition, BMI at diagnosis but not the incidence of diabetes increased during the years 1983-1999. In conclusion, islet antibodies improved the classification of diabetes. Autoimmune Type 1 diabetic patients were more exposed to heredity for diabetes but no major prediabetic stress factors or environmental factors were detected. BMI at diagnosis but not the incidence of diabetes had increased during 1983-1999. Ascertainment of Type 1 diabetic patients was adequate in DISS

Studiolösningar för digitala möten och hybridmöten

Webbinarier och andra former av digitala arrangemang har sedan pandemin blivit vanliga lösningar för kommunikation och samverkan. Bra bild- och ljudkvalitet är viktigt tillsammans med att skapa energi i sändningarna. Därför investerar många organisationer nu i såväl teknisk utrustning som praktiska studiolösningar.  I den här skriften ger vi några förslag på hur man på ett enkelt och kost-nadseffektivt sätt kan skapa en studio för bl a webbsändningar, webbi-narier eller digitala konferenser. Vi presenterar olika tekniska lösningar och ger förslag på hur man rent praktiskt kan utforma själva studion och hur man där löser ljussättning, ljudupptagning, ljudmiljö, kamera och bildmixning.   Rapporten är framtagen av REMM-gruppen, Trafikverket i samarbete med DIGG.</p

Studiolösningar för digitala möten och hybridmöten

Webbinarier och andra former av digitala arrangemang har sedan pandemin blivit vanliga lösningar för kommunikation och samverkan. Bra bild- och ljudkvalitet är viktigt tillsammans med att skapa energi i sändningarna. Därför investerar många organisationer nu i såväl teknisk utrustning som praktiska studiolösningar.  I den här skriften ger vi några förslag på hur man på ett enkelt och kost-nadseffektivt sätt kan skapa en studio för bl a webbsändningar, webbi-narier eller digitala konferenser. Vi presenterar olika tekniska lösningar och ger förslag på hur man rent praktiskt kan utforma själva studion och hur man där löser ljussättning, ljudupptagning, ljudmiljö, kamera och bildmixning.   Rapporten är framtagen av REMM-gruppen, Trafikverket i samarbete med DIGG.</p

Esophageal Dysmotility is More Common Than Gastroparesis in Diabetes Mellitus and is Associated With Retinopathy.

Gastroparesis is a well-known complication of diabetes mellitus, both in symptomatic and asymptomatic patients. Esophageal dysmotility has also been described, but is not as well-characterized. The etiology and effect of these complications need to be clarified. The aim of the present study was to evaluate esophageal and gastric motility, complications, gastrointestinal symptoms, and plasma biomarkers in a cross-sectional study comprising patients with diabetes mellitus

Appearance of islet cell autoantibodies after clinical diagnosis of diabetes mellitus

Islet cell antibodies (ICA) and glutamic acid decarboxylase antibodies (GAD65Ab) are often present at diagnosis of insulin dependent diabetes mellitus (type I diabetes) and are supposed to decline in level and frequency during the first years of disease. We have analysed ICA and GAD65Ab at onset and after one gear in 395 population based randomly selected 15-34 year old patients newly diagnosed with diabetes mellitus, to study how these autoantibodies persist, disappear and appear and their relation to C-peptide levels. Of the 395 samples 212 (54%) were positive for ICA, 250 (63%) were positive for GAD65Ab and 170 (43%) were positive for both. At follow up after one year, 27/183 (15%) of the ICA negative patients and 25/145 (17%) of the GAD65Ab negative patients had converted to positivity. Among the 103 patients negative for both ICA and GAD65Ab, 16 turned positive for one or both antibodies after one year. Patients converting to positivity for one or the other antibody after one year, had lower C-peptide levels after one year than patients who initially were and remained negative, supporting the hypothesis that these patients have a genuine type I diabetes. In conclusion, newly diagnosed patients may be negative for autoantibodies at diagnosis but develop these antibodies later on during the disease

Glutamic acid decarboxylase antibodies (GADA) is the most important factor for prediction of insulin therapy within 3 years in young adult diabetic patients not classified as Type 1 diabetes on clinical grounds

Background Differentiation between Type 1 and Type 2 diabetes in adults is difficult at diagnosis. In this study we tested the hypothesis that autoantibodies at diagnosis are predictive for insulin treatment within 3 years in patients initially not classified as Type 1 diabetes. Methods In a nationwide population-based study, blood samples were obtained from 764 patients, all diagnosed with diabetes during a 2-year period. At diagnosis, 583 (76%) were classified as Type 1, 110 (14%) as Type 2 and 71 (9.3%) could not be classified. Results Among patients not classified as Type 1 diabetes, 52 (47%) of Type 2 and 42 (59%) of unclassified patients were positive for islet cell antibodies CICA), glutamic acid decarboxylase antibodies (GADA) or tyrosine phosphatase antibodies (IA-2A). These patients (n=94) had lower body mass index (BMI) (p<0.001) and lower C-peptide (p<0.001) compared to the autoantibody negative patients (n=87). Compared to clinically classified Type 1 diabetes patients positive for autoantibodies (n=477), they have higher BMI (p<0.001), higher C-peptide (p<0.001) and the same levels of ICA, GADA and IA-2A. After 3 years, 93% of autoantibody positive patients initially not classified as Type 1 were on insulin. When ICA, GADA, IA-2A, BMI and C-peptide were tested in a multiple logistic regression, only GADA was signiificant for insulin treatment within 3 years (OR = 18.8; 95% CI 1.8-191) in patients treated with diet or oral drugs at diagnosis. Conclusions A correct classification is difficult in adult diabetic patients. The presence of pancreatic autoantibodies, especially GADA, at diagnosis of diabetes are highly predictive for insulin therapy within 3 years from diagnosis

Combinations of beta cell specific autoantibodies at diagnosis of diabetes in young adults reflects different courses of beta cell damage

To explore the natural course of beta cell function in recent onset diabetes, a subgroup (n = 157) of all incident cases (n = 879) 15-34 years old. 1992-1993 in Sweden. and with positivity for at least one autoantibody of islet cell antibodies (ICA), glutamic acid decarboxylase antibodies (GADA) or tyrosine phosphatase antibodies (1A-2A) were followed prospectively thr the first four years with annual analysis of C-peptide. The aim was to relate the course of beta cell function, measured as C-peptide, in early diabetes with the presence of different islet autoantibodies at diagnosis. We found that patients positive for ICA alone (n = 11 ) had significantly higher C-peptide levels both at diagnosis and during the first three years compared with the other patients (n = 146; p = 0.022, p < 0.001, p = 0.004 and p = 0.0022). Patients positive for GADA alone or in combination with other antibodies (n = 125) had significantly lower C-peptide during the first three years after diagnosis compared with the other patients (n = 32. p < 0.001, p = 0.0011 and p = 0.0136). Patients with two or three autoantibodies had C-peptide levels similar to levels found in patients positive only for GADA. However. after four years, there were no significant differences between any of the groups of different autoantibody combinations. At diagnosis. 55% (86/157) of the patients had C-peptide: levels above the lower normal range of 0.25 nmol/l, but the frequency of patients with beta cell Function above this level decreased after two years to 41% (65/157; p = 0.035) and after four years to 22% (35/157; p = 0.0041)

Family characteristics and life events before the onset of autoimmune type 1 diabetes in young adults - A nationwide study

OBJECTIVE - To elucidate whether family characteristics and stressful life events were associated with onset of autoimmune type 1 diabetes in young adults. RESEARCH DESIGN AND METHODS - This investigation was based on a nation-wide study (Diabetes Incidence Study in Sweden) of newly diagnosed patients aged 15-34 years. Patients clinically classified as type 1 diabetic with antibodies to islet cells and/or to GAD65 were compared with age- and sex-matched control subjects via questionnaire. The questionnaire covered diabetes heredity, social environment, educational level, and life events experienced during the 12 months before diagnosis. RESULTS - The rate of response was 82% for the diabetic patients and 65% for the control subjects. Questionnaires from 349 diabetic patients and 979 control subjects were considered. Diabetes in relatives was more frequent in the patients (odds ratio [OR]2.6) who were born in Sweden and whose mothers were of Swedish origin. No major stress factors were detected in the diabetic patients; however, in comparison with the control subjects, the diabetic patients had experienced fewer conflicts with their parents and had less often broken contacts with friends. CONCLUSIONS - Young adults with recent-onset type 1 diabetes were more exposed to heredity for diabetes, but no major prediabetic stress factors were detected. Our study does not directly support the concept that psychosocial stressful life events are involved in the development of autoimmune type 1 diabetes in young adults

Islet cell and glutamic acid decarboxylase antibodies present at diagnosis of diabetes predict the need for insulin treatment : A cohort study in young adults whose disease was initially labeled as type 2 or unclassifiable diabetes

OBJECTIVE - To clarify the predictive value of islet cell antibody (ICA) and GAD65 antibody (GADA) present at diagnosis with respect to the need for insulin treatment 6 years after diagnosis in young adults initially considered to have type 2 or unclassifiable diabetes. RESEARCH DESIGN AND METHODS - The patient material was representative of the entire Swedish population, consisting of patients who were 15-34 years old at diagnosis of diabetes in 1987-1988 but were not considered to have type 1 diabetes at onset. At follow-up, 6 years after the diagnosis, it was noted whether the patient was treated with insulin. The presence of ICA was determined by an immunofluorescence assay, and GADAs were measured by a radioligand assay. RESULTS - Six years after diagnosis, 70 of 97 patients were treated with insulin, and 27 of 97 patients were treated with oral drugs or diet alone. At diagnosis, ICAs and GADAs were present in 41 (59%) of 70 patients and 41 (60%) of 68 patients, respectively, of those now treated with insulin, compared with only 1 (4%) of 26 patients and 2 (7%) of 27 patients who were still not treated with insulin. For either ICA or GADA, the corresponding frequencies were 50 (74%) of 68 for patients who were later treated with insulin and 3 (12%) of 26 for those who were still not treated with insulin, respectively The sensitivity for later insulin treatment was highest (74%) for the presence of ICA or GADA, and the specificity was highest (100%) for ICA and GADA. The positive predictive value was 100% for the combination of ICA and GADA, 98% for ICA alone, and ~95% for GADA alone. CONCLUSIONS - Determination of the presence of ICA and GADA at diagnosis of diabetes improves the classification of diabetes and predicts the future need of insulin in young adults