Msc in Diabetes a population approach Type 1 Diabetes

Number of cases per month of Type 1 diabetes (n=226)

Yüklə 0,95 Mb.
ölçüsü0,95 Mb.
1   2   3   4   5   6

Number of cases per month of Type 1 diabetes (n=226)

Ethnicity and genetics

Ethnicity - incidence per 100,000 in different ethnic groups

  • US Virgin Islands

    • Hispanics 7.2
    • Whites 28.9
    • Blacks 5.9
  • Hokkaido 1.7

  • Aust Euro 13.2


  • If an identical twin has Type 1 diabetes then in 50% of cases the other twin will also develop Type 1 diabetes.

  • If the twins are not identical then less than 10% chance.

Genetic susceptibility

  • HLA-DR3 and HLA-DR4 are more likely to develop Type 1 diabetes

  • HLA-DR2 seems protective

  • Genetics cannot be specified on classical lines of dominant, recessive or intermediate genes

Risk of Type 1 diabetes in siblings.

  • 4% developed Type 1 diabetes by age 22 years.

  • 12% risk in those with HLA DR3 or DR4

  • 56% with raised Islet Cell Antibodies went on to diabetes.

Use of nicotinamide in children with high levels of circulating ICA.

  • 8 children who were 1 st degree relatives of Type 1 diabetics with ICA levels above 80 units were followed for 5 years. All became diabetic after a mean 17 months.

  • 14 other children who were 1 st degree relatives and had raised ICA were given 150 - 300 mg Nicotinamide and followed for 5 years.

  • 1 became diabetic after 25 months

  • Has led to a major RCT (report in 2003)


  • DENIS (Deutsche Nicotinamide Intervention Study) showed no difference in randomised trial involving 55 children for 3 years. (Lampeter EF. Klinghammer A. Scherbaum WA. Heinze E. Haastert B. Giani G. Kolb H. The Deutsche Nicotinamide Intervention Study: an attempt to prevent type 1 diabetes. DENIS Group. Diabetes. 1998; 47(6):980-4)

  • Much larger multi national randomised trial (ENDIT) will report in 2003 (Gale et al)

Cows milk

Incidence of Type 1 diabetes in relation to mean yearly consumption of cows milk

Cows milk

  • Exclude cows milk from rats diet and the incidence of diabetes falls.

  • Children with diabetes have been breast fed for a shorter period than controls.

  • Western Samoan children did not get Type 1 diabetes until they moved to New Zealand

Maternal age

Maternal age

  • Recent study have suggested Type 1 diabetes in children maybe associated with maternal age

Cumulative risk of developing diabetes in siblings of children with Type 1 diabetes in quintiles (median age range 21 -34 years)


  • Coxsackievirus and cytomegalovirus have both been implicated.

  • Multiple infections in early infancy seem to be protective

Mortality and Morbidity


  • Mortality in UK patients with Type 1 diabetes

SMR by age and sex for people with Type 1 diabetes

Mortality in Type 1 diabetes over time

Summary of aetiological findings

  • Type 1 diabetes is increasing

  • Probably caused by a combination of genetic and environmental influences

  • Role of cows milk?

  • Nicotinamide?

  • Seasonal variation

    • Diet?
    • Viruses?


  • Incomplete information on aetiological factors

  • A number of possibilities for prevention have been raised but have yet to lead to a worthwhile population approach

  • Still great potential for preventing increase in developed communities

Yüklə 0,95 Mb.

Dostları ilə paylaş:
1   2   3   4   5   6

Verilənlər bazası müəlliflik hüququ ilə müdafiə olunur © 2024
rəhbərliyinə müraciət

gir | qeydiyyatdan keç
    Ana səhifə