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Objectives: To investigate long-term mortality and its temporal trends as of 1 January 1999 among the 1,075 patients with type 1 diabetes (onset age <18 years, diagnosed between 1965 and 1979) who comprise the Allegheny County population-based registry.Research Design and Methods: Overall, sex- and race-specific mortality rates per person-year of follow-up were determined. Standardized mortality ratios were also calculated. Survival analyses and Cox proportional hazard model were also used. Temporal trends were examined by dividing the cohort into three groups by year of diagnosis (1965-1969, 1970-1974, and 1975-1979).Results: Living status of 972 cases was ascertained as of January 1, 1999 (ascertainment rate 90.4%). The mean duration of diabetes was 25.2 +/- 5.8 (SD) years. Overall, 170 deaths were observed. The crude mortality rate was 627 per 100,000 person-years (95% CI 532-728) and standardized mortality ratio was 519 (440-602). Life-table analyses by the Kaplan-Meier method indicated cumulative survival rates of 98.0% at 10 years, 92.1% at 20 years, and 79.6% at 30 years duration of diabetes. There was a significant improvement in the survival rate between the cohort diagnosed during 1965-1969 and that diagnosed during 1975-1979 by the log-rank test (P = 0.03). Mortality was higher in African-Americans than in Caucasians, but there were no differences seen by sex. The improvement in recent years was seen in both ethnic groups and sexes.Conclusions: An improvement in long-term survival was observed in the more recently diagnosed cohort. This improvement is consistent with the introduction of HbA1 testing, home blood glucose monitoring, and improved blood pressure therapy in the 1980s. [ABSTRACT FROM AUTHOR]

The developing countries are currently facing a double burden of communicable and non-communicable diseases. Physician-scientists, trained in patient care and research skills are crucial in performing cutting-edge clinical research in the developing countries. A major unmet challenge has been the lack of local expertise and the increasing problem of 'brain drain'. The current study was an effort to present and assess a model of research training to health-care professionals in Pakistan in order to increase the research skills. The objective of the current study was to assess the effectiveness of two different methods of research training. An epidemiologic research training workshop was offered to health-care professionals in Pakistan by face-to-face (F2F) and video-teleconferencing (VTC) methods. A total of 38 F2F and 18 VTC participants were included in the workshop which was conducted by research faculty from the University of Pittsburgh. To assess knowledge, pre- and post-test were done. Within each group, paired sample T-test showed significant improvement in scores after the completion of workshop (p<0.001 for F2F and VTC). In the F2F group, mean scores increased from 11.13 (pre-test) to 15.08 (post-test) and in the VTC group, scores increased from 10.67 (pre-test) to 13.22 (post-test). Two sample T-test was found statistically significant (p<0.001). We present a model for training physicians in public health by providing in-house research skills training which can be used to strengthen the local capacity and reduce increasing problems of brain drain. [ABSTRACT FROM AUTHOR]

Objective: Although management of type 1 diabetes improved dramatically in the 1980s, the effect on mortality is not clear.Research Design and Methods: We report trends in 30-year mortality using the Allegheny County (Pennsylvania) childhood-onset (age <18 years) type 1 diabetes registry (n = 1,075) with diagnosis from 1965-1979, by dividing the cohort into three diagnosis year cohorts (1965-1969, 1970-1974, and 1975-1979). Local (Allegheny County) mortality data were used to calculate standardized mortality ratios (SMRs).Results: As of 1 January 2008, vital status was ascertained for 97.0% of participants (n = 1,043) when mean age ± SD and duration of diabetes were 42.8 ± 8.0 and 32.0 ± 7.6 years, respectively. The 279 deaths (26.0%) observed were 7 times higher than expected (SMR 6.9 [95% CI 6.1-7.7]). An improving trend in SMR was seen by diagnosis cohort at 30 years of diabetes duration (9.3 [7.2-11.3], 7.5 [5.8-9.2], and 5.6 [4.0-7.2] for 1965-1969, 1970-1974, and 1975-1979, respectively). Although no sex difference in survival was observed (P = 0.27), female diabetic patients were 13 times more likely to die than age-matched women in the general population (SMR 13.2 [10.7-15.7]), much higher than the SMR for men (5.0 [4.0-6.0]). Conversely, whereas 30-year survival was significantly lower in African Americans than in Caucasians (57.2 vs. 82.7%, respectively; P < 0.001), no differences in SMR were seen by race.Conclusions: Although survival has clearly improved, those with diabetes diagnosed most recently (1975-1979) still had a mortality rate 5.6 times higher than that seen in the general population, revealing a continuing need for improvements in treatment and care, particularly for women and African Americans with type 1 diabetes. [ABSTRACT FROM AUTHOR]

The discovery of islet cell antibodies (ICAs) was the prelude to the understanding that type 1 diabetes mellitus (T1DM) is a chronic autoimmune disease. The issue regarding whether or not the measurement of ICAs should be completely replaced by biochemical markers detecting islet autoantibodies (AAs) for the prediction of T1DM has been the subject of endless international debates. In light of this controversy, we assessed the current role of ICAs as a predictive marker for T1DM progression. We examined a cohort of 1484 first-degree relatives (FDRs) of T1DM probands from the Children's Hospital of Pittsburgh Registry. These relatives were consecutively enrolled between 1979 through 1984 and followed up to 22 yr. Serum obtained at the time of enrollment was assayed for ICAs, glutamic acid decarboxylase (GAD)65, insulin A (IA)-2 AA, and insulin AAs (IAAs). In FDRs who had ICAs in addition to GAD65 and IA-2 AAs, the cumulative risk of developing insulin-requiring diabetes was 80% at 6.7 yr of follow-up, whereas this risk in those with GAD65 and IA-2 AAs without ICAs was only 14% at 10 yr of follow-up (log rank: P < 0.00001). Cox regression analysis showed that diabetes risk was significantly associated with the presence of ICAs in both subjects with low titer and high titer GAD65 and IA-2 AAs. The addition of IAAs in GAD65 and IA-2 AA-positive relatives did not increase the cumulative risk for conversion to insulin-treated diabetes. We provide evidence that a subgroup of ICAs predicts a more rapid progression to insulin-requiring diabetes in GAD65 and IA-2 AA-positive relatives and should remain part of the assessment of T1DM risk for intervention trials. In addition, these findings provide impetus for efforts to identify a novel islet autoantigen(s) reactive with this ICA subset. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The aim of this study was to search for the seasonal and geographic variations in epidemics of type 1 diabetes in China. Research design and methods: Incidence data from 22 type 1 diabetes registration centers across China were analyzed. A Poisson regression model with a sine wave function was applied to evaluate the seasonal trends. A scan statistic was used to examine the occurrence of an epidemic. RESULTS: There was a significant cyclic trend of incidence of type 1 diabetes in China. The northern area had a higher incidence rate than the southern area. Epidemics were discovered in Dalian and Shenyang from late 1992 to late 1993. CONCLUSIONS: There was a strong association of climate and incidence of type 1 diabetes in China, whereby the incidence was higher in the colder areas and in the winter months. Evidence of epidemics existed in two centers in 1992--1993. It is critical to identify the epidemics early and determine the causes of epidemics. [ABSTRACT FROM AUTHOR]