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Pathogenesis of type 1 diabetes: implications for incidence trends
1Hospital for Children, University of Helsinki and Helsinki University Central Hospital, and Folkhälsan Research Center, Helsinki, Finland. mikael.knip@hus.fi
Hormone Research in Paediatrics
|July 23, 2011
Summary
Environmental factors likely trigger type 1 diabetes (T1D) in children, with rising incidence and decreasing diagnosis age. Bovine insulin is a potential dietary antigen driving T1D progression.
Area of Science:
- Immunology
- Endocrinology
- Epidemiology
Background:
- Type 1 diabetes (T1D) incidence has risen significantly post-WWII, particularly in children and adolescents.
- The mean age of T1D diagnosis has concurrently decreased, suggesting environmental influences over genetics.
- Environmental factors are implicated due to low concordance in identical twins and varying incidence across geographic regions.
Purpose of the Study:
- To investigate the role of exogenous factors in the rising incidence of type 1 diabetes.
- To identify potential environmental triggers and dietary antigens contributing to T1D pathogenesis.
- To understand the implications of increasing T1D incidence and decreasing age at diagnosis on long-term complications.
Main Methods:
- Review of epidemiological data on T1D incidence trends and age at diagnosis.
- Analysis of genetic susceptibility versus environmental factors in T1D development.
- Examination of evidence linking viral infections and dietary antigens to T1D pathogenesis.
Main Results:
- Less than 10% of individuals with HLA-conferred susceptibility develop clinical T1D.
- Monozygotic twin concordance for T1D is below 40%.
- Significant geographic variations in T1D incidence exist, with migration studies showing increased risk in high-incidence areas.
Conclusions:
- Diabetogenic enterovirus infections may trigger T1D, with dietary antigens potentially driving the disease.
- Bovine insulin, differing slightly from human insulin, is a strong candidate dietary antigen.
- Continued trends in T1D incidence and diagnosis age will increase long-term complications without improved metabolic control.
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