Advanced Search Abstract In recent years there has been a substantial increase in the proportion of patients requiring renal replacement therapy who suffer from diabetes mellitus. In the lower Neckar region, a survey has been made comprising all patients admitted for renal replacement therapy from 1. Out of a total of patients admitted, 95 suffered from diabetes 10 type I, 85 type II.
Open in a separate window In the non-Hispanic white population the prevalence of T1D was 2. The authors conclude that these rates of T1D among non-Hispanic white youth are among the highest in the world. The incidence of T1D for 0—9 year olds and 10—19 year olds during —05 was Regardless of type, Navajo youth were likely to have poor glycemic control and a high prevalence of unhealthy behaviors and depressed mood.
The remaining genetic risk is made up of many diverse genes, each having a small individual impact on genetic susceptibility A number of reports suggest a recent temporal trend of fewer high-risk HLA genotypes in youth diagnosed with T1D, suggesting an increased influence of environmental factors in the development of T1D during the past few decades 1944 Although the majority of T1D cases occur in individuals without a family history of the disease, T1D is strongly influenced by genetic factors.
In the United States, individuals with a first-degree relative with T1D have a 1 in 20 lifetime risk of developing T1D, compared to a 1 in lifetime risk for the general population Genetic susceptibility Epidemiological analysis of type ii diabetes T1D ranges from marked in childhood-onset T1D to a more modest effect in adult-onset T1D, with children having a higher identical twin concordance rate and a greater frequency of HLA genetic susceptibility 48 Siblings of children with onset of T1D before the age of 5 years have a three- to five-fold greater cumulative risk of diabetes by age 20 compared to siblings of children diagnosed between 5 and 15 years of age Diabetes with onset before age 5 years is a marker of high familial risk and suggests a major role for genetic factors.
The clustering of these autoimmune diseases is related to genes within the major histocompatibility complex Seasonality of onset and birth Patterns in the seasonality for both the month of birth and the month of diagnosis of T1D have been reported.
This birth month effect was not observed in youth recruited from the centers in the more southern locations South Carolina, Hawaii, Southern Californiabut only in the more northern latitudes Colorado, Washington, and Ohio A report from Ukraine also reported a strong seasonal birth pattern with the lowest rates of T1D in December and the highest in April Similar reports of higher rates of T1D among youth born in Spring and lower rates among youth born in the Fall have been published from Europe 55 — 58New Zealand 59and Israel 60but not in other studies from Europe, East Asia or Cuba 5861 — Vitamin D deficiency has been associated with T1D 6465 and the use of cod liver oil a rich source of vitamin D during pregnancy 66 and the first year of life 67 has been associated with a lower risk of T1D.
Recent reports suggest that vitamin D deficiency is common in the pediatric population in the US 68even in solar rich environments A seasonal pattern in the onset of T1D with increased cases during late autumn, winter, and early spring has been well known and repeatedly confirmed in youth 70 The seasonal variation in infections implicated to precipitate T1D is suspected to play a primary role in this observation.
Reports on the seasonality of T1D in adults have been mixed, but a recent report from Sweden on more than patients 15—34 years of age found the higher incidence during January—March and the lowest during May—July with no difference by gender Although viral disease has long been proposed as a potential trigger of beta cell destruction, insufficient exposure to early infections might increase the risk of T1D as the maturation of immune regulation after birth is driven by exposure to microbes The evidence linking specific infections with T1D remains inconclusive Other risk factors Epidemiological studies have identified that environmental factors operating early in life appear to trigger the immune-mediated process in genetically susceptible individuals.
That nongenetic factors play a role in the development of T1D is evidenced by migration studies, rising incidence within genetically stable populations, and twin studies.
The environmental triggers which initiate pancreatic beta cell destruction remain largely unknown. Increased use of vitamin D supplementation during infancy has been associated with reduced risk for childhood T1D Increased maternal consumption of vitamin D during pregnancy has also been associated with decreased risk of islet autoimmunity in the offspring EPIDEMIOLOGICAL PROBLEM – DIABETES 2 More than million of people are aFected by Diabetes Mellitus worldwide.
The Centers for Disease Control and Prevention (CDC) estimated a million the number of American children and adults with diabetes (CDC, ).
Effects of intensive interventions compared to standard care in people with type 2 diabetes and microalbuminuria on risk factors control and cardiovascular outcomes: A systematic review and meta-analysis of randomised controlled trials.
The combination of insulin resistance, dyslipidemia, hypertension, and obesity has been described as a “metabolic syndrome” that is a strong determinant of type 2 diabetes.
Factor analysis was used to identify components of this syndrome in 1, Pima Indians. The discrepancy between the annual incidence of (i) renal failure and of (ii) terminal renal failure suggests that a high proportion of patients with diabetes (mainly type II) and renal failure, dies prior to reaching terminal renal failure.
In 2 studies microvascular complications were found to be associated with an increased risk of UI in those with T2D, which is similar to the results presented here. 5 x 5 Lifford, K.L., Curhan, G.C., Hu, F.B.
et al. Type 2 diabetes mellitus and risk of developing urinary incontinence. The slow onset of type 2 diabetes, and its usual presentation without the acute metabolic disturbance seen in type 1 diabetes, means that the true time of onset is difficult to determine.
There is also a long pre-detection period, and up to one-half of cases in the population may be undiagnosed.