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Making the -future brighter for children with diabetes

One of the important ultimate goals still is to learn enough about the causes of childhood diabetes to be able to prevent it.
More than 10 million people in Europe have diabetes. Some do not develop it until middle age but one particularly severe form usually starts in childhood. Affected children suffer from this illness throughout their lives. The EURODIAB projects are tackling this major health problem by combining scientific skills, data and observations from all over Europe. Their results show that the incidence of childhood diabetes varies considerably over time and between different areas of Europe. They also illustrate how disease can result from the complex interplay of genetic and environmental factors.


Childhood diabetes cannot be controlled by diet. Affected children need to receive insulin therapy and this can mean regular daily injections. Such treatment allows diabetics to lead full and active lives but there are two problems. Firstly, childhood diabetes is a problem for life: there is no cure and long-term diabetics often suffer complications such as eye or kidney problems as they get older. Secondly, the incidence of childhood diabetes is increasing but no one knows for sure why.

Research into diabetes has a long history but the first major pan-European studies into the disease began in 1985. One of the important ultimate goals was, and still is, to learn enough about the causes of childhood diabetes to be able to prevent it. Work in the first three years formed the pilot phase of a concerted action. Diabetes of all types is a problem in every country in Europe and developing a good network between as many of the specialists involved as possible was a priority goal. Once co-operation between different groups was working well, effective scientific studies launched as a series of projects under the EURODIAB label could really get going.

Childhood onset type 1 diabetes in Europe Age group 0-14 years Standardised incidence rate (darker
shades of red are a higher incidence)

Studying 17 million children
The first project, EURODIAB (The Epidemiology and prevention of Diabetes), was set up with a broad brief to expand the research network. It then aimed to use this to study the incidence of childhood diabetes across Europe, the complications the disease caused in later life, and its general social impact. When this project was completed in 1992, all partners agreed that the research network was fully operational and published their findings in the prestigious medical journal, The Lancet. Anders Green, co-ordinator of EURODIAB summarised the main results: "Data was collected from 24 study regions across Europe and Israel, involving a study of 16.8 million children. Incidence varied widely between the regions, ranging from 42.9 annual cases per 100 000 in Finland and 30.2 per 100 000 in Sardinia to 4.6 cases per 100 000 per year in northern Greece. Generally, rates were higher in northern Europe compared to the south, but there were exceptions. Eastern European countries tended to have very low rates."

A complex picture
In 1993, a new phase, EURODIAB ACE (Aetiology of childhood diabetes on an epidemiological basis), began. Its aim was to use the, by now, well-established network to research the nature of childhood diabetes in detail using genetic and immunological methods. The ACE study set out to monitor the frequency of diabetes in children and to describe the trends in incidence of the disease throughout Europe. This study also included teams of scientists from Central and Eastern Europe - in total about 40 different groups worked together, representing a study population of almost 30 million children.

The results were interesting but they painted a complex picture. Some genetic markers were found much more often in children who developed diabetes, suggesting that these might be genes that increase susceptibility. At the same time, the researchers found that some genes seemed to correlate well with the diabetes incidence across Europe. Moreover, the incidence in individual countries was changing quite quickly and this could not be explained by genetics. The evidence pointed to interplay between genes and the environment and that this interplay may differ between populations.

Changing trends
The current phase of the project, EURODIAB TIGER (Type I Genetic Epidemiology Resource) is taking the work forwards to gain some important clues about which causal factors are most important. TIGER scientists are currently collecting material from 2000 patients and their immediate relatives. These samples will be screened and analysed for the distribution of specific genetic and immune markers in conjunction with the concerted action, PARADIGM. This provides the centralised facility that does all the laboratory work. Anders Green comments, "We now know for certain that there is an annual increase in the incidence of childhood diabetes in most countries in Europe. At the moment, the problem is most serious in Central and Eastern Europe. Only a few years ago, rates here were low but they are now increasing rapidly. In Northern Europe the rates at which new cases are appearing may now be reaching a plateau. We cannot yet say for certain what is happening. When we have analysed the data and know more about the genetic factors involved, the next step will be to couple this knowledge with information on the environmental factors - lifestyle, diet, virus infections, for example. My hope is that the huge collaborative network that we have set up will continue. It is a valuable resource that must not be wasted and it is a strong support mechanism, particularly for the teams in Central and Eastern Europe. They will need the network to help cope with the growing diabetes problem in their countries for the foreseeable future."



Project Title:  
EURODIAB - The Epidemiology and prevention of Diabetes
EURODIAB ACE - Aetiology of childhood diabetes on an epidemiological basis
EURODIAB TIGER - Type I genetic epidemiology resource

Biomedecine and Health (BIOMED)

Contract Reference:

CORDIS databaseFor more information on this project,
go to the Cordis database Record 1-2-3