Title of Project : Type 1 diabetes in Northern Ireland children epidemiology, Diabetes is a common and important public health problem, the burden of which is …
Title of Project : Type 1 diabetes in Northern Ireland children -
epidemiology, risk factors and complications
Supervisors : Dr C Patterson and Dr C Cardwell
Aims
Epidemiology: ? To continue to monitor the temporal and geographical
incidence of childhood onset Type 1 diabetes throughout
Northern Ireland
Risk factors: ? To use the Northern Ireland Child Health System
database to investigate early life
environmental risk factors for Type 1diabetes
? To review associations between perinatal risk factors for
childhood onset Type 1 diabetes and conduct meta-analyses of the many
published case-control and cohort studies
? To investigate the association between Type 1 diabetes and
maternal exposure to infections and antibiotics during
pregnancy using data from the General Practice Research
Database
Complications: ? To follow-up the children on the register for mortality
and the occurrence of renal disease
Background
Diabetes is a common and important public health problem, the burden of
which is measured not only in terms of premature mortality and morbidity,
but also by the magnitude of
the cost to the NHS of patient management and
the treatment of complications Although most cases of diabetes occur in
adults, type 1 diabetes is one of the commonest chronic diseases of
childhood, affecting more than 15,000 children aged under 15 years in the
UK To these children and their families diabetes is a major concern, as
therapy currently consists of lifelong insulin injections aimed at
controlling symptoms and diminishing complications rather than providing a
cure In the UK, the incidence of childhood onset Type 1 diabetes has
doubled in the last 20 years but the cause of this increase remains largely
unknown Worryingly the increase is most marked in children under five
years whose disease is difficult to manage clinically and whose
complications are likely to occur at younger ages leading to lost years of
economic productivity Identification of risk factors may lead to
prevention strategies that should reduce health service expenditure
Outline Plan Of Investigation
Epidemiology ? Since 1989 a register of new cases of childhood onset Type
1 diabetes has been maintained throughout Northern Ireland The register
now contains information on 2,500 children with diabetes
some with
diagnosed in the early 1980s and has formed the basis for studies of both
environmental and genetic risk factors for the disease This register
allows continued monitoring of the temporal and geographical distribution
of the incidence of disease throughout Northern Ireland the description of
which will form the first part of this PhD project
Risk factors: ? The Child Health Surveillance system was introduced in the
late 1980s replacing an older child health database which contained only
limited obstetric and neonatal data The system records data on breast
feeding, growth and vaccinations all of which are regarded as potential
risk factors for Type 1 diabetes Over 1,000 children from the Type 1
diabetes register born after 1986 will be identified in the Child Health
Surveillance system This will assist in the identification of risk
factors for Type 1 diabetes focusing particularly on early onset disease
? The General Practice Research Database GPRD is
one of the largest databases of anonymised longitudinal medical records
from primary care Agreement has been obtained to extract maternal data
during pregnancy for approximately 370 cases of
childhood onset Type 1
diabetes and up to 20 randomly selected controls These data will allow the
investigation of maternal characteristics including exposure to infections
during pregnancy and prescribed antibiotics during pregnancy
? It is planned to continue on-going work on
systematic review and meta-analysis of published studies on environmental
risk factors for Type 1 diabetes We have reviewed atopy as a potential
risk factor Diabetes Care, 2003 and showed only a weak protective effect
In a second review we found a small but significant elevation in risk
among children born by Caesarean section Diabetologia, 2008 The PhD
will include further systematic reviews of perinatal factors such as
parental age, birth order, birthweight and pre-eclampsia
Complications ? The majority of early deaths in children with type 1
diabetes are likely to be due to acute metabolic disturbances
hypoglycaemia or diabetic ketoacidosis, but a recent publication from
Leeds identified drug misuse as a common cause of death in young diabetics
We will investigate if there is any evidence to support this in Northern
Ireland by having the Central Services Agency flag children
from the
register in their master patient index
? It is important to establish if better diabetic
control in recent years is reducing the incidence of diabetic nephropathy
and end-stage renal failure Although prospective registration began in
1989, a survey of children with existing diabetes was conducted at that
time so that more than 500 children on the register were diagnosed in the
1980s giving sufficient follow-up for the potential development of diabetic
renal disease We will investigate the incidence of diabetic nephropathy
and renal failure in children from the register by matching records from
the Northern Ireland Renal Service
Summary
These projects will provide a comprehensive research programme into the
epidemiology, risk factors and complications of childhood onset Type 1
diabetes A number of distinct but related projects are proposed which
will allow some flexibility should there be problems in obtaining access to
certain data sources
