Increasing trend of childhood type 1 diabetes in Franche-Comté (France): analysis of age and period effects from 1980 to 1998.

AIMS/HYPOTHESIS: A study was conducted by the Franche-Comté Regional Association of Private Practitioners (Union Régionale des Médecins Libéraux de Franche-Comté) to assess trends in childhood-onset Type 1 diabetes in this administrative region of France, between 1980 and 1998. METHODS: Cases of childhood-onset Type 1 diabetes (aged 0-14 years) were retrospectively recorded with the help of general practitioners, private specialists and hospitals in the Franche-Comté and surrounding administrative regions. Incidence rates and trends during the period were analysed using Poisson regression. RESULTS: During the 19-year study period, 308 cases of childhood-onset Type 1 diabetes were identified. The level of case ascertainment was estimated to be 80.6% (95% CI: 74.7, 87.4). The male-to-female sex ratio was 1.03. The World standardised incidence rate was 6.90/100,000. The incidence rate was 6.03 (95% CI: 4.76, 7.53) for children aged 0 to 4 years, 6.45 (95% CI: 5.23, 7.88) for children aged 5-9 years and 8.56 (95% CI: 7.18, 10.13) for those aged 10-14 years. The annual increase rate was 4.9%, continuous and regular, without any deviation. This trend did not differ according to gender or age group. CONCLUSION/INTERPRETATION: These results confirm that the incidence and the increase rate in childhood Type 1 diabetes in France are average compared to in other European countries over an extended period of time. Furthermore, the regular and linear increase in incidence supports the hypothesis of causal environmental factors diffusing over time. The complementary data provided also illustrate the role that private practitioners may play by their implication in epidemiology and public health.

[Congenital generalized lipodystrophy. Lipid changes. Therapeutic trials]. / Lipodystrophie généralisée congénitale. Perturbations lipidiques. Essais thérapeutiques.

On the occasion of a new case of congenital generalized lipodystrophy the clinical features of this disease are reviewed. Furthermore, the frequent association of type V hypertriglyceridemia is emphasized. Various pathogenic hypotheses guide the therapeutic attempts, which are often unsuccessful.

Circadian metabolic rhythms in obese children.

Obese children display constant hyperinsulinism and, frequently, hyperphagia. In animals, lesions of the hypothalamic system affect simultaneously the circadian rhythm of insulin secretion and of food intake. In this study, circadian metabolic rhythm was examined in obese and non-obese children, by two different protocols. (1) Oral glucose tolerance tests (OGTT) were carried out at 9 a.m. and 3 p.m. on 2 consecutive days. (2) Circadian variations of plasma glucose and insulin were determined. After OGTT, in the control children there was a significant drop in the insulin/glucose ratio in the afternoon, whereas in the obese group this ratio remained high, with no significant change during the day. Differences were also observed in free fatty acid, growth hormone, and cortisol responses. The control children showed a circadian rhythm for blood glucose levels which was not present in obesity. These preliminary data suggest impairment of metabolic rhythms in obese children; they should stimulate further studies on the hypothalamic system in obesity.

[Plasma insulin, C-peptide and glucose concentrations in type I diabetic children after a morning injection of insulin (author's transl)]. / Taux plasmatiques d'insuline, de C peptide et de glucose chez l'enfant diabétique après injection matinale d'un mélange d'insulin.

Plasma levels of insulin, C-peptide and glucose were monitored for 24 hours after a single injection of a mixture of regular and protamine zinc insulin in 22 diabetic children. Results were compared with those in 7 control children. They indicate that plasma insulin in diabetic children is similar or higher than that in controls over the entire time of survey. Plasma insulin is usually high in the first part of the day. However, important variations were observed from one patient to another and, in the same patient, from one day to another. These results stress the necessity of a daily individual adaptation of the doses in diabetic children and adolescents treated with one or several daily injections of insulin.