Chicago Childhood Diabetes Registry

描述(由申请人提供)：最近儿童糖尿病的增加提出了一个紧迫的公共卫生挑战：尽快开展有效的一级和二级预防工作。因此，我们必须了解当前流行病背后的机制，特别是遗传学与行为风险因素不断变化的流行病学之间的相互作用。我们建议在受影响的先证者及其家庭成员中调查儿童糖尿病风险的决定因素。这是以人口为基础的芝加哥儿童糖尿病登记处的竞争延续申请。这个数据库代表了世界上患有糖尿病的非西班牙裔黑人儿童的最大数量，也是美国大陆最大的拉美裔儿童患者数据库。正在进行的事件病例查明将提供基本的流行病学数据，并将在受影响儿童的家庭中进一步努力，从遗传和疾病易感等位基因在家庭中的表达方面描述青年发病的葡萄糖不耐受的谱系。我们将具体解决这些假设： 1.年轻人的糖尿病是由一系列病因过程引起的，从自身免疫型1型胰岛素减少症到肥胖相关的胰岛素抵抗2型糖尿病。一部分儿童表现出混合病因，由于遗传易感性、肥胖和/或缺乏运动而存在胰岛素抵抗，加剧了自身免疫β细胞的破坏。 2.儿童糖尿病流行病学的长期变化与1型和2型风险因素的流行变化直接相关，包括肥胖、缺乏运动和围产期暴露。 3.特定特征的家族聚集性除了影响血糖控制之外，还会影响年轻糖尿病患者的慢性并发症风险。最终，这种方法将允许对来自不同种族群体的家庭中的早发性糖尿病进行真正基于人群的分子流行病学研究。

DESCRIPTION (provided by applicant): Recent increases in childhood diabetes present an urgent public health challenge: to mount effective primary and secondary prevention efforts as soon as possible. We must therefore understand the mechanisms underlying the current epidemic, particularly the interaction of genetics with the changing epidemiology of behavioral risk factors. We propose to investigate the determinants of childhood diabetes risk in affected probands and their family members. This is a competing continuation application for the population-based Chicago Childhood Diabetes Registry. This database represents the largest number of non-Hispanic black children with diabetes worldwide, and the largest patient database for Latino children in the continental US. Ongoing ascertainment of incident cases will provide basic epidemiologic data and will anchor a further effort, in families of affected children, to describe the spectrum of youth-onset glucose intolerance in terms of inheritance and the expression of disease susceptibility alleles within families. We will specifically address these hypotheses: 1. That diabetes in youth is caused by a spectrum of etiologic processes, from the insulinopenia of autoimmune type 1 to obesity-related, insulin-resistant type 2 diabetes. A subset of children demonstrate a mixed etiology, with autoimmune beta-cell destruction aggravated by the presence of insulin resistance due to genetic susceptibility, obesity and/or physical inactivity. 2. That secular changes in the epidemiology of childhood diabetes are directly related to changes in the prevalence of both type 1 and type 2 risk factors, including obesity, physical inactivity, and perinatal exposures. 3. That familial aggregation of specific traits affects the risk of chronic complications in young people with diabetes, over and above that of glycemic control. Ultimately, this approach will permit a truly population-based molecular epidemiologic study of early-onset diabetes in families from a range of ethnic groups.