Environmental trigger(s) of type 1 diabetes: why so difficult to identify?

Abstract

Type 1 diabetes (T1D) is one of the most common chronic diseases with childhood onset, and the disease has increased two- to fivefold over the past half century by as yet unknown means. T1D occurs when the body's immune system turns against itself so that, in a very specific and targeted way, it destroys the pancreatic β-cells. T1D results from poorly defined interactions between susceptibility genes and environmental determinants. In contrast to the rapid progress in finding T1D genes, identification and confirmation of environmental determinants remain a formidable challenge. This review article will focus on factors which have to be evaluated and decision to take before starting a new prospective cohort study. Considering all the large ongoing prospective studies, new and more conclusive data than that obtained so far should instead come from international collaboration on the ongoing cohort studies.

Figure 1

The first box to the left shows total number of children genotyped for the high-risk genotype in MIDIA. Of the 997 children who had parents participating in MIDIA, 908 delivered blood samples more than once for autoantibody testing. The rest of participants delivered stool samples and questionnaires. 706 children had parents who had given a new informed consent in 2008/2009. Abs.: autoantibodies.