Birgit Rami

Prevalence of celiac disease and follow-up of EMA in children and adolescents with type 1 diabetes mellitus.

Background: The prevalence of celiac disease (CD) in children with diabetes mellitus type 1 (DM) is significantly higher than in the nondiabetic population. Most patients with DM and associated CD do not experience typical gastrointestinal symptoms of CD. There is no agreement on the necessity of screening and management of silent CD for patients with DM or on the time scale for screening. Only few data on follow‐up evaluation of children with DM and CD‐related antibodies are available. Methods: One hundred fifty‐seven patients with DM (mean age, 14.8 years; range, 4‐21 years; male, 83) were screened with endomysial antibodies (EMA) between 1993 and 2001. A follow‐up period of at least 3 years, with at least 2 EMA measurements, was possible. Group 1 comprised 37 patients whose first measurement was at the onset of DM. Group 2 comprised 120 patients whose first measurement was during the course of the disease. In patients with positive EMA, small bowel biopsy was performed. Thyroid peroxidase (TPO), thyroglobulin (TgA), glutamate decarboxylase (GAD), antiinsulin (IAA), and islet cell antibodies (IA2) were measured in all patients. Results: EMA was positive in 16 patients, in 5 at onset of DM and in 11 during the course of DM (mean duration, 33.6 months; range, 11‐105 months). Biopsy results showed normal mucosa in seven patients, increased intraepithelial lymphocyte counts in one, and flat mucosa in eight. There was no significant difference between EMA‐positive and EMA‐negative patients regarding height, weight, HbA1c level, frequency of hypoglycemia or hyperglycemia, TPO, TgA, GAD, IAA, or IA2. Conclusion: This study emphasizes the high prevalence of CD in patients with DM. Although several patients already had positive EMA titers at the onset of DM, seroconversion may also occur during the course of the disease. Screening for CD with EMA or tissue transglutaminase should be included in the initial investigation of DM, but should also be repeated over time to detect late seroconversion. JPGN 37:67‐71, 2003.

Diabetes mellitus type 2 in childhood and adolescence in Germany and parts of Austria

A rise in the prevalence of type 2 diabetes mellitus (T2 DM) in adolescence and childhood has been observed in North America, especially in minority populations such as the American Indians, during the past decades [2]. Few epidemiological data on the incidence of the disease in young people exist in Europe [1, 4, 5]. To obtain an estimate of the magnitude of this problem in Germany, we tried to evaluate the prevalence of T2 DM in people under the age of 20 years using the DPV-Wiss database, a database covering half of the existing diabetes patients in this age group in Germany.

Type 2 diabetes mellitus is rare but not absent in children under 15 years of age in Austria

Until recently, most children with diabetes mellitus had type 1 diabetes (T1DM). The prevalence of type 2 diabetes (T2DM) is on the rise in North America, especially in risk populations such as the American Indians. Few epidemiological data on the incidence of the disease exist in Europe. In a prospective population-based epidemiological study, all newly diagnosed cases of diabetes mellitus in patients under 15 years of age were registered nation-wide in Austria between 1999 and 2001. Differential diagnosis (according to the American Diabetes Association diagnostic criteria) was based on clinical case definition. During the 3 years of the study period, 529 cases of DM <15 years were documented, of which 510 were clinically assigned to T1DM (271 boys, 239 girls) resulting in an incidence rate of 12.4/100,000. In the same network, eight cases were diagnosed as T2DM (one boy, seven girls) and two cases with an atypical form of T2DM (two girls). The age of onset of T2DM was 12–15 years and all patients were overweight (body mass index >90th percentile).The calculated incidence for T2DM <15 years in Austria was 0.25/100,000. Conclusion: at present, type 2 diabetes mellitus is rare but exists in children aged under 15 years in Austria. Follow-up of this registration will help to describe the secular trend.

Screening detected celiac disease in children with type 1 diabetes mellitus : Effect on the clinical course - (A case control study)

Objective: To investigate clinical and metabolic characteristics of diabetic children with screening detected celiac disease in a multicenter case-control study. Methods: Cases: 98 diabetic patients were diagnosed as having silent celiac disease by screening with endomysial antibodies and subsequent biopsy. Controls: two controls in the same center were chosen, (stratified by age and age-at-diabetes onset) who were negative for endomysial antibodies (n = 195). Height, weight, HbA1c, insulin dosage and acute complications were documented for at least 1 year of follow up. Results: Mean age of diabetes manifestation was 6.5 ± 4.1 years and diagnosis of celiac disease was made at 10.0 ± 5.4 years. Biopsy showed total or subtotal mucosal atrophy in 74 patients. The mean observation period after the diagnosis of celiac disease was 3.3 ± 1.9 years. Mean HbA1c levels were similar between cases and controls (8.63% ± 1.45% versus 8.50% ± 1.39%; P = 0.35). There was also no difference in the frequency of severe hypoglycemia, ketoacidosis and the applied insulin dosage (P = 0.45). Body mass index-standard deviation score at celiac disease diagnosis (0.57 ± 1.24 versus 0.52 ± 1.07) and height-standard deviation score (0.14 ± 1.13 versus 0.30 ± 0.95) did not differ between cases and controls. After diagnosis of celiac disease, weight gain was diminished in boys with celiac disease compared with their controls (P < 0.05). Female cases also had a lower body mass index than female controls (P = 0.067). Conclusion: In a cohort of diabetic children, silent celiac disease had no obvious effect on metabolic control but negatively influenced weight gain.

Ocular haemodynamics and colour contrast sensitivity in patients with type 1 diabetes

BACKGROUND There is evidence that altered ocular blood flow is involved in the development and progression of diabetic retinopathy. However, the nature of these perfusion abnormalities is still a matter of controversy. Ocular haemodynamics were characterised with two recently introduced methods. METHODS The cross sectional study was performed in 59 patients with type 1 diabetes with a diabetes duration between 12 and 17 years and an age less than 32 years and a group of 25 age matched healthy controls. Scanning laser Doppler flowmetry and laser interferometric measurement of fundus pulsation amplitude were used to assess retinal and pulsatile choroidal blood flow, respectively. In addition, colour contrast sensitivity along the tritan axis was determined. RESULTS Fundus pulsation amplitude, but not retinal blood flow, increased with the progression of diabetic retinopathy. Retinal blood flow was influenced by plasma glucose levels (r = 0.32), whereas fundus pulsation amplitude was associated with HbA1c(r = 0.30). In addition, a negative correlation between the colour contrast sensitivity along the tritan axis and retinal blood flow was observed. CONCLUSIONS The present study indicates that pulsatile choroidal blood flow increases with the progression of diabetic retinopathy. Increased retinal blood flow appears to be related to loss of colour sensitivity in patents with type 1 diabetes.

Incidence and Time Trend of Type 1 and Type 2 Diabetes in Austrian Children 1999–2007

OBJECTIVE To analyze the time trend of the nationwide incidence of type 2 diabetes in children and adolescents < or = 15 years of age compared with type 1 diabetes between 1999 and 2007 in Austria. STUDY DESIGN In a prospective, population-based incidence study, all newly diagnosed patients with diabetes < or = 15 years of age were registered by the Austrian Diabetes Incidence Study Group. The Diabetes type was classified on the basis of clinical and laboratory findings according to ADA criteria. Time trends were estimated by linear regression models. RESULTS During the observation period, 1881 patients with type 1 diabetes and 34 patients with type 2 diabetes could be identified. Sixty-two percent of patients with type 2 diabetes were female, 56% had a positive family history for type 2 diabetes, and 74% presented with diabetes-specific symptoms. The incidence of type 1 diabetes in Austria increased from 12.0 to 18.4/100,000 (P < .001) and the incidence of type 2 diabetes remained stable below 0.6/100 000 (P = .706). CONCLUSIONS The incidence of type 2 diabetes in Austrian children is 10-fold lower than reported in other regions and did not increase over the last 8 years. During the same time period, a significant rise in the incidence of type 1 diabetes was observed.

Postprandial glycaemia after regular and lispro insulin in children and adolescents with diabetes

AbstractWe compared the postprandial blood glucose (BG)-levels following preprandial regular insulin or lispro insulin before and after eating in adolescents with diabetes. Lispro is a rapidly absorbed insulin analogue. Lispro insulin injected immediately before breakfast reduced the postprandial BG-rise significantly compared to the 20 min preprandially administered regular insulin (P<0.01). Postprandial lispro injection resulted in similar BG values as the standard treatment with regular insulin 20 min preprandially. Conclusion Lispro insulin injected immediately before the meal leads to lower postprandial BG levels and seems to be an option for teenagers who use multiple preprandial insulin injections. Postprandial lispro administration could be a benefit in certain situations since it resulted in similar BG values to preprandial regular insulin.

Prevalence of intentional under- and overdosing of insulin in children and adolescents with type 1 diabetes.

Schober E, Wagner G, Berger G, Gerber D, Mengl M, Sonnenstatter S, Barrientos I, Rami B, Karwautz A, Fritsch M, on behalf of the Austrian Diabetic Incidence Study Group. Prevalence of intentional under‐ and overdosing of insulin in children and adolescents with type 1 diabetes.

Prevalence of overweight and obesity in male adolescents in Austria between 1985 and 2000. A population based study.

OBJECTIVE To analyse the prevalence of overweight and obesity in young Austrian men, to describe a possible time trend during the observation period 1985-2000 and to define regional differences within the country. DESIGN Epidemiological population based investigation (conscript health investigation) comparing aggregated data of four cross-sectional studies. SUBJECTS Four cohorts of 18 year-old males (1985: n = 50,475, 1990: n = 47,463, 1995: n 39,275, 2000: n = 43,503), in total n = 180,716. METHODS Measurements of height and weight were performed during the nationwide conscript health investigation. BMI was calculated and overweight was defined as BMI > or = 25.00 kg/m2 and obesity as BMI > or = 30.00 kg/m2. Besides height and weight data, information on place of residence of the young men was used for the study. Chi-squared and Students t-test were calculated to test group differences with respect to their statistical significance. RESULTS The prevalence of overweight increased from 10.9% to 15.5% and of obesity from 1.8% to 4.9% during the observation period. A significant regional trend was found with the highest prevalence of overweight and obesity in the Eastern part of Austria (p < 0.001). BMI was 22.12 +/- 0.34 kg/m2 (mean +/- SD) in 1985 and showed a significant increase (p < 0.001) during the study period to 22.71 +/- 0.25 kg/m2. CONCLUSION Overweight and obesity increased remarkably in young males in Austria between the years 1985 and 2000. The steepest increase was found in the prevalence of obesity and in the Western part of Austria. A significant regional difference could be documented during the whole study period.

Risk factors for type I diabetes mellitus in children in Austria

Abstract The aim of this study was to investigate environmental risk factors in the development of type 1 diabetes mellitus in a population-based case-control study. Parents of all patients with manifestation of type 1 diabetes between 1989 and 1994 in Vienna were asked to complete a questionnaire (n = 114). Control children (n = 495), matched for age and sex, were randomly recruited from all schools in Vienna. Fathers of diabetic children were significantly older at the time their children were born than fathers of control children (P = 0.015). Children with diabetes were more likely to be second- or third-born children (P < 0.05) and fewer went to kindergarten than the control group children (P = 0.007). No significant difference in duration of gestation, percentage of delivery by caesarean section, birth weight or length was found. Neonatal jaundice was more often observed in the patient group (P = 0.038). Breast feeding was reported by 82.7% of mothers of diabetic children and by 81% of mothers of control children, and the duration of breast feeding was longer in patients than in controls (n.s.). Conclusion In our study, the development of type 1 diabetes mellitus was associated with higher paternal age and neonatal jaundice. No correlation could be found with dietary intake of cows milk products in early infancy, vaccination and other environmental factors.