Prediction and Prevention of Type 1 Diabetes Mellitus
Vavřinec J., Cinek O., Koloušková S., Šumník Z., Šnajderová M., Mendlová P., Sekerášová K.
Pediatrická klinika 2. LF UK a FN Motol, Praha přednosta prof. MUDr. J. Vavřinec, DrSc. |
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Summary:
The incidence of type 1 diabetes (DM1) in children varies between continents and countries.
The precise mapping of DM1 incidence and its trends helps to investigate interactions of genetic
and non-genetic factors at a population level.
Authors evaluated total, age-specific and sex-specific incidence rates of DM1 and their trends
in Czech children at 0–14 years of age in the period of 1989–2003. Diabetic children were ascertained
by two independent sources: the Czech Childhood Diabetes Registry Network and the database
of “Association of Parents and Friends of Diabetic Children”. Denominator data on general
population size were obtained from the Czech Statistic Bureau annual reports.
In the period 1st January 1989–31st December 2003 the standardised incidence was 12.0 (CI 95% 11.6–12.4)/100 000/year. The total incidence has an increasing trend over this period
(annual increment 6.8%). Significant male predominance was observed in the group diagnosed at
the age of 0–4 years (boys/girls ratio of incidence 1.19; p = 0.023), female predominance in the
group 5–9 years (boys/girls ratio of incidence 0.88; p = 0,021). Total prevalence of DM1 was
1.02/1000 (CI 95% 0.96–1.06).
The level of DM1 conferred by the HLA class II genes also varies between nations and ethnic
groups. Authors investigated the role of HLA-DQB1,-DQA1 genes, DRB1* subtypes and insulin
gene polymorphism in diabetic population. Authors present IDDM1 and IDDM2 gene polymorphism
association of DM1 in the Czech population.
Clinical studies for primary and secondary DM1 prevention were introduced in first-degree
relatives of diabetic patients. The rationale for TRIGR (Trial to Reduce IDDM in the Genetically
at Risk) began with observational studies that showed that breastfeeding was associated with
somewhat lower rates of children developing DM1. The TRIGR trial will determine whether
delayed exposure to intact food proteins will reduce the changes of developing DM1 later in life.
All babies in the study receive the recommendation to breastfeed for at least the first six months
of life. If a mother is unable to exclusively breastfeed before the baby is 8 months of age, her child
will be randomly assigned to one of two groups. One group of these babies will receive breastfeeding
supplements of a trial formula based on extensively hydrolysed protein; the other group will
receive a special trial formula containing a smaller amount of hydrolysed protein. In hydrolysed
protein, the big protein molecules have been split into very small fragments to provide a source
of nutritional amino acids, but the fragments are likely too small to stimulate the immune system.
Key words:
type 1 diabetes mellitus, incidence and prevalence, primary and secondary prevention,
TRIGR
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