Environmental triggers and determinants of type 1 diabetes.

Abstract:

:Type 1 diabetes is perceived as a chronic immune-mediated disease with a subclinical prodromal period characterized by selective loss of insulin-producing beta-cells in the pancreatic islets in genetically susceptible subjects. A series of evidence supports a critical role of exogenous factors in the development of type 1 diabetes, such as 1) the fact that <10% of individuals with HLA-conferred diabetes susceptibility do progress to clinical disease, 2) a pairwise concordance of type 1 diabetes of <40% among monozygotic twins, 3) a more than 10-fold difference in the disease incidence among Caucasians living in Europe, 4) a several-fold increase in the incidence over the last 50 years, and 5) migration studies indicating that the disease incidence has increased in population groups who have moved from a low-incidence to a high-incidence region. This article discusses the trigger-booster hypothesis claiming that the diabetic disease process is triggered by an exogenous factor with definite seasonal variation and driven by one or several other environmental determinants. In addition, there are a series of modifying factors affecting the fate and pace of the process. Accordingly, progression to clinical type 1 diabetes typically requires the unfortunate combination of genetic disease susceptibility, a diabetogenic trigger, and a high exposure to a driving antigen.

journal_name

Diabetes

journal_title

Diabetes

authors

Knip M,Veijola R,Virtanen SM,Hyöty H,Vaarala O,Akerblom HK

doi

10.2337/diabetes.54.suppl_2.s125

subject

Has Abstract

pub_date

2005-12-01 00:00:00

pages

S125-36

eissn

0012-1797

issn

1939-327X

pii

54/suppl_2/S125

journal_volume

54 Suppl 2

pub_type

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