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7. Age-period-cohort modelling of type 1 diabetes incidence rates among children included in the EURODIAB 25-year follow-up study

Author

Svensson, J., primary, Ibfelt, E. H., additional, Carstensen, B., additional, Neu, A., additional, Cinek, O., additional, Skrivarhaug, T., additional, Rami-Merhar, B., additional, Feltbower, R. G., additional, Castell, C., additional, Konrad, D., additional, Gillespie, K., additional, Jarosz-Chobot, P., additional, Marčiulionytė, D., additional, Rosenbauer, J., additional, Bratina, N., additional, Ionescu-Tirgoviste, C., additional, Gorus, F., additional, Kocova, M., additional, de Beaufort, C., additional, and Patterson, C. C., additional

Published
2022
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8. Mortality trends in type 1 diabetes: a multicountry analysis of six population-based cohorts.

Author

Ruiz, PLD, Chen, L, Morton, JI, Salim, A, Carstensen, B, Gregg, EW, Pavkov, ME, Mata-Cases, M, Mauricio, D, Nichols, GA, Pildava, S, Read, SH, Wild, SH, Shaw, JE, Magliano, DJ, Ruiz, PLD, Chen, L, Morton, JI, Salim, A, Carstensen, B, Gregg, EW, Pavkov, ME, Mata-Cases, M, Mauricio, D, Nichols, GA, Pildava, S, Read, SH, Wild, SH, Shaw, JE, and Magliano, DJ

Abstract

AIMS/HYPOTHESIS: Mortality has declined in people with type 1 diabetes in recent decades. We examined how the pattern of decline differs by country, age and sex, and how mortality trends in type 1 diabetes relate to trends in general population mortality. METHODS: We assembled aggregate data on all-cause mortality during the period 2000-2016 in people with type 1 diabetes aged 0-79 years from Australia, Denmark, Latvia, Scotland, Spain (Catalonia) and the USA (Kaiser Permanente Northwest). Data were obtained from administrative sources, health insurance records and registries. All-cause mortality rates in people with type 1 diabetes, and standardised mortality ratios (SMRs) comparing type 1 diabetes with the non-diabetic population, were modelled using Poisson regression, with age and calendar time as quantitative variables, describing the effects using restricted cubic splines with six knots for age and calendar time. Mortality rates were standardised to the age distribution of the aggregate population with type 1 diabetes. RESULTS: All six data sources showed a decline in age- and sex-standardised all-cause mortality rates in people with type 1 diabetes from 2000 to 2016 (or a subset thereof), with annual changes in mortality rates ranging from -2.1% (95% CI -2.8%, -1.3%) to -5.8% (95% CI -6.5%, -5.1%). All-cause mortality was higher for male individuals and for older individuals, but the rate of decline in mortality was generally unaffected by sex or age. SMR was higher in female individuals than male individuals, and appeared to peak at ages 40-70 years. SMR declined over time in Denmark, Scotland and Spain, while remaining stable in the other three data sources. CONCLUSIONS/INTERPRETATION: All-cause mortality in people with type 1 diabetes has declined in recent years in most included populations, but improvements in mortality relative to the non-diabetic population are less consistent.

Published
2022

9. Age-period-cohort modelling of type 1 diabetes incidence rates among children included in the EURODIAB 25-year follow-up study

Author

Svensson, J; https://orcid.org/0000-0002-9365-0728, Ibfelt, E H, Carstensen, B, et al, Konrad, Daniel; https://orcid.org/0000-0001-9067-4356, Svensson, J; https://orcid.org/0000-0002-9365-0728, Ibfelt, E H, Carstensen, B, et al, and Konrad, Daniel; https://orcid.org/0000-0001-9067-4356

Abstract

AIMS Specific patterns in incidence may reveal environmental explanations for type 1 diabetes incidence. We aimed to study type 1 diabetes incidence in European childhood populations to assess whether an increase could be attributed to either period or cohort effects. METHODS Nineteen EURODIAB centres provided single year incidence data for ages 0-14 in the 25-year period 1989-2013. Case counts and person years were classified by age, period and cohort (APC) in 1-year classes. APC Poisson regression models of rates were fitted using restricted cubic splines for age, period and cohort per centre and sex. Joint models were fitted for all centres and sexes, to find a parsimonious model. RESULTS A total of 57,487 cases were included. In ten and seven of the 19 centres the APC models showed evidence of nonlinear cohort effects or period effects, respectively, in one or both sexes and indications of sex-specific age effects. Models showed a positive linear increase ranging from approximately 0.6 to 6.6%/year. Centres with low incidence rates showed the highest overall increase. A final joint model showed incidence peak at age 11.6 and 12.6 for girls and boys, respectively, and the rate-ratio was according to sex below 1 in ages 5-12. CONCLUSION There was reasonable evidence for similar age-specific type 1 diabetes incidence rates across the EURODIAB population and peaks at a younger age for girls than boys. Cohort effects showed nonlinearity but varied between centres and the model did not contribute convincingly to identification of environmental causes of the increase.

Published
2022

20. Trends in the incidence of diagnosed diabetes: a multicountry analysis of aggregate data from 22 million diagnoses in high-income and middle-income settings

Author

Magliano, DJ, Chen, L, Islam, RM, Carstensen, B, Gregg, EW, Pavkov, ME, Andes, LJ, Balicer, R, Baviera, M, Boersma-van Dam, E, Booth, GL, Chan, JCN, Chua, YX, Fosse-Edorh, S, Fuentes, S, Gulseth, HL, Gurevicius, R, Ha, KH, Hird, TR, Jermendy, G, Khalangot, MD, Kim, DJ, Kiss, Z, Kravchenko, VI, Leventer-Roberts, M, Lin, CY, Luk, AOY, Mata-Cases, M, Mauricio, D, Nichols, GA, Nielen, MM, Pang, D, Paul, SK, Pelletier, C, Pildava, S, Porath, A, Read, SH, Roncaglioni, MC, Ruiz, PLD, Shestakova, M, Vikulova, O, Wang, KL, Wild, SH, Yekutiel, N, and Shaw, JE

Abstract

Background Diabetes prevalence is increasing in most places in the world, but prevalence is affected by both risk of developing diabetes and survival of those with diabetes. Diabetes incidence is a better metric to understand the trends in population risk of diabetes. Using a multicountry analysis, we aimed to ascertain whether the incidence of clinically diagnosed diabetes has changed over time. Methods In this multicountry data analysis, we assembled aggregated data describing trends in diagnosed total or type 2 diabetes incidence from 24 population-based data sources in 21 countries or jurisdictions. Data were from administrative sources, health insurance records, registries, and a health survey. We modelled incidence rates with Poisson regression, using age and calendar time (1995-2018) as variables, describing the effects with restricted cubic splines with six knots for age and calendar time. Findings Our data included about 22 million diabetes diagnoses from 5 billion person-years of follow-up. Data were from 19 high-income and two middle-income countries or jurisdictions. 23 data sources had data from 2010 onwards, among which 19 had a downward or stable trend, with an annual estimated change in incidence ranging from -1.1% to -10.8%. Among the four data sources with an increasing trend from 2010 onwards, the annual estimated change ranged from 0.9% to 5.6%. The findings were robust to sensitivity analyses excluding data sources in which the data quality was lower and were consistent in analyses stratified by different diabetes definitions. Interpretation The incidence of diagnosed diabetes is stabilising or declining in many high-income countries. The reasons for the declines in the incidence of diagnosed diabetes warrant further investigation with appropriate data sources. Copyright (C) 2021 Elsevier Ltd. All rights reserved.

Published
2021

29. Abstracts

Author

Miethke, H., Klostermeyer, H., Coduro, E., Werner, U., Steinhart, H., Engelhardt, U., Herrmann, K., Schwerdtfeger, E., Brauckhoff, S., Tofern, B., Hener, U., Wegner-Hambloch, S., Schrödter, R., Simat, T., Griffig, J., van Wickern, B., von Wachtendonk, D., Pabel, B., Scherz, H., Renger, A., Hagenauer-Hener, U., Meyer, S., Feldheim, W., Reiners, W., Galensa, R., Jahn, C., Hartmann, S., Männlein, E., Manthey, M., Karl, H., Wittmann, R., Täubert, T., Stumm, I., Täufel, A., Oehlenschläger, J., Köhnlein, M., Paschke, A., Hein, W., Ehlermann, D., Schynowski, F., Schlüter, S., Müller, B., Timm, M., Beil, D., Wedekind, R., Schulz, H., Lehmann, G., Zorn, H., Rei, J., Besler, M., Rohrdanz, A., Rathjen, T., Möller, M., von Rymon Lipinski, G., Lederer, M., Karg, J., Sengl, M., Seulen, P., Bauer, U., Majerus, P., Rothenbücher, L., Armbruster, W., Wettach, J., Hild, J., Vogelgesang, J., Wölwer-Rieck, U., van Lishaut, H., Hübner, D., Broschard, T., Carstensen, B., Breithaupt, D., Brüger, B., Kohl-Himmelseher, M., Bartsch, A., Lacorn, M., Schubring, R., Fritsche, J., Otteneder, H., Endres, O., Hahn, H., Rohse, H., Pfaff, K., Gutmacher, B., Stephani, A., Schmidt, C., and Krings, U.

Published
1996
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30. Abstracts

Author

Hagenauer-Hener, U., Engelhardt, U., Kroh, L., Schulz, H., Schwerdtfeger, E., Herrmann, K., von Wachtendonk, D., Steinhart, H., Eulitz, K., Möller, M., Hener, U., Besler, M., Simat, T., van Wickern, B., Schulz, C., Feldheim, W., Scherz, H., Miethke, Manthey, M., Carstensen, B., Dillhage, N., Fritsche, J., Männlein, E., Wegner-Hambloch, S., Pabel, B., Pabel, S., Reiners, W., Heimhuber, B., Knerr, T., Renger, A., Täufel, A., Rathjen, T., Täubert, T., Timm, M., Otteneder, H., Hübner, D., Broschard, T., Hein, W., Zorn, H., van Lishaut, H., Kohl-Himmelseher, M., Reiß, J., Meyer, S., Schlüter, S., Mätzel, U., Brüger, B., Hartmann, S., Hees, C., Majerus, P., Beil, D., Breithaupt, D., Ledereraf, M., Seulen, P., Hild, J., Griffig, J., Wittmann, R., Armbruster, W., Wölwer-Rieck, U., Köhnlein, M., Wettach, J., Sengl, M., Bauer, U., Rohrdanz, A., Schynowski, F., Vogelgesang, J., Werner, U., Paschke, A., Spiegel, H., Bartsch, A., Bohnenstengel, F., Haselein, I., Karg, J., Brockmann, R., Schubring, R., Fretzdorff, B., Simat, Thomas, Marx, F., Endres, O., Wischmann, H., Schulz, Chr, Wedekind, R., Pfaff, K., Stephani, A., Raddatz, H., Ehlermann, D., Hahn, H., Rohse, H., and Krings, U.

Published
1996
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40. Incidence of HPV-related Anogenital Intraepithelial Neoplasia and Cancer in Men With Diabetes Compared With the General Population.

Author

Reinholdt, Kristian, Thomsen, Louise Thirstrup, Munk, Christian, Dehlendorff, Christian, Carstensen, Bendix, Jørgensen, Marit Eika, Kjaera, Susanne Krüger, Kjaer, Susanne Krüger, Reinholdt, K, Thomsen, L T, Munk, C, Dehlendorff, C, Carstensen, B, Jørgensen, M E, and Kjaer, S K

Abstract

Background: Diabetes may increase risk of human papillomavirus (HPV)-related precancer and cancer. We estimated incidence of penile and anal high-grade intraepithelial neoplasia (hgPeIN, hgAIN) and squamous cell carcinoma (SCC) in men with diabetes compared with the entire Danish male population without diabetes.Methods: In this registry-based cohort study, we included all men born 1916-2001 and residing in Denmark (n = 2,528,756). From nationwide registries, we retrieved individual-level information on diabetes, educational level, and diagnoses of hgPeIN, hgAIN, penile SCC, and anal SCC. We used Poisson regression models to estimate incidence of hgPeIN, hgAIN, penile SCC, and anal SCC as a function of diabetes status, attained age, calendar period, and education. We estimated incidence rate ratios (IRRs) of each outcome in men with diabetes compared with nondiabetic men, both for diabetes overall and separately for type 1 (T1D) and type 2 diabetes (T2D).Results: Men with diabetes had increased incidence rate of penile SCC compared with nondiabetic men (IRR = 1.5, 95% CI = 1.2, 1.9). We saw similar trends for anal SCC, hgPeIN, and hgAIN. The combined incidence rate of penile and anal SCC was increased in men with T2D (IRR = 1.5, 95% CI = 1.3, 1.8), but not with T1D (IRR = 0.53, 95% CI = 0.20, 1.4) compared with men without diabetes.Conclusion: The incidence of penile and anal high-grade intraepithelial neoplasia and SCC in men with diabetes was increased compared with men without diabetes. For penile and anal SCCs, this was primarily due to an increased risk in men with T2D. [ABSTRACT FROM AUTHOR]

Published
2021
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50. Cancer incidence in persons with type 1 diabetes: a five-country study of 9,000 cancers in type 1 diabetic individuals

Author

Carstensen, B, Read, SH, Friis, S, Sund, R, Keskimaki, I, Svensson, A-M, Ljung, R, Wild, SH, Kerssens, JJ, Harding, JL, Magliano, DJ, Gudbjornsdottir, S, Carstensen, B, Read, SH, Friis, S, Sund, R, Keskimaki, I, Svensson, A-M, Ljung, R, Wild, SH, Kerssens, JJ, Harding, JL, Magliano, DJ, and Gudbjornsdottir, S

Abstract

AIMS/HYPOTHESIS: An excess cancer incidence of 20-25% has been identified among persons with diabetes, most of whom have type 2 diabetes. We aimed to describe the association between type 1 diabetes and cancer incidence. METHODS: Persons with type 1 diabetes were identified from five nationwide diabetes registers: Australia (2000-2008), Denmark (1995-2014), Finland (1972-2012), Scotland (1995-2012) and Sweden (1987-2012). Linkage to national cancer registries provided the numbers of incident cancers in people with type 1 diabetes and in the general population. We used Poisson models with adjustment for age and date of follow up to estimate hazard ratios for total and site-specific cancers. RESULTS: A total of 9,149 cancers occurred among persons with type 1 diabetes in 3.9 million person-years. The median age at cancer diagnosis was 51.1 years (interquartile range 43.5-59.5). The hazard ratios (HRs) (95% CIs) associated with type 1 diabetes for all cancers combined were 1.01 (0.98, 1.04) among men and 1.07 (1.04, 1.10) among women. HRs were increased for cancer of the stomach (men, HR 1.23 [1.04, 1.46]; women, HR 1.78 [1.49, 2.13]), liver (men, HR 2.00 [1.67, 2.40]; women, HR 1.55 [1.14, 2.10]), pancreas (men, HR 1.53 [1.30, 1.79]; women, HR 1.25 [1.02,1.53]), endometrium (HR 1.42 [1.27, 1.58]) and kidney (men, HR 1.30 [1.12, 1.49]; women, HR 1.47 [1.23, 1.77]). Reduced HRs were found for cancer of the prostate (HR 0.56 [0.51, 0.61]) and breast (HR 0.90 [0.85, 0.94]). HRs declined with increasing diabetes duration. CONCLUSION: Type 1 diabetes was associated with differences in the risk of several common cancers; the strength of these associations varied with the duration of diabetes.

Published
2016

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