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Type 1 diabetes in children with non-Swedish background: epidemiology and clinical outcome
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
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. , 59 p.
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 102
Keyword [en]
Type 1 diabetes, HbA1c, children, adolescents, ethnicity, epidemiology, immigration, adoption, socio-demographic, registers
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
URN: urn:nbn:se:oru:diva-32843ISBN: 978-91-7529-010-2 (print)OAI: oai:DiVA.org:oru-32843DiVA: diva2:681126
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: 2015-12-28Bibliographically approved
List of papers
1. Impaired metabolic control and socio-demographic status in immigrant children at onset of type 1 diabetes
Open this publication in new window or tab >>Impaired metabolic control and socio-demographic status in immigrant children at onset of type 1 diabetes
2014 (English)In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 31, no 11, 1418-1423 p.Article in journal (Refereed) Published
Abstract [en]

Aim: The aim of the present study was to compare clinical and socio-demographic conditions at the onset of Type1 diabetes in children born to immigrant families and children born to Swedish families, and to assess whether those conditions had an impact on metabolic status.

Methods and design: This was an observational nationwide population-based matched cohort study on prospectively recorded registry data of all children with diabetes in Sweden and their families during 2000-2010. Out of a total of 13415 children from the Swedish Childhood Diabetes Registry (SWEDIABKIDS), 879 children born to immigrant parents were collected. To these we added 2627 children with Swedish-born parents, matched for gender, age and year of onset of Type1 diabetes.

Results: The proportion of low capillary pH (<7.30) at onset was higher in the immigrant cohort [25.8% vs. 16.4% in the Swedish cohort (P<0.001)]. HbA(1c) was also higher [95mmol/mol (10.8%) vs. 88mmol/mol (10.2%), respectively (P<0.001)]. In a logistic regression model with low pH as the dependent variable, we were unable to reveal any significant association to socio-demographic factors, but the odds ratio for HbA(1c) was 0.983 (95%CI 0.976-0.991) and for plasma glucose was 0.953 (95%CI 0.933-0.973).

Conclusion: Children born to immigrant parents have lower capillary pH and higher HbA(1c) at diabetes onset. Immigrant families harbour lower socio-demographic living conditions, but this fact does not seem to influence the inferior metabolic condition at diabetes onset.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2014
Keyword
diabetes type 1
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:oru:diva-32946 (URN)10.1111/dme.12511 (DOI)000344010200020 ()24861156 (PubMedID)2-s2.0-84902733946 (Scopus ID)
Projects
Type 1 diabetes in children with non-Swedish background – epidemiology and clinical outcome
Note

Funding Agencies:

Centre for Clinical Research Sörmland, Uppsala University, Sweden

Swedish Child Diabetes Foundation (Barndiabetesfonden), Linköping, Sweden

Available from: 2014-01-06 Created: 2014-01-06 Last updated: 2017-03-23Bibliographically approved
2. Being born in Sweden increases the risk for type 1 diabetes: a study of migration of children to Sweden as a natural experiment
Open this publication in new window or tab >>Being born in Sweden increases the risk for type 1 diabetes: a study of migration of children to Sweden as a natural experiment
2012 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 101, no 1, 73-77 p.Article in journal (Refereed) Published
Abstract [en]

Aim: To investigate whether the age of first exposure to a high-incidence country like Sweden determines the risk of T1DM in children with an origin in a low incidence region of the world.

Methods: Register study in a Swedish study population in the age 6–25 years in three categories of residents with an origin in low incidence regions of T1DM (Eastern Europe, East Asia, South Asia and Latin America); 24 252 international adoptees; 47 986 immigrants and 40 971 Swedish-born with two foreign-born parents and a comparison group of 1 770 092 children with Swedish-born parents. Retrieval of a prescription of insulin during 2006 was used as an indicator of T1DM and analysed with logistic regression.

Results: The odds ratios (OR) for T1DM were lower than the Swedish majority population for residents with an origin in the four low incidence regions. Being Swedish-born implied a higher risk for T1DM in the four low incidence study groups compared with the internationally adopted with an OR of 1.68 (CI 1.03–2.73).

Conclusions: Being born in Sweden increases the risk for T1DM in children with an origin in low incidence countries. This may imply that exposures in utero or very early infancy are important risk factors for T1DM

Place, publisher, year, edition, pages
West Sussex, United Kingdom: Wiley-Blackwell, 2012
Keyword
Adoption, children, diabetes type 1, epidemiology, immigration
National Category
Medical and Health Sciences Pediatrics
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-32941 (URN)10.1111/j.1651-2227.2011.02410.x (DOI)000297630000025 ()21767306 (PubMedID)2-s2.0-82955195809 (Scopus ID)
Projects
Type 1 diabetes in children with non-Swedish background – epidemiology and clinical outcome
Available from: 2014-01-06 Created: 2014-01-06 Last updated: 2017-03-24Bibliographically approved
3. East africans in Sweden have a high risk for type 1 diabetes
Open this publication in new window or tab >>East africans in Sweden have a high risk for type 1 diabetes
2012 (English)In: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 35, no 3, 597-598 p.Article in journal (Refereed) Published
Abstract [en]

Citing this article BMJ Open October 31, 2013 3:e003418

Objective: To investigate the prevalence of type 1 diabetes in children with an origin inSub-Saharan Africa in Sweden.

Research design and methods: Nationwide register study based on retrievedprescriptions of insulin during 2009 in children aged 0–18 years. The study population consistedof 35,756 children in families with an origin in Sub-Saharan Africa and 1,666,051 children withnative Swedish parents.

Results: The odds ratio (OR) for insulin medication in Swedish-born children in familiesoriginating in East Africa was 1.29 (95% CI 1.02–1.63) compared with offspring of nativeSwedish parents, after adjustment for age and sex, and less common in children who themselveswere born in East Africa: 0.50 (0.34–0.73). Offspring of parents from other parts of Sub-SaharanAfrica had a comparatively low risk for insulin medication.

Conclusions: This study indicates that Swedish-born children with an origin in EastAfrica have a high risk of type 1 diabetes.

Place, publisher, year, edition, pages
Alexandria, USA: American Diabetes Association, 2012
Keyword
Diabetes type 1
National Category
Medical and Health Sciences Endocrinology and Diabetes
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-32942 (URN)10.2337/dc11-1536 (DOI)000300801400027 ()22143362 (PubMedID)2-s2.0-84859058816 (Scopus ID)
Projects
Type 1 diabetes in children with non-Swedish background – epidemiology and clinical outcome
Available from: 2014-01-06 Created: 2014-01-06 Last updated: 2016-06-09Bibliographically approved
4. Parental country of birth is a major determinant of childhood type 1 diabetes in Sweden
Open this publication in new window or tab >>Parental country of birth is a major determinant of childhood type 1 diabetes in Sweden
2008 (English)In: Pediatric Diabetes, ISSN 1399-543X, E-ISSN 1399-5448, Vol. 9, no 1, 35-39 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To test the hypothesis that the risk of childhood diabetes type 1 increases with migration from a low to a high incidence region.

Methods: Register study of a national cohort of 783 547 children born between 1987 and 1993 who remained in Sweden in 2002, including 3225 children with childhood type 1 diabetes identified in hospital discharge data. Logistic regression analysis was used to test the hypotheses.

Results: Offspring of two parents born in very low (Asia excluding Middle East and Latin America) and low (southern and eastern Europe and the Middle East) incidence regions had the lowest adjusted odds ratios (ORs) of childhood type 1 diabetes; 0.21 (0.11-0.41) and 0.37 (0.29-0.48), respectively, compared with the Swedish majority population. When one parent was born in a low incidence country and one parent was Swedish born, the adjusted ORs increased but remained lower than the Swedish majority population.

Conclusions: Parental country of birth is an important determinant of childhood type 1 in Sweden. Heritable factors seem most likely to explain this pattern.

Place, publisher, year, edition, pages
Blackwell Munksgaard, 2008
Keyword
Diabetes type 1
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-32940 (URN)10.1111/j.1399-5448.2007.00267.x (DOI)000255130200006 ()
Projects
Type 1 diabetes in children with non-Swedish background – epidemiology and clinical outcome
Available from: 2014-01-06 Created: 2014-01-06 Last updated: 2014-04-14Bibliographically approved
5. Immigrant childrenwith type 1 diabetes have impaired metabolic control after three years oftreatment: a nation-wide cohort study in Sweden
Open this publication in new window or tab >>Immigrant childrenwith type 1 diabetes have impaired metabolic control after three years oftreatment: a nation-wide cohort study in 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.

Keyword
diabetes type 1
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-34720 (URN)
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: 2014-04-22Bibliographically approved

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  • ieee
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