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Impaired metabolic control and socio-demographic status in immigrant children at onset of type 1 diabetes
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden; Department of Pediatrics, Mälarsjukhuset Hospital, Eskilstuna.
Division of Paediatrics, Department of Molecular and Clinical Medicine, Linköping University; Department of Pediatrics, the University Hospital in Linköping, Linköping.
Centre for Clinical Research Sörmland, Uppsala University, Uppsala, Sweden.
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Pediatrics.
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. Vol. 31, no 11, 1418-1423 p.
Keyword [en]
diabetes type 1
National Category
Endocrinology and Diabetes
Identifiers
URN: urn:nbn:se:oru:diva-32946DOI: 10.1111/dme.12511ISI: 000344010200020PubMedID: 24861156Scopus ID: 2-s2.0-84902733946OAI: oai:DiVA.org:oru-32946DiVA: diva2:683757
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: 2017-12-06Bibliographically 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. 59 p.
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 102
Keyword
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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