A total of 884 new patients aged <15 yr were diagnosed with type 1 diabetes over the 20-year period covered by this study. There was an increase in the mean age at diagnosis from 7.6 yr in 1990/1 to 8.9 yr in 2008/9 (0.07/yr, r2 = 0.31, p = 0.009). This was observed in both males (0.07/yr, r2 = 0.22, p = 0.04) and females (0.06/yr, r2 = 0.13, p = 0.12).

The World Health Organisation (WHO) has mandated November 14 as World Diabetes Day, an international event to raise awareness about diabetes. Close to 350 million people in the world have diabetes and WHO reports that a person dies from this disease every 6 seconds – that’s 5 million deaths. Currently 1 in 11 adults have diabetes worldwide and this is predicted to increase to 1 adult in 10 (652 million) by 2040. Sobering statistics indeed.
Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: support from Waitemata District Health Board for the development of SMS4BG, and support from the Health Research Council of New Zealand in partnership with the Waitemata District Health Board and Auckland District Health Board, and the New Zealand Ministry of Health for the randomised controlled trial; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.
It’s heart-wrenching to watch all that people go through as natural disasters play out on our television screens. Tucked away, along with sympathy for those in the midst of a hurricane, earthquake, flood or other catastrophic events, is the very understandable thought, “I’m so glad that’s not happening to me!”. The truth is, however, that we are all susceptible to major life-changing events, and they can happen with very little notice. Those with a chronic medical condition, like diabetes, are especially vulnerable and should take seriously the advice to be prepared.    (more…)
Interventions The intervention group received a tailored package of text messages for up to nine months in addition to usual care. Text messages provided information, support, motivation, and reminders related to diabetes self management and lifestyle behaviours. The control group received usual care. Messages were delivered by a specifically designed automated content management system.
The incidence of type 1 diabetes was higher in New Zealand Europeans than other ethnic groups throughout the study period (Figure 2, p<0.0001). There was little difference in incidence among non-European ethnic groups. The annual incidences (per 100,000) by 2009 were: Europeans 32.5 (95% CI 23.8–43.3), Non-Europeans 14.4 (95% CI 9.2–21.4), Maori 13.9 (95% CI 5.2–29.7), Pacific Islanders 15.4 (95% CI 7.3–28.5), and Other 13.5 (95% CI 5.8–26.8). The rate of increase in incidence over the study period was very similar across all ethnicities, as illustrated by the slopes in Figure 2. However, while the average increase in incidence was higher for Europeans than Non-Europeans in children of all age groups (Table 1), the increase was proportionally lower in Europeans (2-fold) than Non-Europeans (3-fold) due to a lower baseline incidence in the latter group (Figure 2). Nonetheless, in both ethnic groups type 1 diabetes incidence in children 10–14 yr increased at a higher rate than in the youngest 0–4 yr group, with a >2-fold difference observed among both Europeans and Non-Europeans (Table 1). Age at diagnosis across the study period was similar in both ethnic groups (p = 0.47).

-Keep your blood pressure under control. The same lifestyle changes that control blood glucose levels (dietary modifications and exercise) may also help you keep your blood pressure at safe levels. The American Diabetes Association recommends that people with diabetes keep their blood pressure below 140/80, but check with your health care professional about what target is best for you.


We thank the participants who took part in this study as well as the staff at the primary care practices and diabetes clinics across New Zealand who referred their patients to the study; the National Institute for Health Innovation’s IT team for their work on the text message delivery system, and all those involved in the study design and set up; Coral Skipper, Louise Elia, Erana Poulsen, and Hamish Johnstone (Māori Advisory Group members); Aumea Herman (Pacific adviser); Joanna Naylor and Michelle Garrett (content development advisers); Richard Edlin (health economist); Mahalah Ensor (assistance with recruitment); Hannah Bartley, Rachel Sullivan, Anne Duncan, and Gillian Lockhart (research assistants); Michelle Jenkins and John Faatui (data management support); and Karen Carter and Angela Wadham (project management support).
Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf and declare: support from Waitemata District Health Board for the development of SMS4BG, and support from the Health Research Council of New Zealand in partnership with the Waitemata District Health Board and Auckland District Health Board, and the New Zealand Ministry of Health for the randomised controlled trial; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

We saw no significant interaction between the treatment group and any of the prespecified subgroups: type 1 versus type 2 diabetes (P=0.82), non-Māori/non-Pacific versus Māori/Pacific ethnicity (P=0.60), high urban versus high rural/remote region (P=0.38). Adjusted mean differences on change in HbA1c from baseline to nine months for patients with type 1 and type 2 diabetes were −5.75 mmol/mol (95% confidence interval −10.08 to −1.43, P=0.009) and −3.64 mmol/mol (−7.72 to 0.44, P=0.08), respectively. Adjusted mean differences for non-Māori/non-Pacific and Māori/Pacific people were −4.97 mmol/mol (−8.51 to −1.43, P=0.006) and −3.21 mmol/mol (−9.11 to 2.70, P=0.28), respectively. Adjusted mean differences for participants living in high urban and high rural/remote areas were −4.54 mmol/mol (−8.40 to −0.68, P=0.02) and −3.94 mmol/mol (−9.00 to 1.12, P=0.13), respectively (table 3).
The Endocrinology Service at Starship Children's Health provides specialist care for all children diagnosed with type 1 diabetes in the Auckland region (New Zealand). Its Paediatric Diabetes Service provides centralised medical care for all diabetic children up to 15 yr who reside in the Auckland region, drawing from the regional population of approximately 1.5 million [12]. All children or adolescents diagnosed with type 1 diabetes who attended the Paediatric Service between 1 January 1990 and 31 December 2009 were eligible for this study. Subjects were captured from a comprehensive database (Starbase) that gathers data on all children with type 1 diabetes in the Auckland region. This information was cross-referenced with hospital admission data and subsequent clinical follow up, leading to a case ascertainment >95% for children with type 1 diabetes [13].
The flexibility of mobile phones and their adoption into everyday life mean that they are an ideal tool in supporting people with diabetes whose condition needs constant management. Mobile phones, which have been used effectively to support diabetes management,13141516 offer an ideal avenue for providing care at the patient’s desired intensity. Additionally, they can provide effective methods of support to patients in rural and remote locations where access to healthcare providers can be limited.1718 Although there is growing support for the use of mobile health (mHealth) in diabetes, there is increasing evidence of a digital divide, with lower use of some technologies in specific population groups.1920 These groups include people who have low health literacy,21 have low income,222324 and are members of ethnic minorities.2526 Contributing factors include low technology literacy, mismatch between individual needs and the available tools, lack of local information, cost, literacy and language barriers, and lack of cultural appropriateness.27 For mHealth tools to be used to manage poor diabetes control, they need to be designed to the needs and preferences of those people who need the greatest support by considering these factors.
In a perfect world, the answer to the question “should someone with diabetes take steroids?” would be a simple “no”. Of course, not only do we not live in a perfect world, there are also few simple answers for diabetics. Steroids can play havoc with blood sugar levels, but they can also be the best choice in treating some very serious conditions. So, perhaps the better answer would be “maybe” with the added caveat of making sure you are aware of the consequences and prepared to be proactive in managing them.   (more…)

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