Il pianeta Diabete - Sezioni Regionali

La SINDROME CARDIO-NEFRO-METABOLICA
Tempio, Hotel Pausania Inn, 1 Ottobre 2010
Epidemiologia del diabete mellito
Il pianeta Diabete
Marco Songini, Primario
SC di Diabetologia - Azienda
Ospedaliera “G.Brotzu”Cagliari
L’EPIDEMIA DI
DIABETE
195 mil DM di cui
5 mil IDDM (400.000
bambini)
Diabete mellito: classificazione
(2009)
Diabete di tipo 1 (insulino-dipendente)
– Autoimmune classico e LADA/NIRAD, neonatale IPEX (X-linked recessivo)
– Idiopatico
– fulminante
Diabete di tipo 2 (non insulino-dipendente)
Diabete gestazionale (tipo 1 e 2)
Diabete da:
da
– difetti genetici funzione β-cellula: MODY 1, 2, 3, DNA mitocondriale,
neonatale...
– difetti genetici azione insulinica: insulino resistenza tipo A, leprecaunismo, . .
– patologie pancreas esocrino: pancreatite, pancreatectomia, tumori, fibrosi
cistica . .
– endocrinopatie: acromegalia, Cushing, feocromocitoma, glucagonoma, . .
– da farmaci e sostanze chimiche: glucocorticoidi, tiazidici, diazossido, vacor, .
.
– infezioni: rosolia congenita, . .
– sindromi genetiche associate: Down, Klinefelter, Turner, Wolfram,
Friedereich, . .
Major types of diabetes
and metabolic syndrome
this century
Demenza
+
Alzheimer
Type3
Type1classico
+
Lada
Type2
+
Sindrome
Metabolica
Type2
Mody
DM
Undiagnosed
‘hidden’ ‘hidden
AGT (IGT eepidemic’
IFG)
(IGT e IFG)
IGT+IFG / Pre-Diabetes
Negli USA 15 + 26%
‘hidden’ AGT (IGT e IFG)
At-Risk + Met Syn
Harris et al., Diabetes Care, 1998
Costi del Diabete (2010)
€ 11 miliardi (>8 % del totale della SS)
Procapite: sino a > € 8.000 l’anno
17.3%
Morte prematura
Disabilità 37.8%
28%
Ambulatorio
6.7%
Ricovero
5.6%
Infermiere
domiciliare
US ’97 $ 98 billions 2002 132 ; pt/y 13.243 vs healthy/y 2.560 = 1\3 spesa sanità US
Epidemiologia del diabete tipo 2
The World ‘Epidemic’ Trend of Diabetes & Obesity
Estimated prevalence increasing….has incidence
paralleled as much? 0.9 western countries but
2.9% yearly far east countries
millions of patients
350
300
250
200
150
100
50
0
1990 1995 2000 2005 2010 2015 2020 2025 2030
calendar year
Prevalenza del diabete, 1995
(età > 20 aa)
Circa 97 milioni di diabetici nel mondo
7%
5%
5%
5%
5%
22%2
22%2
6%
6%
1%
1%
6%
3%
6%
6%
5%
5%
King, Aubert, Herman: Diabetes Care, 1998
L’epidemia di diabesità anni 2000’ età 20-79 yrs :
DM,obesità,SM + ‘hidden’ AGT (IGT e IFG)
26.
5
32.
9
24
%
14.
2
17.
5
23
%
84.5
132.
3
57%
9.4
15.
6
22.
5
44
%
14.
1
50
%
1.0
1.3
30
%
Mondo
2000:162 millioni DM, 314 milioni IGT/SM
Incidenza nel 2000
2010: 220 millioni (+46%)
Incidenza nel 2010
% aumento dal 2000 al 2010 2030: >200% =366 milioni, >500mil AGT/SM
Eccesso morte da DM 2000 = 6%(3.2mil)
80% nel 3°+ 4° mondo
Modificato da Amos AF et al Diabet Med 1997;14:S7-S85.
Increasing Burden of Chronic Diseases
DIABETE USA TIPO 2 = 17 MILIONI
DIABETE USA TIPO 1 = 1.5 MILIONI
Age Distribution of the US Population
Age groups where
chronic disease is
most prevalent
Source: 2000 US Census
50,000,000
45,000,000
40,000,000
Population
35,000,000
Population shift
will increase
care burden
30,000,000
25,000,000
2.5X
20,000,000
Current workforce
shortages pose
difficulty with care
burden at this
level
15,000,000
10,000,000
5,000,000
0
85 and over
75 to 84
65 to 74
55 to 64
45 to 54
35 to 44
25 to 34
15 to 24
5 to 14
under 5
Age (in deciles)
Courtesy of Brent Lowensohn, Kaiser Research
Prospective increase of obesity in the world
Increment
1986 – 2000
BMI > 30
(obese)
x 2
BMI > 40
(moderately
obese)
x4
BMI > 50
x6
(severe obese)
KOREA
JAPAN
SWITZERLAND
NORWAY
ITALY
AUSTRIA
DENMARK
FRANCE
SWEDEN
NETHERLANDS
POLAND
TURKEY
ICELAND
BELGIUM
PORTUGAL
GERMANY
IRELAND
SPAIN
FINLAND
CZECH REPUBLIC
SLOVAK REPUBLIC
LUXEMBOURG
HUNGARY
NEW ZELAND
AUSTRALIA
GREECE
CANADA
UNITED KINGDOM
MEXICO
% OBESITÀ
UNITED STATES
0
5
10
15
20
%
25
30
35
OBESITY AND
MODERNIZATION
Frequency (%)
Traditional living
European
Urban Polynesians,
Aborigines
20
25
30
Body Mass Index (Kg/m²)
35
40
In Nauru and Pima
From this . . .
. . . to this
DIABESITY
Top Three Countries in the world
Diabetic patients in Million
60
50
40
57 million
30
20
19 million
10
0
U.S. CHINA INDIA
1995
U.S. CHINA INDIA
2025
King et al, Diabetes Care, 1998
Obesity (BMI>30) in USA
1960-2000 (males)
40
35
30
1960-62
1971-74
1976-80
1988-94
1999-2000
25
20
15
10
5
0
20-39y
40-59y
60-74y
Flegal & al, JAMA 2002, 288, 1723-7
Obesity* Trends In Adults in the USA
1991-2001
1991
1995
2001
*BMI ≥30.
Mokdad et al. JAMA. 1999;282:1519-1522.
Mokdad et al. JAMA. 2001;286:1195-1200.
No Data
<10%
10%-14%
15%-19%
≥20%
Diabesità – Trend temporale USA adulti (1991 - 2001)
1:3 US nati 2000 svilupperanno DM, diabetici >15 mil -> 22 mil nel 2025, >60 mil IR (MetSyn): 1\4
futuri DM
l’aspettativa di vita US si abbasserà di 5 anni nelle prossime decadi causa il DM
NHANES 2003
Prev DM+AGT
=14%
Prev MetSyn
=24% (↑età)
JAMA 2003; 289:76-79
Obesità e diabete tipo 2
nei bambini/giovani:
“nintendonization”
Una nuova preoccupante
dimensione della epidemia di
diabesità
SOVRAPPESO E OBESITA’
NELL’INFANZIA E NELL’ADOLESCENZA
30-40% dei bambini in
età
scolare
è
in
sovrappeso.
10-12% dei bambini in
età scolare è obeso.Uno
su due ÆDM >30anni
+ IMA <40anni
Prevalenza dell’obesità in Italia
Diabesità nei bambini/giovani:prevalenza
USA (1999-2001) vs Italia (1994-2001)
L’ Italia ha la prevalenza di obesità infantile più alta d’ Europa (36%)
Prevalenza di alterazioni del metabolismo glucidico in
bambini e adolescenti obesi (età 4-18 aa)
prevalenza (%)
25
22,1
20
15
USA n = 167
Italia n = 701
10
4,4
5
2,4
0,1
0
IGT
diabete
Sinha R et al. NEJM (2002); 346: 802-810
Invitti C et al. Diabetes Care (2003); 26: 118-124
Features of the Metabolic Syndrome
Central obesity
(94 and 80cm)
hyperleptinemia
Microalbuminuria
Low-grade
inflammation
Prothrombotic state
(PAI-1,FBG,vW,fX,plt)
PCOS
Cardiovascular
Disease
IGT, T2DM
InsResistance
(+/- iperins.; HOMA)
Dyslipidemia
(↑ TG e/o ↓ HDL)
Hepatic steatosis
Hypertension
Sleep apnea
Genetics +Lifestyle
Ortopedic problems
Diabesità: prevalenza
USA: adulti MessicoAmericani/Anglo-Americani
Prevalenza di T2D (%)
25
20
15
Messicani
Americani
10
Anglo
Americani
5
0
magri
obesi
maschi
magre
obese
femmine
Stern et al. Am J Epidemiol 12:834-851, 1984
Diabesità:incidenza
USA: Indiani Pima (adulti) - incidenza/1000 anno
Incidenza di T2D71000 anno
80
70
60
50
40
30
20
10
0
<20
20-25
25-30
30-35
35-40
>40
BMI
Knowlwr et al. Am J Epidemiol 113: 144-156; 1981
Epidemiologia del
diabete tipo 1
TYPE 1 DM: ww Incidence
ASIA
Risk range:
• Sardinia: 42
• Venezuela, China: 0.1
• 420 fold difference!
OCEANIA
AMERICA
SARDINIA
EUROPE
0
5
10
15
20
25
30
35
40
Total Incidence (per 100000 person-years)
Hot-spots: Sardinia, Puerto Rico, Kuwait
(Karvonen M, Diabetologia,1993)
10
Incidenza del diabete
tipo 1 in Europa e in
alcuni paesi del
20
Mediterraneo
7
(0-14 anni)*
42
32
13
19
10
8
6
22
13
13
6 9.6
10
10 15
12
12 12.9 7
8
9
8
9
Moderato rischio
22 11
32
Hot-spots:
Sardinia,Baleari,Libia
10 9.8 6
12 8 8,9
8
6
42
12
6
7
23
6
12,9
8,9
12
12
Adapted from Songini et al. Diabetes Care
2004
26
23
Alto rischio
Basso rischio
36
7
7
5
6
9
18
17
14,9
8 8
5
TYPE 1 DIABETES IN ITALY (/100.000 0-14yrs)
RIDI STYDY GROUP
13
9
7
11
10
12
10
8
10
8
9
6
42
High risk
Moderate risk
Low risk
27%of all DM are
insulin-treated
compared to Italy 8%
Diabetes Care 2004
15
12
Popolazione 15-29 anni coperta dai Registri RIDI = 10.2%
Incidenza del T1D nel mondo
Gradiente polo-equatore: vero o falso?
40
35
30
25
20
15
10
5
0
Fin
lan
No dia
rv
eg
ia
Sv
ez
i
Es a
to
ni
Po a
lon
Sa
i
rd a
Pu egn
er
to a
Ri
co
Ku
wa
it
Su
da
n
Isr
ae
le
incidenza (per
100.000/anno)
Marjatta Karvonen et al., Diabetes Care 23:1516-1526,2000
Worldwide Incidence of Type 1 Diabetes
in Children < 14 Years, by Sex
Finland
Sardinia
US White
US Black
UK, Oxford
Denmark
Germany
Hungary
Poland
Romania
Israel
Hong Kong
China, Beijing
0
10
20
30
Incidence (per 100,000/year)
Karvonen et al., Diabetes Care, 23, 2000
Boys
Girls
40
50
Minor rischio nelle femmine, soprattutto in Sardegna
RIDI STUDY GROUP
RR=0.91, (0.85-0.97)
RR=0.77 (0.70-0.85)
1
1
1
1
1
M
F
1
0
0
0
0
0
Italia peninsulare
Sardegna
Time trends in Type 1 Diabetes incidence
( 0 - 14 years)‫‏‬
Incidence (per 100,000)‫‏‬
45
40
Finland (40.2%)‫‏‬
35
Sardinia
(35.9%)‫‏‬
30
Sweden (25.8%)‫‏‬
25
Norway (21.2%)‫‏‬
20
15
Denmark
(16.4%)‫‏‬
10
Hungary (8.8%)‫‏‬
5
0
1960 1965 1970 1975 1980 1985
Calendar year
1990 1994
Numero di casi con T1D nel 2000
IDF
Diabetes
Atlas
2000
Incidenza del diabete tipo 1
nella fascia d’età 15-29 anni in alcune aree Italiane
Area
Anni
Incidenza
(per 100.000)
95% C.I.
M/F
Completezza
Prov. Torino
1984-91
6.72
5.96-7.58
1.67
95%
Prov. Torino
1984-96
6.55
-----
-----
-----
Prov. Pavia
1988-2000
6.20
4.90-7.81
1.38
100%
Umbria
1993-2001
8.08
6.58-9.58
1.41
98.5%
Prov. Oristano
1989-2001
20.7
17.0-25.3
-----
100%
Sardegna
1989-1999
19.3
1.5
71%
Rep S.Marino
(0-29 anni)
1969-1988
6.0
1
98.8%
Casu, Songini, il Diabete, dicembre 2004
-----
Trend dell’incidenza del T1D
Incidenza e fascia d’età ad Antwerp (Belgio) in un
periodo di 12 anni (1989-2000)‫‏‬
16
Incidence x100.000
14
Anticipazione
12
1989
2000
10
8
6
4
2
0
0-14yrs
15-34yrs
Total
I Weets et al, Diabetes Care 2002;25:840-46
INCIDENZA DEL DIABETE TIPO 1
A KRONOBERG 1998-2001
80
70
60
INCIDENCE N
50
40
30
20
10
0
0-9
10 19
20-29
30-39
40-49
50-59
AGE
M. Thunander et al
60-69
70-79
80-89
90+
MALE
FEMALE
TOTAL
Diabetes Care 2005
n. 3606 casi
Periodo 1990-1999
I dati del RIDI (Registro Italiano Diabete Insulinodipendente) non
sostengono l’ipotesi di uno spostamento dell’esordio del diabete di
tipo 1 verso le età più giovani
L’incidenza è in costante aumento in tutti le classi di età
39
Summary
IMMUNITY
AGE
GENES
BMI
INSULIN THERAPY
T1DM
in children
Strong
+++
child
HLA++
low
Immediate
T1DM
in adults
++
adult
HLA +
Normal/low
immediate
LADA
+
adult
HLA
Normal/low
variable
T2DM
weak
adult
?
High
infrequent
Leslie RDG et at. Diabetes Res & Clin Pract (in press)
T1D
Gestational Diabetes Mellitus
in Sardinia
Results from an Early, Universal
Screening Procedure
C Murgia, Diab Care 2006
Prevalence of GDM
In the word: 7% (range: 1-14%)
In Italy (Di Cianni, Diabetes Res Clin Pract 2003)
8% (range: 2.3-10%)
Prevalence of GDM in Sardinian gestational age
groups
Gestational age
(wks)
N
% on overall screened
population
% on GDM
patients
(N=1103)
(N=247)
16-18
73
6.6
28.4
24-26
64
5.8
25.9
30-32
110
9.9
44.5*†
Total
247
22.3
χ Square: *P<0.01 vs 20-24 wks; †P<0.02 vs 16-18 wks
C Murgia, Diab Care 2006
Epidemiology of T1D
Secular trend of T1D in Sardinia
Prevalence (per 1000)
7,00
6,00
5,00
4,00
3,00
2,00
1,00
Birth cohorts
Male conscript register - 18 years of age
Casu, Songini et al 2004.
1978
1976
1974
1972
1970
1966
1968
1962
1964
1960
1958
1956
1952
1954
1950
1948
1946
1944
1942
1938
1940
1936
0,00
Epidemiology of T1D
Geographical distribution of T1D (0-14) RR
RR Alghero: 0.986 (0.979-0.993)
Incid. Catalunia : 11.5 (10.6-12.4)
RR Arborea: n.c. (incid.=0)
Incid. Veneto 0-29: 10.9
T1D RR
RR Carloforte: 0.999 (0.996-1.00)
Incid. Liguria: 11.7 (7.6-16.2)
<0.95
0.95-1.00
1.00-1.05
1.05-1.10
>1.10
T1D Relative Risk 0-14 yrs (1989-99)
Inc. cumulativa x 1000
Incidenza cumulativa (per mille) del
diabete tipo 1. Confronti tra provincia
di Oristano, Cabras e Italia
18
16
14
12
10
8
6
4
2
0
Oristano
Italia
Cabras
0-4
5-9
10-14
15-19
20-24
25-29
Classi d'età
O. Frongia, comunicazione personale
Prediction study-young ages
Prevalence of 2-3 islet-related Abs in SC from 36 villages
of the four Sardinian provinces (1986-95)
0.47 %
T1D risk
(/100,000)
SS
52.7
38.6
33.3
31.0
1.20 %
OR
NU
0.34 %
N = 8.434
T1D = 43
Median FU 10 yrs
(range 2mo-20 yrs)
0.96 %
N = 8.434
Age: 6-14
Songini, personal communication
CA
Sardinia: 0.68%
PPV = 32%
Studi nei Migranti
Effetto della
migrazione sul
rischio di T1D
10
42
21
20 23
Sardinians migrated to
Pavia: RR 3.0
7
13
19
Offspring of both Sardinian
parents (only one) migrated to
Turin: RR 3.2 (2.1)
Lombardy: RR 3.3 (2.0)
Lazio: RR 4.3 (2.0)
19
11
14
12
15
6
RR (relative risk) = migrated pop./host pop.
36
26
10
6
8
Venetians
6 migrated
to Sardinia
6
RR 0.2
12
22
13
13
7
10 15
12
8
9
8
6
10
42
7
12 8 9.8
7
8
6
12
6-9
Italians from Lazio and
Lombardy migrated to
9Germany:
7 7/100.000
incidence
7RR 0.5
5
4
6
9
18
8
10
15
8
85 3
Studi ecologici in Sardegna
Epidemiologia T1D
10
χ2
Age 0-4
9
81=
8
66.6
p= 0.88
7
6
5
4
3
2
1
0
0
30
60
90
120
150
180
210
240
270
300
330
360
Incidence per 100.000 person/month
Time (days)‫‏‬
10
χ282= 72.8
p= 0.76
Age 5-9
9
8
7
6
5
4
3
2
1
0
0
30
60
90
120
150
180
210
240
270
300
330
360
Time (days)‫‏‬
10
χ283= 80.4
p= 0.56
Age 10-14
9
Incidence per 100.000 person/month
Incidence per 100.000 person/month
Onset seasonality in Sardinian pts aged 0-14 (1989-96)‫‏‬
8
7
Registries
Insulin-dependent
Diabetes mellitus
Italy
6
Carle ,Songini et al. Diabetes Care 2004
5
4
3
2
1
0
0
30
60
90
120
150
180
210
Time (days)‫‏‬
240
270
300
330
360
Epidemiologia T1D
Birth seasonality in Sardinians T1D patients
aged 0-14 years (1989-1998)‫‏‬
T1D patients
General population
2000
16
1800
14
Mean number of births/month
Mean number of births/month
1600
12
10
8
6
4
2
1400
1200
1000
800
600
400
200
0
0
Jan-March
Apr-June
p=0.003
July-Sept
Oct-Dec
Jan-March
Apr-June
July-Sept
Oct-Dec
p=0.009
p=0.01
N=1118
1989-1998
Songini,Casu, Laron et al., J Pediatr Endocrinol Metab. 2001
N=314,084
1979-1995
ISTAT
Studi ecologici
Correlation with T1D risk in Sardinia
Temperature
NO
(North-South)‫‏‬
Precipitation
NO
(North-South)‫‏‬
G6PD-
NO
(whole island)‫‏‬
G6PD- *
YES
(Central-West)‫‏‬
Population density
NO
(whole island)‫‏‬
Urban/rural
NO
(whole island)‫‏‬
Songini,Bottazzo et al. 1999
* Mastinu F. 1999
Studi ecologici
Standardized incidence rate (per
100.000)
Gross domestic product (1994) and T1D incidence
(1989-1994)‫‏‬
45
40
35
30
25
20
15
10
5
0
0
5000
10000
15000
20000
25000
30000
Gross Domestic Products (US$ per head)
Patterson et al. 2001
Eurodiab ACE Study Group
35000
40000
Studi ecologici
Standardised incidence rate (per
100.000)
National coffee consumption and T1D incidence
(1989-1994)‫‏‬
45
40
35
30
25
20
15
10
5
0
0
50
100
150
200
Coffee consumption (60 Kg bags per 1000 heads)
Patterson et al. 2001
Eurodiab ACE Study Group
250
Studi ecologici
Standardised incidence rate (Per
100.000)
Latitude and T1D incidence (1989-1994)‫‏‬
45
40
35
30
25
20
15
10
5
0
30
35
40
45
50
Latitude (°N)
Patterson et al. 2001
Eurodiab ACE Study Group
55
60
65
70
Studi ecologici
T1D incidence 0-14 yrs (/100,000)
1) No correlation between nitrate level in tap water and T1D incidence
among the 21 Sardinian health districts (1989-98)‫‏‬
65
60
55
50
45
40
35
30
25
20
15
10
5
0
rp = -0.16
p = N.S.
N = 1,118
0
2
4
6
8
10
12
14
16
18
Median nitrate concentration (mg/l)
2) No association between the consumption of bottled waters with
different concentration of nitrates and the incidence of T1D
Casu, Bottazzo, Songini et al. 2000
Studi ecologici
Breast feeding in Sardinia
Influence of feeding habits on the risk of T1D in
Sardinia
T1D cases
Breast feeding
Yes
No
Meloni et al. 1997
84
16
Controls
70
30
OR (95% C.I.)‫‏‬
1
(ref. cathegory)‫‏‬
0.41(0.19-0.91)‫‏‬
Studi ecologici
Cow’s milk consumption and T1D incidence
50
Sardinia
30
T1D incidence (per 100,000)
T1D incidence (per 100,000)
35
25
20
15
10
5
45
40
35
30
Sardinia
25
20
15
10
5
0
0
70
75
80
85
90
95
Cow's milk consumption (litres/person/yr)
Italy
Fava et al. 1994
Muntoni et al. 1994
100
0
50
100
150
200
Cow's milk consumption (litres/person/yr)
World
250
Studi ecologici
Cow’s milk and T1D
β-casein A1-B intake and T1D incidence
40
Sardinia-actual (38.6)‫‏‬
T1D incidence (per 100,000)
35
30
25
20
15
10
Sardinia-predicted (8.6)‫‏‬
5
0
0,00
0,50
1,00
1,50
2,00
2,50
3,00
3,50
casein A1-B consumption (g/person/day)
Elliott et al. 1999
Songini, Casu, Bottazzo, Elliott et al. 2001
4,00
4,50
Malaria and Sardinia
Studi ecologici
Malaria and T1D in Sardinia
the Hygiene hypothesis: might it play a role?
Decrease prevalence of parasite infections
Disruption/malfunction of the immune system
K autoimmunity
Relative risk of T1D due to past malaria in all Sardinian areas
with low and high morbidity for malaria (Fermi, 1938)‫‏‬
Songini, Bernardinelli, Bottazzo et al. 1998
Parassitosi intestinali
bambini sardi positivi agli elminti intestinali
Anni ’80
Anni ’50
Anni ’70
scolari positivi
40-60%
Su 200 bambini
di una colonia marina
50% positivi
Clinica Pediatrica di Cagliari
Dal 1985 al 2004
12 bambini sono
risultati ripetutamente positivi
nonostante la terapia
Più del 40% di
scolari cagliaritani
e circa il 30%
di scolari della
Sardegna
centro-meridionale
positivi
Settimo San Pietro
2005
3 soli scolari positivi
su 162 analizzati !!
Istituto di Parassitologia
Università di Cagliari
Incidenza del diabete tipo1 e della TBC (/100.000)
1990-1994
0-15 anni
EUROPE
60
50
40
30
20
10
RO
HR
PT
ES
MK
PL
SI
LT
CZ
HU
EE
LV
FR-GR
BG LU
CH AT
IE
FInland
DK
NL
IS
0
DE
BE
IL
IT
0
SK
TBC
TBC
80
70
OUTSIDE EUROPE
NO
UK
SE
20
SARDINIA*
40
TYPE 1 DM
450
400
350
300
250
200
150
100
50
0
60
P<0.001
PE
SD
IN
TH
MY
CN
KR
JP
MX
MU
CO SA
CL
DZ
OM
0
KW
TN
AU
NZ-US
10
CA
20
TYPE 1 DM
30
P<0. 01
Italy except Sardinia
* SARDINIA: TBC AND TYPE 1 DM INCIDENCE RATES (1996-2005, 0-14 YEARS)
L. Airaghi – A. Tedeschi, Acta Diabetol (2006)‫‏‬
TBC E DIABETE TIPO 1 IN SARDEGNA
1996-2005 (0-14 anni)
INCIDENCE RATE (X 100.000)
60
DIABETES
TBC
50
40
30
20
10
0
1996
1997
1998
1999
2000
2001
YEARS
OER- Regione Autonoma della Sardegna, EURODIAB
2002
2003
2004
2005
Metabolomics
• 13 children who became T1DM in the first 3 years of life
• 52 sex-, age- and HLA-matched children who did not
become T1DM in the first 3 years of life
• Dry blood spot at birth (within the first 3 days of life)
• Measurement of essential and nonessential amino acids
Blood concentrations of 13 Amino Acids (AA)
at 3 days of age
(Ala, Arg, Asp, Ctr, Glu, Gly, Leu, Met, Orn, Phe, Pro, Tyr, Val)
(95% CI) TOTAL AA
1200
µmol/l
1100
P = 0.010
1000
900
800
700
600
Children who developed Type 1 diabetes by the age of 3 yrs (No = 13)
Sex-, age- and HLA-matched control children (No = 52)
Never have doctors known so much
about how to identify and control this
disease, yet the epidemic
keeps on raging ….
Grazie per la Vostra paziente
attenzione!