Title:
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Type 1 diabetes - epidemiology, risk factors and complications
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This thesis examined the incidence and temporal trends of Type 1 diabetes diagnosed in Northern Ireland
children using data from the Northern Ireland Childhood Diabetes Register (NICDR). Overall, there was
evidence of a departure from linearity in incidence with indications that rates are levelling off in recent years.
Further analyses also indicated that birth cohort effects were evident in the incidence rates suggesting that
exposures in early life may play an aetiological role in this condition.
A systematic review and meta-analyses was performed in this thesis to investigate the association of
childhood vaccinations and subsequent risk of Type 1 diabetes. Twelve studies investigating a range of
vaccinations were included. Results provided no evidence to suggest an association between childhood
vaccinations and risk of Type 1 diabetes.
A study using data from the Clinical Practice Research Datalink (CPRD) was included in this thesis to report
findings on depression and other complications in young people diagnosed with Type 1 diabetes. This study
found that rates of depression were significantly higher in cases with diabetes compared to controls without
diabetes. Results also showed elevated rates of microvascular complications and significantly higher rates
of cardiovascular disease compared to matched controls.
Another focus of this thesis was on mortality in individuals with Type 1 diabetes. Population-based studies
reporting relative mortality in Type 1 diabetes diagnosed in young people were systematically reviewed. In
total, 23 independent studies were included. Associations between relative mortality and study/ country
characteristics were explored. In addition to this review, a further two UK-based studies were performed to
investigate mortality, one using data from the NICDR and the other using the CPRD. Both studies found
excess mortality rates in individuals with Type 1 diabetes when compared, respectively, to the general
population and to a group of controls without diabetes.
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