Original Article
Decreased prevalence of atopic diseases in children with diabetes,☆☆

https://doi.org/10.1067/mpd.2000.109109Get rights and content

Abstract

Objective: To test the hypothesis that atopic diseases in early life are associated with a reduced risk (protection) for the development of type 1 diabetes in childhood. Study design: European centers (n = 8) with access to population-based type 1 diabetes registries (>90% degree of ascertainment) participated in a case control study focusing on early exposures and risk factors for type 1 diabetes. Altogether, data from 1028 members of a case group and 2744 members of a control group corresponding to 85.4% eligible members of the case group and 76.1% of the control group were analyzed. Information in this study was collected regarding atopic diseases (atopic eczema, allergic rhinoconjunctivitis, and asthma). Results: Atopic disease and asthma particularly are associated with significant reductions in risk of childhood type 1 diabetes. The risk reduction associated with asthma was observed reasonably consistently among the 8 study centers, which represent a wide range of diabetes incidence. Risk reductions associated with all 3 expressions of atopy were particularly marked in children whose type 1 diabetes was diagnosed in the 10- to 14-year age group. Conclusion: These findings indicate that atopic conditions may be protective against the development of type 1 diabetes and are consistent with the immunologic concept of TH1 (type 1 diabetes) and TH2 (atopy) diseases being mutually exclusive. (J Pediatr 2000;137:470-4)

Section snippets

Study Design and Methods

The 8 participating centers had developed population-based registers of childhood-onset diabetes that had operated since 1989 and were validated by the standards of EURODIAB ACE6: Austria, Latvia, Lithuania, Luxembourg, Romania, Bulgaria, Leeds (UK), and Northern Ireland (UK). Altogether, 1204 patients with onset of diabetes before the age of 15 years and 3606 members of a population-based control group selected within age strata compatible with the age distribution of cases were invited to the

Results

Table II shows the odds ratios and 95% confidence limits for the association between asthma and childhood- onset insulin-dependent diabetes mellitus by center.The Mantel-Haenszel combined odds ratio was significantly decreased (P =.008) for asthma, with no evidence of heterogeneity among centers (Table II). The combined odds ratios for atopic eczema was not decreased, and there was heterogeneity among centers. This heterogeneity was mainly due to the high odds ratio in the Bulgarian center.

Discussion

This multicenter case control study showed a decreased prevalence of atopic diseases, particularly asthma, in children with diabetes, suggesting that the occurrence of atopic diseases may protect against the development of type 1 diabetes. This protective effect was not observed in the 2 younger age groups (0 to 4 years and 5 to 9 years), but all 3 expressions of atopic diseases were markedly inversely related to type 1 diabetes diagnosed between 10 and 14 years of age. This age-dependent

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This study is part of the EURODIAB ACE study granted by the Biomed I and II programmes from the European Union. Local grants were supplied from the Swedish Medical Research Council, project number 07531, The Swedish Diabetes Association, the British Diabetic Association, the Hungarian National Research Fund, (project number 019192), and CRP-Sauté, Luxembourg. *The participating investigators are listed in the Appendix.

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Reprint requests: G. Soltész, Department of Paediatrics, University Medical School of Pécs, H-7623 Pécs, József A. u. 7.

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*The participating investigators are listed in the Appendix.

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