Spring harvest? Reflections on the rise of type 1 diabetes

Can we slow the rising incidence of childhood-onset autoimmune diabetes? The overload hypothesis

“…A recent editorial in this journal has argued that the increasing incidence of type 1 diabetes in the young is the result of accelerated disease progression [6]. The focus of interest should therefore shift to accelerating factors rather than potential triggers of autoimmunity.…”

A run-to-run control strategy to adjust basal insulin infusion rates in type 1 diabetes

“…For this reason, a day is divided into four segments: midnight to 4:00, 4:00 to 10:00, 10:00 to 18:00 and 18:00 to midnight. For each segment the basal infusion rate is set to (3) as the initial estimate. From this starting point, it is necessary to fine-tune the infusion rates based on the subject's response.…”

“…There are an estimated 18 million people worldwide with the disease [1], [2], and with a clear rising trend in its incidence [3]. People with type 1 diabetes fully depend on exogenous insulin, and managing their disease is a daily challenge.…”

Comment on: Gale EAM (2005) Spring harvest? Reflections on the rise of type 1 diabetes. Diabetologia 48:2245–2250; and Walker M, Mari A, Jayapaul MK et al (2005) Impaired beta cell glucose sensitivity and whole-body insulin sensitivity as predictors of hyperglycaemia in non-diabetic subjects. Diabetologia 48:2470–2476

“…To the Editor: Your interesting Editorial makes the point that accelerated emergence of type 1 diabetes in childhood may reflect the loss of some protective factor in the environment, and postulates that this mechanism could also contribute to the rising incidence of type 2 diabetes in childhood and beyond [1]. Walker et al show that impaired islet beta cell glucose sensitivity and whole-body insulin sensitivity are not only independent predictors of hyperglycaemia in non-diabetic subjects, but together outweigh the predictive effects of the commonly recognised lifestyle and body-build risk factors [2].…”

“…Walker et al show that impaired islet beta cell glucose sensitivity and whole-body insulin sensitivity are not only independent predictors of hyperglycaemia in non-diabetic subjects, but together outweigh the predictive effects of the commonly recognised lifestyle and body-build risk factors [2]. As Gale points out [1], an understanding of what it is we have come to lack could lead to the reversal of environmentally mediated increases in the risk of diabetes, in the same way that folic acid supplementation has led to reductions in spinal cord defects in recent years. The urgent question, therefore, is: what environmental factor with all the necessary protective effects have we become short of in recent years?…”