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Immigrant childrenwith type 1 diabetes have impaired metabolic control after three years oftreatment: a nation-wide cohort study in Sweden
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Pediatrics Örebro University Hospital, Sweden.
Division of Paediatrics, Department of Molecular and Clinical Medicine, Linkoping University, Sweden; Department of Pediatrics, Linköping University Hospital, Linköping, Sweden.
Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden.
2014 (English)Manuscript (preprint) (Other academic)
Abstract [en]

Objective: To compare clinical status after three years of treatment and socio-demographic conditions at onset in children with diabetes born to immigrant parents with children to Swedish born parents. Design: Observational nationwide population based cohort-study on prospectively recorded registry data.

Setting: All children with diabetes in Sweden and their parents between 2000 and 2010.

Patients: 879 children with diabetes born to immigrant parents out of a total of 13 415 children, the immigrant cohort. To these we added 2627 children with diabetes of Swedish born parents, matched for gender, age and year of onset, the Swedish cohort.

Main outcome: The immigrant children had a higher median HbA1c, 69 mmol/mol (8.5 %), compared to their Swedish peers 62 (7.8 %), p = 0.002, and the 75th percentile of 72 (8.8 %) vs 70 (8.5 %). There was however no difference in frequency of severe events of hypoglycemia or keto-acidosis between the two cohorts (p = 0.258). A linear regression model with HbA1c as dependent variable pointed out insulin units per kg BW as the main reason for inferior metabolic control, OR 11.410, CI 95% 7.418_15.402, p < 0.001.

Conclusions: Children with diabetes born to immigrant parents have worse metabolic status three years after disease onset.

Place, publisher, year, edition, pages
2014.
Keywords [en]
diabetes type 1
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
URN: urn:nbn:se:oru:diva-34720OAI: oai:DiVA.org:oru-34720DiVA, id: diva2:712183
Note

Article in manuscript not yet submitted due to delay from the journal of Diabetic Medicine according the previous article dealing with the onset of diabetes type 1.

Available from: 2014-04-14 Created: 2014-04-14 Last updated: 2018-09-12Bibliographically approved
In thesis
1. Type 1 diabetes in children with non-Swedish background: epidemiology and clinical outcome
Open this publication in new window or tab >>Type 1 diabetes in children with non-Swedish background: epidemiology and clinical outcome
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Sweden holds third place of diabetes incidence in young people after Finland and Sardinia. One fifth of the population is nowadays of foreign descent. We have a substantial number of immigrants from countries where the risk for T1D is considerably lower. Migration as a natural experiment is a concept to assess the risk for diabetes in offspring of immigrant parents and assess the interaction between genetics (genotype) and the impact of environment (phenotype).

Aims: To study the risk of incurring diabetes for children of immigrant parents living in Sweden (I) and further study the risk if the child is born in Sweden or not (II); to specifically study and evaluate if children from East Africa have increased risk to develop T1D (III). To investigate if clinical and sociodemographic status at T1D onset differs between immigrant children compared to their Swedish indigenous peers (IV). Finally to study the clinical outcome and the impact of socio-demographic factors at diabetes onset after three years of treatment (V).

Methods: All five studies are observational, nationwide and population based, on prospectively collected data. Statistics mainly by logistic and linear regressions.

Results: Parental country of origin is a strong determinant for diabetes in the offspring. Children born to immigrant parents seem to keep their low risk compared to their Swedish peers (I). When adding the factor of being born in Sweden, the pattern changed; there was a significantly (p < 0.001) increased risk for T1D if the child was born in Sweden (II). East Africans have a substantial risk for T1D and especially if the children are born in Sweden (III). Immigrant children and adolescents have worse metabolic start at T1D onset compared to their indigenous Swedish peers (IV). After 3 years of treatment, the immigrant children had a sustained higher median HbA1c, compared to their Swedish peers (V).

Conclusions: Genotype and influences during fetal life or early infancy have an important impact for the risk of T1D pointing towards epigenetics playing a substantial role. Children with an origin in East Africa have a high risk of incurring T1D. Immigrant children have worse metabolic start at T1D onset, which sustains after three years of treatment

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2014. p. 59
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 102
Keywords
Type 1 diabetes, HbA1c, children, adolescents, ethnicity, epidemiology, immigration, adoption, socio-demographic, registers
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-32843 (URN)978-91-7529-010-2 (ISBN)
Public defence
2013-04-11, Hörsal C2, Campus USÖ, Universitetssjukhuset, S Grev Rosengatan, 701 85 Örebro, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2014-01-31 Created: 2013-12-19 Last updated: 2017-10-17Bibliographically approved

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