Type 1 diabetes—early life origins and changing epidemiology

Abstract

Type 1 diabetes is a chronic, immune-mediated disease characterised by the destruction of insulinproducing cells. Standardised registry data show that type 1 diabetes incidence has increased 3-4% over the past three decades, supporting the role of environmental factors. Although several factors have been associated with type 1 diabetes, none of the associations are of a magnitude that could explain the rapid increase in incidence alone. Moreover, evidence of changing prevalence of these exposures over time is insufficient. Multiple factors could simultaneously explain the changing type 1 diabetes incidence, or the magnitude of observed associations could have been underestimated because of exposure measurement error, or the mismodelling of complex exposure-time-response relationships. The identification of environmental factors influencing the risk of type 1 diabetes and increased understanding of the cause at the individual level, regardless of the ability to explain the changing incidence at the population level, is important because of the implications for prevention.

Pathophysiological Role and Therapeutic Implications of Vitamin D in Autoimmunity: Focus on Chronic Autoimmune Diseases

“…The causes of T1DM onset are incompletely defined and a combined effect of genetic predisposition and environmental triggers has been hypothesized [135,136]. It is estimated that 542,000 children aged under 14 years are affected by T1DM, with an incidence that has increased by 3-4% over the last thirty years [137]. The pathogenetic role of vitamin D in T1DM onset is debated.…”

Typ-1-Diabetes: Früherkennung und Ansätze zur Prävention

“…Es wird angenommen, dass Umweltfaktoren, die auf eine genetische Prädisposition treffen, entscheidend mit zur Initiierung des Autoimmunprozesses beitragen. Dabei liegt es nahe, dass dem frühen Säuglingsalter, in dem dieser Prozess noch nicht in Gang gekommen ist, eine besondere Bedeutung zukommt [23].…”

A dose–response meta-analysis between serum concentration of 25-hydroxy vitamin D and risk of type 1 diabetes mellitus

“…Type 1 diabetes mellitus (T1DM) is an insulin-dependent diabetes that is characterized by immune-mediated destruction of pancreatic β cells, which leads to severe insulin deficiency [1]. The incidence of T1DM was 22.3/ 100,000 persons in the USA in 2014-2015, which has nearly doubled among the youth (aged <20 years) in the past decade [2].…”

“…However, the estimated incidence of T1DM for individuals across ages is 1.01/100,000 persons in China [4]. It is believed that factors, such as obesity, breastfeeding, maternal and perinatal factors, virus infection, omega-3 fatty acid status, and serum 25(OH)D concentration play crucial roles in the prevention regimen of T1DM [1]. Reportedly, the number of patients with T1DM presenting with insufficient serum 25(OH)D concentration is growing rapidly [5].…”

“…The 25-hydroxylase enzyme in the liver transforms vitamin D to an intermediate inactive form of this vitamin, 25(OH)D, which is then transformed to the active form 1,25-hydroxy vitamin D by 1α-hydroxylase enzyme in the kidney [7]. As vitamin D regulates the immune system and autoimmunity, it may serve as a potential protective factor in the development of T1DM [1]. The effects of vitamin D on non-skeleton disorder remains debatable.…”