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See detailSeasonal variation in month of diagnosis in children with type 1 diabetes registered in 23 European centers during 1989-2008: little short-term influence of sunshine hours or average temperature
Patterson, C.; Gyürüs, E.; Rosenbauer, J. et al

in Pediatric Diabetes (2015), 16(8), 573-580

BACKGROUND: The month of diagnosis in childhood type 1 diabetes shows seasonal variation. OBJECTIVE: We describe the pattern and investigate if year-to-year irregularities are associated with ... [more ▼]

BACKGROUND: The month of diagnosis in childhood type 1 diabetes shows seasonal variation. OBJECTIVE: We describe the pattern and investigate if year-to-year irregularities are associated with meteorological factors using data from 50 000 children diagnosed under the age of 15 yr in 23 population-based European registries during 1989-2008. METHODS: Tests for seasonal variation in monthly counts aggregated over the 20 yr period were performed. Time series regression was used to investigate if sunshine hour and average temperature data were predictive of the 240 monthly diagnosis counts after taking account of seasonality and long term trends. RESULTS: Significant sinusoidal pattern was evident in all but two small centers with peaks in November to February and relative amplitudes ranging from ± 11 to ± 38% (median ± 17%). However, most centers showed significant departures from a sinusoidal pattern. Pooling results over centers, there was significant seasonal variation in each age-group at diagnosis, with least seasonal variation in those under 5 yr. Boys showed greater seasonal variation than girls, particularly those aged 10-14 yr. There were no differences in seasonal pattern between four 5-yr sub-periods. Departures from the sinusoidal trend in monthly diagnoses in the period were significantly associated with deviations from the norm in average temperature (0.8% reduction in diagnoses per 1 °C excess) but not with sunshine hours. CONCLUSIONS: Seasonality was consistently apparent throughout the period in all age-groups and both sexes, but girls and the under 5 s showed less marked variation. Neither sunshine hour nor average temperature data contributed in any substantial way to explaining departures from the sinusoidal pattern. [less ▲]

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See detailTrends in childhood type 1 diabetes incidence in Europe during 1989-2008: evidence of non-uniformity over time in rates of increase
Patterson, C.C.; Gyürüs, E.; Rosenbauer, J. et al

in Diabetologia (2012), 55(8), 2142-2147

Aims/hypothesis The aim of the study was to describe 20- year incidence trends for childhood type 1 diabetes in 23 EURODIAB centres and compare rates of increase in the first (1989–1998) and second ... [more ▼]

Aims/hypothesis The aim of the study was to describe 20- year incidence trends for childhood type 1 diabetes in 23 EURODIAB centres and compare rates of increase in the first (1989–1998) and second (1999–2008) halves of the period. Methods All registers operate in geographically defined regions and are based on a clinical diagnosis. Completeness of registration is assessed by capture–recapture methodology. Twenty-three centres in 19 countries registered 49,969 new cases of type 1 diabetes in individuals diagnosed before their 15th birthday during the period studied. Results Ascertainment exceeded 90% in most registers. During the 20-year period, all but one register showed statistically significant changes in incidence, with rates universally increasing. When estimated separately for the first and second halves of the period, the median rates of increase were similar: 3.4% per annum and 3.3% per annum, respectively. However, rates of increase differed significantly between the first half and the second half for nine of the 21 registers with adequate coverage of both periods; five registers showed significantly higher rates of increase in the first half, and four significantly higher rates in the second half. Conclusions/interpretation The incidence rate of childhood type 1 diabetes continues to rise across Europe by an average of approximately 3–4% per annum, but the increase is not necessarily uniform, showing periods of less rapid and more rapid increase in incidence in some registers. This pattern of change suggests that important risk exposures differ over time in different European countries. Further time trend analysis and comparison of the patterns in defined regions is warranted. [less ▲]

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See detailIncidence trends for childhood type 1 diabetes in Europe during 1989-2003 and predicted new cases 2005-20: a multicentre prospective registration study Lancet
Patterson, C.C.; Dahlquist, G.G.; Gyürüs, E. et al

in Lancet (2009), 373(9680), 2027-2033

Background The incidence of type 1 diabetes in children younger than 15 years is increasing. Prediction of future incidence of this disease will enable adequate fund allocation for delivery of care to be ... [more ▼]

Background The incidence of type 1 diabetes in children younger than 15 years is increasing. Prediction of future incidence of this disease will enable adequate fund allocation for delivery of care to be planned. We aimed to establish 15-year incidence trends for childhood type 1 diabetes in European centres, and thereby predict the future burden of childhood diabetes in Europe. Methods 20 population-based EURODIAB registers in 17 countries registered 29 311 new cases of type 1 diabetes, diagnosed in children before their 15th birthday during a 15-year period, 1989–2003. Age-specific log linear rates of increase were estimated in five geographical regions, and used in conjunction with published incidence rates and population projections to predict numbers of new cases throughout Europe in 2005, 2010, 2015, and 2020. Findings Ascertainment was better than 90% in most registers. All but two registers showed significant yearly increases in incidence, ranging from 0·6% to 9·3%. The overall annual increase was 3·9% (95% CI 3·6–4·2), and the increases in the age groups 0–4 years, 5–9 years, and 10–14 years were 5·4% (4·8–6·1), 4·3% (3·8–4·8), and 2·9% (2·5–3·3), respectively. The number of new cases in Europe in 2005 is estimated as 15 000, divided between the 0–4 year, 5–9 year, and 10–14 year age-groups in the ratio 24%, 35%, and 41%, respectively. In 2020, the predicted number of new cases is 24 400, with a doubling in numbers in children younger than 5 years and a more even distribution across age-groups than at present (29%, 37%, and 34%, respectively). Prevalence under age 15 years is predicted to rise from 94 000 in 2005, to 160 000 in 2020. Interpretation If present trends continue, doubling of new cases of type 1 diabetes in European children younger than 5 years is predicted between 2005 and 2020, and prevalent cases younger than 15 years will rise by 70%. Adequate health-care resources to meet these children's needs should be made available. Funding European Community Concerted Action Program. [less ▲]

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See detailIs childhood onset type1 diabetes a wealth-related disease. An ecological analysis of European incidence rates
Patterson, C.C.; Dahlquist, G.; Soltesz, G. et al

in Diabetologia (2001), 44

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See detailTrends in the incidence of childhood onset diabetes in Europe. 1989-1998
Green, A.; Patterson, C.C.; De Beaufort, Carine UL

in Diabetologia (2001), 44(3), 3-8

AIMS/HYPOTHESIS: To study the epidemiology of childhood-onset (Type I) insulin-dependent diabetes mellitus in Europe, the EURODIAB collaborative group in 1988 established prospective, geographically ... [more ▼]

AIMS/HYPOTHESIS: To study the epidemiology of childhood-onset (Type I) insulin-dependent diabetes mellitus in Europe, the EURODIAB collaborative group in 1988 established prospective, geographically-defined registers of all children diagnosed with Type I diabetes under 15 years of age. This report is based on 24,423 children, registered by 36 centres, with complete participation during the period 1989-1998 and representing most European countries with a population coverage of approximately 20 million children. METHODS: Multiple sources of ascertainment were used to validate the level of ascertainment. Trends in Type I diabetes incidence during the period were analysed using Poisson regression with the results from the 36 centres pooled into nine regions. RESULTS: The standardised average annual incidence rate of Type I diabetes varied more than tenfold between centres. Overall, the annual increase in incidence was 3.2% (95%-CI: 2.7%, 3.7%), being highest for children in the 0-4-year age-group 4.8% (3.8%, 5.9%) and lowest for children in the 10-14-year age group 2.1 % (1.4%, 2.8%). However, the absolute increases in Type I diabetes were roughly similar in the three age-groups of 0-4, 5-9 and 10-14 years. Central Eastern Europe showed the highest increase whereas Sardinia and Northern Europe (except Finland) showed no evidence of an increase. For all age-groups relatively fewer cases had disease onset during the summer months, especially the 10-14-year age-group. CONCLUSION/INTERPRETATION: The extremely large range of incidence rates within Europe has been confirmed. The incidence rate is generally increasing but is more pronounced in some regions than in others. Seasonality at disease onset is apparent even in the youngest age-group. [less ▲]

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See detailGeographical variation of presentation at diagnosis of type 1 diabetes in children: the EURODIAB Study
Levy-Marchal, C.; Patterson, C.C.; Green, A. et al

in Diabetologia (2001), 44(3), 75-80

We aimed to describe the frequency and degree of diabetic ketoacidosis in children across Europe at the time of diagnosis of Type I (insulin-dependent) diabetes mellitus and to determine if factors such ... [more ▼]

We aimed to describe the frequency and degree of diabetic ketoacidosis in children across Europe at the time of diagnosis of Type I (insulin-dependent) diabetes mellitus and to determine if factors such as age and geographical region contribute to the risk of diabetic ketoacidosis. METHODS: The study was part of the EURODIAB project. A total of 24 centres, covering a population at risk of more than 15 million children below 15 years of age, recruited 1,260 children at the time of clinical diagnosis. RESULTS: Polyuria, by far the most frequent symptom, was observed in 96% of the children. In only 25% of the children was the duration of symptoms less than 2 weeks and this proportion was larger in the under 5 year age-group (37 vs 22%; p < 0. 001). Of the 11 centres that recorded diabetic ketoacidosis status, the overall proportion with diabetic ketoacidosis (pH < 7.3) was 40% (95%-CI: 36-44%) in at least 90 % of cases. After stratification by centre, the odds ratio for diabetic ketoacidosis in the under 5 age-group was 1.02 (95%-CI:0.69-1.49) relative to the older children. There was significant variation between the 11 centres in the frequency of diabetic ketoacidosis which ranged from 26 to 67% (p = 0.002). An inverse correlation between the frequency of diabetic ketoacidosis and the background incidence rate was found in these centres (Spearman's rank correlation, rs = -0.715;p = 0.012). CONCLUSION/INTERPRETATION: Rising standards of medical information and greater awareness concurrent with an overall increase in incidence could have resulted in changes in the clinical presentation at onset of Type I childhood diabetes in Europe. [less ▲]

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See detailCorrelations between the incidence of childhood onset type 1 diabetes in Europe and HLA genotypes
Ronningen, K.S.; Keiding, N.; Green, A. et al

in Diabetologia (2001), 44(3), 51-59

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See detailIncidence of childhood-onset insulin-dependent diabetes mellitus: the EURODIAB ACE Study
Green, A.; Patterson, C.C.; Gale, E.A. et al

in Lancet (1992), 339(8798), 905-909

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