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Review
. 2018 Oct 23;18(12):136.
doi: 10.1007/s11892-018-1113-2.

The Environmental Determinants of Diabetes in the Young (TEDDY) Study: 2018 Update

Marian Rewers  1 , Heikki Hyöty  2   3 , Åke Lernmark  4 , William Hagopian  5 , Jin-Xiong She  6 , Desmond Schatz  7 , Anette-G Ziegler  8 , Jorma Toppari  9 , Beena Akolkar  10   11 , Jeffrey Krischer  12 ; TEDDY Study Group
Collaborators, Affiliations
Review

The Environmental Determinants of Diabetes in the Young (TEDDY) Study: 2018 Update

Marian Rewers et al. Curr Diab Rep. .

Abstract

Purpose of review: The environmental triggers of islet autoimmunity leading to type 1 diabetes (T1D) need to be elucidated to inform primary prevention. The Environmental Determinants of Diabetes in the Young (TEDDY) Study follows from birth 8676 children with T1D risk HLA-DR-DQ genotypes in the USA, Finland, Germany, and Sweden. Most study participants (89%) have no first-degree relative with T1D. The primary outcomes include the appearance of one or more persistent islet autoantibodies (islet autoimmunity, IA) and clinical T1D.

Recent findings: As of February 28, 2018, 769 children had developed IA and 310 have progressed to T1D. Secondary outcomes include celiac disease and autoimmune thyroid disease. While the follow-up continues, TEDDY has already evaluated a number of candidate environmental triggers, including infections, probiotics, micronutrient, and microbiome. TEDDY results suggest that there are multiple pathways leading to the destruction of pancreatic beta-cells. Ongoing measurements of further specific exposures, gene variants, and gene-environment interactions and detailed "omics" studies will provide novel information on the pathogenesis of T1D.

Keywords: Autoimmunity; Children; Type 1 diabetes.

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Conflict of interest statement

Conflict of Interest Marian Rewers, William Hagopian, Jin-Xiong She, Desmond Schatz, Anette-G Ziegler, Beena Akolkar, and Jeffrey Krischer declare that they have no conflict of interest.

Heikki Hyöty reports grants from National Institute of Health (NIH) to carry out the TEDDY study; and being a Shareholder and member of the board of Vactech Ltd., which develops vaccines against picornaviruses.

Ake Lernmark is a Member of the Scientific Advisory Board of Diamyd Medical AB, Stockholm, Sweden.

Jorma Toppari reports grants from NIH/NIDDK.

Figures

Fig. 1
Fig. 1
TEDDY cohort retention. Annual loss to follow-up (%)
Fig. 2
Fig. 2
TEDDY nested case-control analyses [38]. All cases of persistent confirmed IA (N = 418) including childrenwho developed T1D (N = 114) ascertained by May 31, 2012 were selected. A total 1253 controls were matched to the cases of persistent confirmed IA (generally 3:1) on clinical center, sex, and family history of T1D. All the controls were included in studies for the dietary biomarkers and metabolomics and 418 controls (1:1) were included in metagenomics and gene expression studies. For the 114 T1D cases, 342 controls were selected for dietary biomarkers and metabolomics and 114 controls for the other studies. Number of samples tested include the following: dietary biomarkers (n = 23,594), metabolomics (n = 12,959), gene expression (n = 5200), microbiome (n = 13,403), viral metagenomics (n = 6380), proteomics (n = 5500)
Fig.3
Fig.3
The incidence of islet autoantibodies. Early “IAA-first” phenotype followed by “GADA-first” phenotype
See this image and copyright information in PMC

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