Tatsuhiko Urakami

Increased Incidence of Non-Insulin Dependent Diabetes Mellitus Among Japanese Schoolchildren Correlates with an Increased Intake of Animal Protein and Fat

Non-insulin dependent diabetes (NIDDM) was diagnosed in 188 of more than 7 million Tokyo schoolchildren tested between 1974 and 1994 for glycosuria followed by oral glucose tolerance testing. The incidence rate of NIDDM in youth has continued to increase since 1976. While the daily energy intake has not changed significantly, the consumption of animal protein and fat by the Japanese population has greatly increased during the past two decades, and this change in diet, with low levels of physical activity, may exacerbate insulin resistance and glucose intolerance. Clin Pediatr. 1998;37:111-116

Continuing Stability of Center Differences in Pediatric Diabetes Care: do advances in diabetes treatment improve outcome? The Hvidoere Study Group on Childhood Diabetes

OBJECTIVE—To reevaluate the persistence and stability of previously observed differences between pediatric diabetes centers and to investigate the influence of demography, language communication problems, and changes in insulin regimens on metabolic outcome, hypoglycemia, and ketoacidosis. RESEARCH DESIGN AND METHODS—This was an observational cross-sectional international study in 21 centers, with clinical data obtained from all participants and A1C levels assayed in one central laboratory. All individuals with diabetes aged 11–18 years (49.4% female), with duration of diabetes of at least 1 year, were invited to participate. Fourteen of the centers participated in previous Hvidoere Studies, allowing direct comparison of glycemic control across centers between 1998 and 2005. RESULTS—Mean A1C was 8.2 ± 1.4%, with substantial variation between centers (mean A1C range 7.4–9.2%; P < 0.001). There were no significant differences between centers in rates of severe hypoglycemia or diabetic ketoacidosis. Language difficulties had a significant negative impact on metabolic outcome (A1C 8.5 ± 2.0% vs. 8.2 ± 1.4% for those with language difficulties vs. those without, respectively; P < 0.05). After adjustement for significant confounders of age, sex, duration of diabetes, insulin regimen, insulin dose, BMI, and language difficulties, the center differences persisted, and the effect size for center was not reduced. Relative center ranking since 1998 has remained stable, with no significant change in A1C. CONCLUSIONS—Despite many changes in diabetes management, major differences in metabolic outcome between 21 international pediatric diabetes centers persist. Different application between centers in the implementation of insulin treatment appears to be of more importance and needs further exploration.

Are family factors universally related to metabolic outcomes in adolescents with Type 1 diabetes

Aims  To assess the importance of family factors in determining metabolic outcomes in adolescents with Type 1 diabetes in 19 countries.

Insulin treatment in children and adolescents with diabetes

Department of Pediatrics, Uddevalla Hospital, Uddevalla,SwedenCorresponding author:Hans-Jacob Bangstad, MDDepartment of PaediatricsOslo University HospitalUlleval˚Kirkeveien 166Oslo N-0407Norway.Tel: 0047-22118765;fax: 0047-22118663;e-mail: haba@uus.noConflicts of interest: RH has received lecture honoraria fromNovo Nordisk, Lilly, Sanofi-Aventis, Medtronic and Roche. PJ-Chas received lecture fees from Eli Lilly, Novo-Nordisk, Sanofi-Aventis, Abbott, Bayer, Medtronic and Roche.The remainingauthors have declared no potential conflicts.Editors of the ISPAD Clinical Practice Consensus Guide-lines 2009 Compendium: Ragnar Hanas, Kim Donaghue,Georgeanna Klingensmith, and Peter Swift.This article is a chapter in the

Type 2 diabetes in the child and adolescent

Phil Zeitlera, Junfen Fub, Nikhil Tandonc, Kristen Nadeaua, Tatsuhiko Urakamid, Timothy Barrette and David Maahsf aThe Children’s Hospital Colorado, Aurora, CO, USA; bThe Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, China; cAll India Institute of Medical Sciences, New Delhi, India; dNihon University School of Medicine, Tokyo, Japan; eBirmingham Children’s Hospital, Birmingham, UK and fThe Barbara Davis Center for Childhood Diabetes, Aurora, CO, USA

Epidemiology of type 1 (insulin-dependent) and type 2 (non-insulin-dependent) diabetes mellitus in Japanese children

The overall annual IDDM incidence rates by area in Japan for 1985-1989 for children 0-14 years of age at diagnosis were from 1.65 to 2.07 per 100,000. The incidence in males and females did not show any temporal trends during the period between 1980 and 1989. The prevalence of IDDM was about 1 per 10,000. The clinical features at diagnosis among Japanese IDDM children identified during the 2-year period between 1979 and 1980 were as follows. Fourteen percent of the cases were in coma and 12% of the cases were asymptomatic at diagnosis. There is a suggestion that slow onset IDDM is often seen in Japan. In these children, the decline of serum CPR levels and the prevalence of ICA (islet cell antibodies) over the course of diabetes was slower than in those with an abrupt onset classical IDDM. During the period from 1975 through 1990 the incidence rates of NIDDM in school children showed as much as an approximate 1.5-fold increase along with a similar increase in the prevalence of obesity. About eighty percent of these NIDDM children were obese. A predominance of female children developing diabetes was seen in both type of diabetes, IDDM and NIDDM, in Japan. Non-obese type NIDDM in children was more common in females than in males. It is interesting to note that the mean height of Japanese children with IDDM was not different from the national average, but children with NIDDM were significantly taller than the national average.

Target setting in intensive insulin management is associated with metabolic control: The Hvidoere Childhood Diabetes Study Group Centre Differences Study 2005

Swift PGF, Skinner TC, de Beaufort CE, Cameron FJ, Åman J, Aanstoot H‐J, Castaño L, Chiarelli F, Daneman D, Danne T, Dorchy H, Hoey H, Kaprio EA, Kaufman F, Kocova M, Mortensen HB, Njølstad PR, Phillip M, Robertson KJ, Schoenle EJ, Urakami T, Vanelli M, Ackermann RW, Skovlund SE for the Hvidoere Study Group on Childhood Diabetes. Target setting in intensive insulin management is associated with metabolic control: the Hvidoere Childhood Diabetes Study Group Centre Differences Study 2005.

ISPAD Clinical Practice Consensus Guidelines 2014. Type 2 diabetes in the child and adolescent.

Phil Zeitlera, Junfen Fub, Nikhil Tandonc, Kristen Nadeaua, Tatsuhiko Urakamid, Timothy Barrette and David Maahsf aThe Children’s Hospital Colorado, Aurora, CO, USA; bThe Children’s Hospital, Zhejiang University School of Medicine, Hangzhou, China; cAll India Institute of Medical Sciences, New Delhi, India; dNihon University School of Medicine, Tokyo, Japan; eBirmingham Children’s Hospital, Birmingham, UK and fThe Barbara Davis Center for Childhood Diabetes, Aurora, CO, USA

Association of polymorphism in the interferon ? gene with IDDM

SummaryCytokines may play importmant roles in the pathogenesis of insulin-dependent diabetes mellitus (IDDM). We analysed a dinucleotide repeat polymorphism within the first intron of the interferon γ (IFN-γ) gene in Japanese diabetic patients (175 IDDM and 145 non-insulin-dependent diabetes mellitus) and 267 control subjects. A significant difference was observed in the global allele distribution of the polymorphism between the IDDM and control groups (p=0.039). The difference from the control group was more evident in the patients whose insulin therapy started within 1 year from onset (p=0.006) or in the young-onset (<10 years) patients (p=0.0006). The alleles “3” and “6” were increased in the IDDM patients, and a significant increase in the frequency of the “3/6” genotype was observed in the IDDM patient group (9.1%, RR 2.9, p=0.010), in the patients with initial insulin therapy less than 1 year from onset (10.6%, RR 3.4, p=0.004), or in the young-onset patients (16.7%, RR 5.7, p=0.0003) in comparison to the control subjects (3.4%). There was a tendency towards frequent occurrence of clinical characteristics which reflect young or abrupt onset of diabetes or both, and depletion of insulin secretion capacity in the patients with “3/6” or “6/6” in comparison to the patients with other genotypes. These results suggest that the IFN-γ gene region may contribute to the pathogenesis of IDDM and could be a genetic marker for IDDM.

Urine Glucose Screening Program at Schools in Japan to Detect Children with Diabetes and Its Outcome-Incidence and Clinical Characteristics of Childhood Type 2 Diabetes in Japan

A large number of children with type 2 diabetes have been detected by a urine glucose screening program conducted at schools in Japan since 1975. The incidence of type 2 diabetes in children has increased over the last three decades, and the incidence is estimated to be approximately 3.0/100,000/y during 1975–2000. The incidence of type 2 diabetes in junior high school children is three to six times higher than that in primary school children. More than 80% of children with type 2 diabetes are obese, and boys are more likely to be obese than girls. It is speculated that the increase in the incidence of childhood type 2 diabetes over the years may be a consequence of the increase in the frequency of obesity in school children. However, this trend of increasing incidence of childhood obesity has recently become weaker, and perhaps as a consequence, the incidence of type 2 diabetes has also decreased after the year 2000 in some cities of Japan. Improved attention to physical activity and eating habits among young people may be responsible at least in part to the decrease in the incidence of type 2 diabetes noted in recent years in big cities of Japan.