Thyroid function, morphology and autoimmunity in children and adolescents with type 1 diabetes mellitus

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The course of diabetes in children, adolescents and young adults: does the autoimmunity status matter?

Initial classification of diabetes of young may require revision to improve diagnostic accuracy of different forms of diabetes. The aim of our study was to examine markers of beta-cell autoimmunity in a cohort of young (0-25 years) patients with type 1 diabetes and compare the presentation and course of the disease according to the presence of pancreatic antibodies

Breast-Feeding and Childhood-Onset Type 1 Diabetes:A pooled analysis of individual participant data from 43 observational studies

OBJECTIVE To investigate if there is a reduced risk of type 1 diabetes in children breastfed or exclusively breastfed by performing a pooled analysis with adjustment for recognized confounders. RESEARCH DESIGN AND METHODS Relevant studies were identified from literature searches using MEDLINE, Web of Science, and EMBASE. Authors of relevant studies were asked to provide individual participant data or conduct prespecified analyses. Meta-analysis techniques were used to combine odds ratios (ORs) and investigate heterogeneity between studies. RESULTS Data were available from 43 studies including 9,874 patients with type 1 diabetes. Overall, there was a reduction in the risk of diabetes after exclusive breast-feeding for >2 weeks (20 studies; OR = 0.75, 95% CI 0.64-0.88), the association after exclusive breast-feeding for >3 months was weaker (30 studies; OR = 0.87, 95% CI 0.75-1.00), and no association was observed after (nonexclusive) breast-feeding for >2 weeks (28 studies; OR = 0.93, 95% CI 0.81-1.07) or >3 months (29 studies; OR = 0.88, 95% CI 0.78-1.00). These associations were all subject to marked heterogeneity (I(2) = 58, 76, 54, and 68%, respectively). In studies with lower risk of bias, the reduced risk after exclusive breast-feeding for >2 weeks remained (12 studies; OR = 0.86, 95% CI 0.75-0.99), and heterogeneity was reduced (I(2) = 0%). Adjustments for potential confounders altered these estimates very little. CONCLUSION The pooled analysis suggests weak protective associations between exclusive breast-feeding and type 1 diabetes risk. However, these findings are difficult to interpret because of the marked variation in effect and possible biases (particularly recall bias) inherent in the included studies

Maternal age at birth and childhood type 1 diabetes: a pooled analysis of 30 observational studies

WSTĘP. Celem badania było sprawdzenie, czy u dzieci urodzonych przez starsze matki występuje większe ryzyko zachorowania na cukrzycę typu 1, poprzez łączną analizę wcześniejszych badań z użyciem indywidualnych danych pacjentów dla skorygowania względem znanych czynników błędu. MATERIAŁ I METODY. Odpowiednie badania, opublikowane przed czerwcem 2009 roku, zostały zidentyfikowane w bazach MEDLINE, Web of Science i EMBASE. Skontaktowano się z autorami analiz i poproszono o dostarczenie indywidualnych danych pacjentów lub przeprowadzenie wcześniej określonych analiz. Dla każdej z analiz oszacowano ryzyko wystąpienia cukrzycy typu 1 względem wieku matki zarówno przed, jak i po uwzględnieniu potencjalnych czynników błędu. W celu uzyskania złożonych ilorazów szans i zbadania różnic między badaniami zastosowano metody oparte na metaanalizie. WYNIKI. Dostępne dane pochodziły z 5 badań kohortowych i 25 badań porównawczych, obejmujących 14 724 przypadki cukrzycy typu 1. Ogółem, prawdopodobieństwo wystąpienia cukrzycy typu 1 w dzieciństwie wzrosło średnio o 5% (95% CI 2–9) na każde 5 lat wieku matki (p = 0,006), ale wyniki badań nie były jednorodne (niejednorodność I2 = 70%). W badaniach z małym ryzykiem błędu wyraźnie było widać wzrost szans na wystąpienie cukrzycy — 10% na każde 5 lat wieku matki. Uwzględnienie potencjalnych czynników błędu tylko nieznacznie wpłynęło na te szacunki. WNIOSKI. Wykazano niewielki, ale istotny, liniowy wzrost ryzyka występowania dziecięcej cukrzycy typu 1 wraz z wiekiem matki, ale siła tego skojarzenia różniła się między badaniami. Niewielki odsetek przypadków wzrostu występowania dziecięcej cukrzycy typu 1 w ostatnich latach można by wytłumaczyć rosnącym wiekiem matek. (Diabet. Prakt. 2010; 11, 5: 181–193)OBJECTIVE. The aim if the study was to investigate whether children born to older mothers have an increased risk of type 1 diabetes by performing a pooled analysis of previous studies using individual patient data to adjust for recognized confounders. MATERIAL AND METHODS. Relevant studies published before June 2009 were identified from MEDLINE, Web of Science, and EMBASE. Authors of studies were contacted and asked to provide individual patient data or conduct prespecified analyses. Risk estimates of type 1 diabetes by maternal age were calculated for each study, before and after adjustment for potential confounders. Meta-analysis techniques were used to derive combined odds ratios and to investigate heterogeneity among studies. RESULTS. Data were available for 5 cohort and 25 casecontrol studies, including 14,724 cases of type 1 diabetes. Overall, there was, on average, a 5% (95% CI 2–9) increase in childhood type 1 diabetes odds per 5-year increase in maternal age (P = 0.006), but there was heterogeneity among studies (heterogeneity I2 = 70%). In studies with a low risk of bias, there was a more marked increase in diabetes odds of 10% per 5-year increase in maternal age. Adjustments for potential confounders little altered these estimates. CONCLUSIONS. There was evidence of a weak but significant linear increase in the risk of childhood type 1 diabetes across the range of maternal ages, but the magnitude of association varied between studies. A very small percentage of the increase in the incidence of childhood type 1 diabetes in recent years could be explained by increases in maternal age. (Diabet. Prakt. 2010; 11, 5: 181–193

The course of diabetes in children, adolescents and young adults: does the autoimmunity status matter?

Initial classification of diabetes of young may require revision to improve diagnostic accuracy of different forms of diabetes. The aim of our study was to examine markers of beta-cell autoimmunity in a cohort of young (0-25 years) patients with type 1 diabetes and compare the presentation and course of the disease according to the presence of pancreatic antibodies