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Dahlquist, Gisela
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Toppe, C., Möllsten, A., Waernbaum, I., Schön, S., Gudbjörnsdottir, S., Landin-Olsson, M. & Dahlquist, G. (2019). Decreasing Cumulative Incidence of End-Stage Renal Disease in Young Patients With Type 1 Diabetes in Sweden: a 38-Year Prospective Nationwide Study. Diabetes Care, 42(1), 27-31
Open this publication in new window or tab >>Decreasing Cumulative Incidence of End-Stage Renal Disease in Young Patients With Type 1 Diabetes in Sweden: a 38-Year Prospective Nationwide Study
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2019 (English)In: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 42, no 1, p. 27-31Article in journal (Refereed) Published
Abstract [en]

Objective: Diabetic nephropathy is a serious complication of type 1 diabetes. Recent studies indicate that end-stage renal disease (ESRD) incidence has decreased or that the onset of ESRD has been postponed; therefore, we wanted to analyze the incidence and time trends of ESRD in Sweden.

Research design and methods: In this study, patients with duration of type 1 diabetes >14 years and age at onset of diabetes 0–34 years were included. Three national diabetes registers were used: the Swedish Childhood Diabetes Register, the Diabetes Incidence Study in Sweden, and the National Diabetes Register. The Swedish Renal Registry, a national register on renal replacement therapy, was used to identify patients who developed ESRD.

Results: We found that the cumulative incidence of ESRD in Sweden was low after up to 38 years of diabetes duration (5.6%). The incidence of ESRD was lower in patients with type 1 diabetes onset in 1991–2001 compared to onset in 1977–1984 and 1985–1990, independently of diabetes duration.

Conclusion: The risk of developing ESRD in Sweden in this population is still low and also seems to decrease with time.

Place, publisher, year, edition, pages
American Diabetes Association, 2019
National Category
Pediatrics Urology and Nephrology
Identifiers
urn:nbn:se:umu:diva-153168 (URN)10.2337/dc18-1276 (DOI)000453904900014 ()30352897 (PubMedID)
Funder
Swedish Research Council, 0753Västerbotten County Council
Available from: 2018-11-08 Created: 2018-11-08 Last updated: 2019-01-10Bibliographically approved
Persson, S., Dahlquist, G., Gerdtham, U.-G. & Carlsson, K. S. (2018). Why childhood-onset type 1 diabetes impacts labour market outcomes: a mediation analysis. Diabetologia, 61(2), 342-353
Open this publication in new window or tab >>Why childhood-onset type 1 diabetes impacts labour market outcomes: a mediation analysis
2018 (English)In: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 61, no 2, p. 342-353Article in journal (Refereed) Published
Abstract [en]

Aims/hypothesis: Previous studies show a negative effect of type 1 diabetes on labour market outcomes such as employment and earnings later in life. However, little is known about the mechanisms underlying these effects. This study aims to analyse the mediating role of adult health, education, occupation and family formation.

Methods: A total of 4179 individuals from the Swedish Childhood Diabetes Register and 16,983 individuals forming a population control group born between 1962 and 1979 were followed between 30 and 50 years of age. The total effect of having type 1 diabetes was broken down into a direct effect and an indirect (mediating) effect using statistical mediation analysis. We also analysed whether type 1 diabetes has different effects on labour market outcome between the sexes and across socioeconomic status.

Results: Childhood-onset type 1 diabetes had a negative impact on employment (OR 0.68 [95% CI 0.62, 0.76] and OR 0.76 [95% CI 0.67, 0.86]) and earnings (−6%, p < 0.001 and −8%, p < 0.001) for women and men, respectively. Each of the mediators studied contributed to the total effect with adult health and occupational field accounting for the largest part. However, some of the effect could not be attributed to any of the mediators studied and was therefore likely related to other characteristics of the disease that hamper career opportunities. The effect of type 1 diabetes on employment and earnings did not vary significantly according to socioeconomic status of the family (parental education and earnings).

Conclusions/interpretation: A large part of the effect of type 1 diabetes on the labour market is attributed to adult health but there are other important mediating factors that need to be considered to reduce this negative effect.

Keywords
Children, Education, Inpatient care, Mediation analysis, Occupation, Outpatient care, Sickness nefits, Type 1 diabetes
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-144082 (URN)10.1007/s00125-017-4472-3 (DOI)000419011600010 ()29170854 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2009-0768Swedish Research Council, 2014–646
Available from: 2018-01-31 Created: 2018-01-31 Last updated: 2018-06-09Bibliographically approved
Toppe, C., Möllsten, A., Schon, S. & Dahlquist, G. (2017). Socio-economic factors influencing the development of end-stage renal disease in people with Type 1 diabetes: a longitudinal population study. Diabetic Medicine, 34(5), 676-682
Open this publication in new window or tab >>Socio-economic factors influencing the development of end-stage renal disease in people with Type 1 diabetes: a longitudinal population study
2017 (English)In: Diabetic Medicine, ISSN 0742-3071, E-ISSN 1464-5491, Vol. 34, no 5, p. 676-682Article in journal (Refereed) Published
Abstract [en]

Aims: The development of end-stage renal disease (ESRD) in Type 1 diabetes is multifactorial. Familial socio-economic factors may influence adherence to and understanding of diabetes treatment, and also general health behaviour. We investigate how parental and personal education level and exposure to low economic status, indicated by the need for income support, influence the development of ERSD caused by Type 1 diabetes.

Methods: Participants were retrieved from the nationwide Swedish Childhood Diabetes Registry, which was linked to the Swedish Renal Registry, to find people with ESRD caused by Type 1 diabetes, and to Statistic Sweden to retrieve longitudinal socio-economic data on participants and their parents. Data were analysed using Cox regression modelling.

Results: Of 9287 people with diabetes of duration longer than 14 years, 154 had developed ESRD due to diabetes. Median diabetes duration (range) for all participants was 24.2 years (14.0-36.7 years). Low maternal education ( 12 years) more than doubled the risk of developing ESRD, hazard ration (HR) = 2.9 [95% confidence interval (95% CI): 1.7-4.8]. For people with a low personal level of education HR was 5.7 (3.4-9.5). In an adjusted model, the person's own education level had the highest impact on the risk of ESRD. If at least one of the parents had ever received income support the HR was 2.6 (1.9-3.6).

Conclusions: Socio-economic factors, both for the parents and the person with diabetes, have a strong influence on the development of ESRD in Type 1 diabetes. It is important for caregivers to give enough support to more vulnerable people and their families.

National Category
Pediatrics
Identifiers
urn:nbn:se:umu:diva-134699 (URN)10.1111/dme.13289 (DOI)000399672200012 ()27862276 (PubMedID)
Available from: 2017-06-30 Created: 2017-06-30 Last updated: 2018-11-08Bibliographically approved
Waernbaum, I. & Dahlquist, G. (2016). Low mean temperature rather than few sunshine hours are associated with an increased incidence of type 1 diabetes in children. European Journal of Epidemiology, 31(1), 61-65
Open this publication in new window or tab >>Low mean temperature rather than few sunshine hours are associated with an increased incidence of type 1 diabetes in children
2016 (English)In: European Journal of Epidemiology, ISSN 0393-2990, E-ISSN 1573-7284, Vol. 31, no 1, p. 61-65Article in journal (Refereed) Published
Abstract [en]

The well-known north-south gradient and the seasonal variability in incidence of childhood type1 diabetes indicate climatological factors to have an effect on the onset. Both sunshine hours and a low temperature may be responsible. In the present study we tried to disentangle these effects that tend to be strongly connected.

Exposure data were sunshine hours and mean temperature respectively obtained from eleven meteorological stations in Sweden which were linked to incidence data from geographically matched areas. Incident cases during 1983-2008 were retrieved from the population based Swedish childhood diabetes register. We used generalized additive models to analyze the incidence as a function of mean temperature and hours of sun adjusted for the time trend, age and sex.

In our data set the correlation between sun hours and temperature was weak (r=0.36) implying that it was possible to estimate the effect of these variables in a regression model. We fit a general additive model with a smoothing term for the time trend. In the model with sun hours we found no significant effect on T1 incidence (p=0.17) whereas the model with temperature as predictor was significant (p=0.05) when adjusting for the time trend, sex and age. Adding sun hours in the model where mean temperature was already present did not change the effect of temperature.

There is an association with incidence of type1 diabetes in children and low mean temperature independent of a possible effect of sunshine hours after adjustment for age, sex and time trend. The findings may mirror the cold effect on insulin resistance and accords with the hypothesis that overload of an already ongoing beta cell destruction may accelerate disease onset.

Place, publisher, year, edition, pages
Springer, 2016
Keywords
Climate, Incidence, Risk factors, Time trend adjustment, Type 1 diabetes mellitus
National Category
Public Health, Global Health, Social Medicine and Epidemiology Endocrinology and Diabetes Pediatrics
Identifiers
urn:nbn:se:umu:diva-101214 (URN)10.1007/s10654-015-0023-8 (DOI)000370376600007 ()
Funder
Swedish Research Council, 07531Riksbankens Jubileumsfond, P11-0814:1
Available from: 2015-03-25 Created: 2015-03-25 Last updated: 2018-06-07Bibliographically approved
Berhan, Y., Eliasson, M., Möllsten, A., Waernbaum, I. & Dahlquist, G. (2015). Impact of Parental Socioeconomic Status on Excess Mortality in a Population-Based Cohort of Subjects With Childhood-Onset Type 1 Diabetes. Diabetes Care, 38(5), 827-832
Open this publication in new window or tab >>Impact of Parental Socioeconomic Status on Excess Mortality in a Population-Based Cohort of Subjects With Childhood-Onset Type 1 Diabetes
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2015 (English)In: Diabetes Care, ISSN 0149-5992, E-ISSN 1935-5548, Vol. 38, no 5, p. 827-832Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: The aim of this study was to analyze the possible impact of parental and individual socioeconomic status (SES) on all-cause mortality in a population-based cohort of patients with childhood-onset type 1 diabetes.

RESEARCH DESIGN AND METHODS: Subjects recorded in the Swedish Childhood Diabetes Registry (SCDR) from 1 January 1978 to 31 December 2008 were included (n =14,647). The SCDR was linked to the Swedish Cause of Death Registry (CDR) and the Longitudinal Integration Database for Health Insurance and Labour Market Studies (LISA).

RESULTS: At a mean follow-up of 23.9 years (maximum 46.5 years), 238 deaths occurred in a total of 349,762 person-years at risk. In crude analyses, low maternal education predicted mortality for male patients only (P = 0.046), whereas parental income support predicted mortality in both sexes (P < 0.001 for both). In Cox models stratified by age-at-death group and adjusted for age at onset and sex, parental income support predicted mortality among young adults (≥18 years of age) but not for children. Including the adult patient’s own SES in a Cox model showed that individual income support to the patient predicted mortality occurring at ≥24 years of age when adjusting for age at onset, sex, and parental SES.

CONCLUSIONS: Exposure to low SES, mirrored by the need for income support, increases mortality risk in patients with childhood-onset type 1 diabetes who died after the age of 18 years.

National Category
Clinical Medicine Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:umu:diva-101362 (URN)10.2337/dc14-1522 (DOI)000353505600023 ()
Funder
Swedish Research Council, 07531
Available from: 2015-03-27 Created: 2015-03-27 Last updated: 2018-06-07Bibliographically approved
Toppe, C., Möllsten, A., Schön, S. & Dahlquist, G. (2015). Low cumulative incidence of end-stage renal disease in young patients with type 1 diabetes in Sweden: a population based study. Paper presented at 51st Annual Meeting of the European-Association-for-the-Study-of-Diabetes (EASD), Stockholm, SWEDEN, SEP 14-18, 2015. Diabetologia, 58(Suppl. 1 Abstr. 402), S201-S202
Open this publication in new window or tab >>Low cumulative incidence of end-stage renal disease in young patients with type 1 diabetes in Sweden: a population based study
2015 (English)In: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 58, no Suppl. 1 Abstr. 402, p. S201-S202Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Background and aims: A previous study from our group showed a low cumulative incidence of end-stage renal disease (ESRD) in a Swedish cohort of type 1 diabetes (T1D) patients with median duration of 20 years. We speculated that a good diabetes health care system might have postponed the peak incidence of ESRD and that young age at onset of T1D can postpone the development of diabetic nephropathy (DN) and ESRD. Moreover, diabetes onset during puberty may promote the development of diabetic complications. Our previous study also indicated differences by sex in ESRD development and a possible interaction with age at onset. Female patients who developed T1D after puberty had similar risk of ESRD as those with onset before 10 years of age. Male patients had the same high risk with onset during puberty and after puberty, those with onset before 10 years had the lowest risk. The aims of the present study are to assess the cumulative incidence of ESRD due to DN in a large prospective population-based cohort of T1D patients at maximum 36 years of diabetes duration and to study the effects of sex and age at onset of T1D.

Materials andmethods: Since 1977 all incident cases of T1D in the ages 0-14 years are recorded in the Swedish Childhood Diabetes Register (SCDR). The Swedish Renal Registry (SRR) started in 1991 and collects data on all patients with active uraemia treatment, ESRD. We decided to include patients with diabetes duration ≥14 years. In total 9381 patients from the SCDR were included. We have recently received permission to include data from the Swedish National Diabetes Register, a national quality register, and are awaiting data to include patients with age at onset 15-34 years.

Results: For the childhood onset cases the median diabetes duration was 23.8 years, maximum 36.7 years, and 154 patients had developed ESRD due to diabetes. The cumulative incidence was 4.5%. There was no statistical difference between male and female patients with age at diabetes onset before 15 years of age, males 5.0%, females 3.8%.We confirm that onset of diabetes before 10 years of age postpones the development of ESRD when compared to onset during 10-14 years, HR 2.3 (95% CI= 1.7-3.3). Further analyses will be available for presentation in September.

Conclusion: The cumulative risk of ESRD due to diabetic nephropathy in Swedish T1D patients at maximum36 years of diabetes duration is still exceptionally low. There is no difference in the development of ESRD between male and female patients with onset of diabetes before 15 years of age.

Place, publisher, year, edition, pages
Springer, 2015
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-109374 (URN)000359820901092 ()
Conference
51st Annual Meeting of the European-Association-for-the-Study-of-Diabetes (EASD), Stockholm, SWEDEN, SEP 14-18, 2015
Available from: 2015-09-30 Created: 2015-09-25 Last updated: 2018-11-08Bibliographically approved
Patterson, C., Gyürüs, E., Rosenbauer, J., Cinek, O., Neu, A., Schober, E., . . . Dahlquist, G. (2015). Seasonal 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. Pediatric Diabetes, 16(8), 573-580
Open this publication in new window or tab >>Seasonal 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
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2015 (English)In: Pediatric Diabetes, ISSN 1399-543X, E-ISSN 1399-5448, Vol. 16, no 8, p. 573-580Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2015
Keywords
epidemiology, seasonality, sunshine, temperature, temporal change, type 1 diabetes mellitus
National Category
Endocrinology and Diabetes Pediatrics
Identifiers
urn:nbn:se:umu:diva-101460 (URN)10.1111/pedi.12227 (DOI)000363929400002 ()25316271 (PubMedID)
Note

Article first published online: 15 October 2014

Available from: 2015-03-31 Created: 2015-03-31 Last updated: 2018-06-07Bibliographically approved
Patterson, C., Guariguata, L., Dahlquist, G., Soltész, G., Ogle, G. & Silink, M. (2014). Diabetes in the young - a global view and worldwide estimates of numbers of children with type 1 diabetes. Diabetes Research and Clinical Practice, 103(2), 161-175
Open this publication in new window or tab >>Diabetes in the young - a global view and worldwide estimates of numbers of children with type 1 diabetes
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2014 (English)In: Diabetes Research and Clinical Practice, ISSN 0168-8227, E-ISSN 1872-8227, Vol. 103, no 2, p. 161-175Article in journal (Refereed) Published
Abstract [en]

This paper describes the methodology, results and limitations of the 2013 International Diabetes Federation (IDF) Atlas (6th edition) estimates of the worldwide numbers of prevalent cases of type 1 diabetes in children (<15 years). The majority of relevant information in the published literature is in the form of incidence rates derived from registers of newly diagnosed cases. Studies were graded on quality criteria and, if no information was available in the published literature, extrapolation was used to assign a country the rate from an adjacent country with similar characteristics. Prevalence rates were then derived from these incidence rates and applied to United Nations 2012 Revision population estimates for 2013 for each country to obtain estimates of the number of prevalent cases. Data availability was highest for the countries in Europe (76%) and lowest for the countries in sub-Saharan Africa (8%). The prevalence estimates indicate that there are almost 500,000 children aged under 15 years with type 1 diabetes worldwide, the largest numbers being in Europe (129,000) and North America (108,700). Countries with the highest estimated numbers of new cases annually were the United States (13,000), India (10,900) and Brazil (5000). Compared with the prevalence estimates made in previous editions of the IDF Diabetes Atlas, the numbers have increased in most of the IDF Regions, often reflecting the incidence rate increases that have been well-documented in many countries. Monogenic diabetes is increasingly being recognised among those with clinical features of type 1 or type 2 diabetes as genetic studies become available, but population-based data on incidence and prevalence show wide variation due to lack of standardisation in the studies. Similarly, studies on type 2 diabetes in childhood suggest increased incidence and prevalence in many countries, especially in Indigenous peoples and ethnic minorities, but detailed population-based studies remain limited.

Place, publisher, year, edition, pages
Elsevier, 2014
Keywords
Diabetes, Incidence, Prevalence, Children, Type 1 diabetes, Type 2 diabetes
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-88552 (URN)10.1016/j.diabres.2013.11.005 (DOI)000333087200003 ()24331235 (PubMedID)
Available from: 2014-05-08 Created: 2014-05-08 Last updated: 2018-06-07Bibliographically approved
Berhan, Y., Möllsten, A., Carlsson, A., Högberg, L., Ivarsson, A. & Dahlquist, G. (2014). Five-region study finds no evidence of undiagnosed type 2 diabetes in Swedish 11- to 13-year-olds. Acta Paediatrica, 103(10), 1078-1082
Open this publication in new window or tab >>Five-region study finds no evidence of undiagnosed type 2 diabetes in Swedish 11- to 13-year-olds
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2014 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 103, no 10, p. 1078-1082Article in journal (Refereed) Published
Abstract [en]

AIM: Childhood obesity is now an established public health problem in most developed countries, and there is concern about a parallel increase of type 2 diabetes. The aim of this study was to estimate the prevalence of undiagnosed type 2 diabetes in overweight Swedish school children from 11 to 13 years of age.

METHODS: Body mass index (BMI) was measured in 5528 schoolchildren in the 6th grade, from 11 to 13 years of age, in five different regions in Sweden. Overweight was defined by international age- and sex-specific BMI cut-offs, corresponding to adult BMI cut-offs of 25 kg/m(2) at 18 years of age (ISO-BMI ≥25, n = 1275). Haemoglobin A1c (HbA1c) was measured in 1126 children with ISO-BMI ≥25. Children with a Diabetes Control and Complications Trial aligned HbA1c ≥6.1% on two occasions underwent an oral glucose tolerance test (OGTT) to establish the diabetes diagnosis.

RESULTS: Of 1126 children with ISO-BMI ≥25, 24 (2.1%) had at least one HbA1c value ≥6.1%. Three of them had HbA1c ≥6.1% on two occasions, and all of them had a normal OGTT.

CONCLUSION: In this cross-sectional, population-based screening study of a high-risk group of 11- to 13-year-old Swedish school children, we found no indication of undiagnosed diabetes or impaired glucose tolerance.

Keywords
childhood obesity, diabetes mellitus type 2, epidemiology
National Category
Pediatrics
Identifiers
urn:nbn:se:umu:diva-94194 (URN)10.1111/apa.12729 (DOI)000342753400022 ()24976437 (PubMedID)
Available from: 2014-10-06 Created: 2014-10-06 Last updated: 2018-06-07Bibliographically approved
Toppe, C., Möllsten, A., Schön, S., Jonsson, A. & Dahlquist, G. (2014). Renal replacement therapy due to type 1 diabetes; time trends during 1995-2010: a Swedish population based register study. Journal of diabetes and its complications, 28(2), 152-155
Open this publication in new window or tab >>Renal replacement therapy due to type 1 diabetes; time trends during 1995-2010: a Swedish population based register study
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2014 (English)In: Journal of diabetes and its complications, ISSN 1056-8727, E-ISSN 1873-460X, Vol. 28, no 2, p. 152-155Article in journal (Refereed) Published
Abstract [en]

Background: End stage renal disease (ESRD), is the most severe complication of diabetes mellitus. This population-based study analysed time trends for start of renal replacement therapy (RRT) due to type 1 diabetes compared to type 2 diabetes and other diagnoses. Material and Methods: We used data on patients who were registered 1995-2010 in the Swedish Renal Registry, a nationwide register covering 95 % of all patients with uraemia. The patients were analysed according to their original kidney disease. The incidence was analysed by calendar year, age at start of RRT and gender. Results: Of 17389 patients who were registered, 1833 had type 1 diabetes; 65% were men. The mean age at onset of RRT for patients with type 1 diabetes was 52.8 years which increased by more than 3 years over the studied period. The number of patients in need of RRT due to type 1 diabetes decreased, while RRT due to type 2 diabetes increased during the period studied. Conclusions: The overall incidence of RRT in Sweden is rather constant over the years but the need for RRT in type 1 diabetes patients decreased and patients with type 1 diabetes tend to become older at onset of RRT. 

Keywords
Diabetes mellitus, Incidence, Nephropathy, Renal replacement therapy
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-88411 (URN)10.1016/j.jdiacomp.2013.10.007 (DOI)000333542900010 ()
Available from: 2014-05-07 Created: 2014-05-05 Last updated: 2018-11-07Bibliographically approved
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