Incidence of Insulin‐dependent Diabetes Mellitus in Age Groups Over 30 years in Denmark

Mølbak, Anne Grethe; Christau, Bjo̸rn; Marner, B.; Borch‐Johnsen, Knut; Nerup, J.

doi:10.1111/j.1464-5491.1994.tb00327.x

Cited by 147 publications

(92 citation statements)

References 19 publications

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“…Type 1 diabetes has traditionally been considered a disease of childhood, but more recent epidemiological studies have indicated that the incidence is comparable in adults [6]. The age-specific incidence rate of type 1 diabetes shows a bimodal distribution.…”

Section: Introductionmentioning

confidence: 99%

Type 1 diabetes in Japan

2006

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Section: Introductionmentioning

confidence: 99%

Type 1 diabetes in Japan

2006

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“…More than half of the patients with Type I diabetes present in adulthood, when their onset is slow and many do not develop acidosis or require insulin for many years [1]. Type II diabetes occurs in teenagers [2], sometimes with keto-acidosis [3], and insulin-dependency frequently ensues given time.…”

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confidence: 99%

The accelerator hypothesis: weight gain as the missing link between Type I and Type II diabetes

2001

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Diabetes is currently of two types. Type I (insulin-dependent) diabetes mellitus is an autoimmune disorder of childhood, characterised by acute onset, ketoacidosis and insulin dependency. Type II diabetes is a metabolic disorder of middle-life, slow in onset and non-insulin-dependent.The definitions need urgent revision. More than half of the patients with Type I diabetes present in adulthood, when their onset is slow and many do not develop acidosis or require insulin for many years [1]. Type II diabetes occurs in teenagers [2], sometimes with keto-acidosis [3], and insulin-dependency frequently ensues given time. Clinically, there is little other than tempo to distinguish two types of diabetes. The HypothesisThe`Accelerator Hypothesis' argues that Type I and Type II diabetes are one and the same, distinguishable only by their rate of beta cell loss and the accelerators responsible. The first accelerator, a constitutionally (intrinsically) high rate of beta-cell apoptosis, is necessary for diabetes to develop but in itself rarely Diabetologia (2001) AbstractBlood glucose concentrations are controlled by a loop incorporating two components, the beta cells which secrete insulin and the insulin-sensitive tissues (liver, muscle, adipose) which respond to it. Loss of blood glucose control might result from failure of the beta cells to secrete insulin, resistance of the tissues to its action, or a combination of both. The distinctions between Type I (insulin-dependent) and Type II (non-insulin-dependent) diabetes mellitus are becoming increasingly blurred both clinically and aetiologically, where beta-cell insufficiency is the shared characteristic. The`Accelerator Hypothesis' identifies three processes which variably accelerate the loss of beta cells through apoptosis: constitution, insulin resistance and autoimmunity.None of the accelerators leads to diabetes without excess weight gain, a trend which the`Accelerator Hypothesis' deems central to the rising incidence of both types of diabetes in the industrially developed world. Weight gain causes an increase in insulin resistance, which results in the weakening of glucose control. The rising blood glucose (glucotoxicity) accelerates beta-cell apoptosis directly in all and, by inducing beta-cell immunogens, further accelerates it in a subset genetically predisposed to autoimmunity. Rather than overlap between two types of diabetes, the`Accelerator Hypothesis' envisages overlay. Body mass is central to the development and rising incidence of all diabetes. Only tempo distinguishes the`types'. The control of weight gain, and with it insulin resistance, could be the means of minimising both.

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“…It is estimated that almost 40% of type 1 diabetes patients are diagnosed after the age of 30. 8 Other features commonly seen in type 1 diabetes patients which may help with diagnosis is the presence of other autoimmune conditions, low BMI and a history of DKA. However, some people may fit the biochemical diagnosis of DKA but in fact do not have insulin deficiency.…”

Section: Discussionmentioning

confidence: 99%