Comparison of the incidence of insulin-dependent diabetes mellitus in childhood among five Baltic populations during 1983-1988.

We have carried out a comparison of the incidence of childhood onset insulin-dependent diabetes mellitus (IDDM) between five populations around the Baltic Sea. These were Finland, Estonia, Latvia, Lithuania and Poland. The risk of IDDM is highest in the world in Finland and also very high in Sweden, on the western and northern side of the Baltic Sea. The risk of IDDM in children on the eastern side of the Baltic Sea has not been known before. The data collection period covered the years 1983-1988. A marked variation in incidence was seen within this relatively small geographical area. Among these five populations, the incidence increased with the latitude. Our present results confirmed the very high incidence of IDDM in Finland. The average age-standardized yearly incidence of IDDM/100,000 was in males under 15 years of age 36.9 in Finland, 10.7 in Estonia, 6.4 in Latvia, 6.5 in Lithuania and 6.0 in Poland. In females the incidence was 31.6, 10.0, 6.9, 7.0 and 6.4 in these five populations, respectively. The differential in incidence in Estonia as compared with Latvia, Lithuania and Poland was statistically significant (P = 0.0002). A slight male excess in incidence was found in countries with higher incidence--Finland and Estonia, but in lower incidence countries the sex ratio was opposite (P = 0.019 for the interaction sex-population). During 1983-1988 the incidence increased significantly in Finland but not in other populations although a large year-to-year variation in incidence was observed in each country, particularly in males. We recorded a peak in IDDM incidence in most of these populations around 1986.

Comparison of incidence of IDDM in childhood between Estonia and Finland, 1980-1988.

OBJECTIVE: To compare nationwide incidence of childhood insulin-dependent diabetes mellitus (IDDM) in children aged 0-14 yr between Estonia and Finland during 1980-1988. For Estonia, which has a population genetically and linguistically related to Finland, only limited information was available. Finland has the highest incidence of IDDM in the world. RESEARCH DESIGN AND METHODS: The registration of all new cases of IDDM in Estonia was conducted by the local district pediatricians who reported every newly diagnosed diabetic patient to the Republic Endocrinology Centre. Registration of all new cases of IDDM in Finland was based on the statistics of the Social Insurance Institution, which approves free-of-charge insulin treatment for diabetes. These data were validated with one or more additional data sources. The case ascertainment rate approached 100% in both countries. RESULTS: The average yearly incidence of IDDM standardized for age for the years 1980-1988 in Estonia was approximately 33% of that in Finland. Among males it was 11.3 (95% confidence interval [CI] 10.3-12.3) per 100,000 in Estonia and 35.1 (95% CI 33.4-36.9) per 100,000 in Finland, and among females 10.1 (95% CI 9.2-11.1) per 100,000 in Estonia and 30.4 (95% CI 28.8-32.1) per 100,000 in Finland. When the two periods 1980-1982 and 1986-1988 were compared, the age-standardized incidence in Estonia remained unchanged, whereas in Finland it increased approximately 20%. CONCLUSIONS: The data between two populations who are ethnically and linguistically similar and live geographically close but in a different environment, provides further evidence that both genetic and environmental factors are contributing to the risk of IDDM.

Incidence and prevalence of type 1 (insulin-dependent) diabetes in Estonia in 1988.

The objective of this study was to determine the incidence and prevalence of Type 1 (insulin-dependent) diabetes in Estonia in different sex and age groups. The data collection was based on a centralized retrospective registration of all cases of Type 1 diabetes nationwide using the records of all hospitals and polyclinics where diabetic patients are treated. In 1988, 35 new cases of Type 1 diabetes were diagnosed among children aged 0-14 years (10.3 per 100,000) and 131 among the population over 15 years. The highest incidence of Type 1 diabetes (39.9 per 100,000) was found in the age group 15-19 years. The total number of patients with Type 1 diabetes in Estonia was 2,719 in 1988. The overall prevalence was 1.72 per 1,000. It was highest in the age group 40-49 years (3.04 in males and 2.77 in females). In children under 15 years 204 cases of Type 1 diabetes were identified at the end of 1988. These data suggest that the risk of Type 1 diabetes in Estonia is not low, but is certainly not as high as in Finland where the population is ethnically and linguistically similar and where the highest incidence of Type 1 diabetes is found.

[Immunoreactive insulin level in the blood and the blast transformation reaction to insulin and the pancreatic tissue at the initial stages of diabetes mellitus]. / Uroven' immunoreaktivnogo insulina v krovi i reaktsiia blasttransformatsii k insulinu i tkani podzheludochnoi zhelezy v nachal'nykh stadiiakh sakharnogo diabeta.

The following was examined in 60 adult persons with normal weight and obesity: insulin level during the glucose tolerance test and lymphocyte sensitization to insulin and the pancreas tissue. An increased insulin level both on fasting stomach and after glucose tolerance was noted in obese persons. A delayed elevation of insulin level, particularly in combination of obesity with deranged glucose tolerance was often seen. Immunological reactions to insulin and the pancreatic tissue were mostly noted in patients with moderate obesity and at the initial stage of the carbohydrate metabolism deragement. Lymphocyte sensitization to insulin was characteristic of cases when the glucose was flat, insulin secretion--moderately elevated and insulin/glucose index--increased.

[Study of glucose tolerance disorder in women with a complicated obstetrical anamnesis]. / Izuchenie narusheniia tolerantnosti k gliukoze u zhenshchin s oslozhnennym akusherskim anamnezom.

The authors examined selectively 849 women with complicated obstetrical anamnesis in the past and at random 636 women with the aid of the glucose tolerance test (GTT). The incidence of pathological GTT among women with various types of pathology of pregnancy (24%) was greater than in the control group (16.9%). Diabetes mellitus was revealed in 7.8 and 5.1% of cases, respectively. Some types of pathology of pregnancy were of particular significance in the development of the prediabetic state. A high incidence of GTT of diabetic type was noted in women with perinatal death of the fetus (13.1%) and the neonate (11.8%), in women with a large fetus in combination with other types of pathology of pregnancy (12.6%), and also among women who had delivered three and more large fetuses in the past (19.5%). The incidence of diabetic GTT increased in older and obese women; in marked excess of body weight the percentage of GTT of diabetic type was about the same in all the women under study. Among the women with pathology of pregnancy adiposity developed more frequently and in younger persons, and the excess of body weight was much greater in comparison with the control group. The authors consider that GTT should be conducted in all the women with the mentioned pathology of pregnancy in the anamnesis for the purpose of early detection of diabetes mellitus and also for perinatal fetal protection.