Advertisement

Epidemiology and Risk Factors of Type 1 Diabetes

  • Chiara Guglielmi
  • Richard David Leslie
  • Paolo Pozzilli
Reference work entry
Part of the Endocrinology book series (ENDOCR)

Abstract

Type 1 diabetes (T1D) is one of the most widespread chronic diseases of childhood. T1D results from the autoimmune destruction of insulin-producing beta cells in the pancreas. Genetic, epigenetic, metabolic, and environmental factors act together to precipitate the onset of the disease. Clinical T1D represents the end stage of a process resulting from the progressive beta-cell destruction following an asymptomatic period that may last for years. This knowledge, together with recent advances in the ability to identify individuals at increased risk for clinical disease, has paved the way for trials aimed at preventing or delaying the clinical onset of T1D. Individuals at risk for T1D can be identified by a positive family history or by genetic, immunological, or metabolic markers. These markers can be combined to achieve a higher positive predictive value for T1D and to identify those individuals to be selected for intervention trials.

The purpose of this chapter is to set out the epidemiology and the main risk factors which characterizes T1D.

Keywords

Age Body mass index (BMI) Epidemiology Geography Gender Risk factors Seasonality Type 1 diabetes 

References

  1. Akerblom HK, Virtanen SM, Ilonen J, et al. Dietary manipulation of beta cell autoimmunity in infants at increased risk of type 1 diabetes: a pilot study. Diabetologia. 2005;48:829–37.CrossRefGoogle Scholar
  2. Altieri B, Grant WB, Casa SD, et al. Vitamin D and pancreas: the role of sunshine vitamin in the pathogenesis of diabetes mellitus and pancreatic cancer. Crit Rev Food Sci Nutr. 2017;57(16):3472–3488.CrossRefGoogle Scholar
  3. Bell RA, Mayer-Davis EJ, Beyer JW, SEARCH for Diabetes in Youth Study Group, et al. Diabetes in non-Hispanic white youth: prevalence, incidence, and clinical characteristics: the SEARCH for Diabetes in Youth Study. Diabetes Care. 2009;32(Suppl 2):S102.CrossRefGoogle Scholar
  4. Beyerlein A, Krasmann M, Thiering E, et al. Ambient air pollution and early manifestation of type 1 diabetes. Epidemiology. 2015;26:e31–2.CrossRefGoogle Scholar
  5. Bingley PJ, Gale EA, European Nicotinamide Diabetes Intervention Trial (ENDIT) Group. Progression to type 1 diabetes in islet cell antibody-positive relatives in the European Nicotinamide Diabetes Intervention Trial: the role of additional immune, genetic and metabolic markers of risk. Diabetologia. 2006;49:881–90.CrossRefGoogle Scholar
  6. Bizzarri C, Pitocco D, Napoli N, for the IMDIAB Group, et al. No protective effect of calcitriol on beta-cell function in recent-onset type 1 diabetes: the IMDIAB XIII trial. Diabetes Care. 2010;33:1962–3.CrossRefGoogle Scholar
  7. Bodansky HJ, Stephenson C, Haigh D, et al. Evidence for an environmental effect in the aetiology of insulin dependent diabetes in a transmigratory population. BMJ. 1992;304:1020–2.CrossRefGoogle Scholar
  8. Boitard C, Efendic S, Ferrannini E, et al. A tale of two cousins: type 1 and type 2 diabetes. Diabetes. 2005;54:S1–3.CrossRefGoogle Scholar
  9. Carlsson S, Midthjell K, Grill V. Influence of family history of diabetes on incidence and prevalence of latent autoimmune diabetes of the adult: results from the Nord-Trøndelag Health Study. Diabetes Care. 2007;30:3040–5.CrossRefGoogle Scholar
  10. Chiang JL, Kirkman MS, Laffel LMB, et al. Type 1 diabetes through the life span: a position statement of the American Diabetes Association. Diabetes Care. 2014;37:2034–54.CrossRefGoogle Scholar
  11. Chowdhury S. Puberty and type 1 diabetes. Indian J Endocrinol Metab. 2015;19:S51–4.CrossRefGoogle Scholar
  12. Couper JJ, Beresford S, Hirte C, et al. Weight gain in early life predicts risk of islet autoimmunity in children with a first-degree relative with type 1 diabetes. Diabetes Care. 2009;32:94–9.CrossRefGoogle Scholar
  13. Dabelea D, D’Agostino RB Jr, Mayer-Davis EJ, et al. Testing the accelerator hypothesis: body size, β-cell function, and age at onset of type 1 (autoimmune) diabetes. Diabetes Care. 2006;29:290–4.CrossRefGoogle Scholar
  14. Dahlquist G. Can we slow the rising incidence of childhood-onset autoimmune diabetes? The overload hypothesis. Diabetologia. 2006;49:20–4.CrossRefGoogle Scholar
  15. Fortunato F, Cappelli MG, Vece MM, et al. Incidence of type 1 diabetes among children and adolescents in Italy between 2009 and 2013: the role of a regional childhood diabetes registry. J Diabetes Res. 2016;2016:7239692.CrossRefGoogle Scholar
  16. Fourlanos S, Narendran P, Byrnes GB, et al. Insulin resistance is a risk factor for progression to type 1 diabetes. Diabetologia. 2004;47:1661–7.CrossRefGoogle Scholar
  17. Fronczak CM, Barón AE, Chase HP, et al. In utero dietary exposures and risk of islet autoimmunity in children. Diabetes Care. 2003;26:3237–42.CrossRefGoogle Scholar
  18. Gale EA. The rise of childhood type 1 diabetes in the 20th century. Diabetes. 2002;51:3353–61.CrossRefGoogle Scholar
  19. Gale EA, Gillespie KM. Diabetes and gender. Diabetologia. 2001;44:3–15.CrossRefGoogle Scholar
  20. Gillespie KM, Gale E, Bingley PJ. High familial risk and genetic susceptibility in early onset childhood diabetes. Diabetes. 2002;51:210–4.CrossRefGoogle Scholar
  21. Harjutsalo V, Sund R, Knip M, et al. Incidence of type 1 diabetes in Finland. JAMA. 2013;310:427–8.CrossRefGoogle Scholar
  22. Hummel S, Pflüger M, Hummel M, et al. Primary dietary intervention study to reduce the risk of islet autoimmunity in children at increased risk for type 1 diabetes: the BABYDIET study. Diabetes Care. 2011;34:1301–5.CrossRefGoogle Scholar
  23. Hyttinen V, Kaprio J, Kinnunen L, et al. Genetic liability of type 1 diabetes and the onset age among 22,650 young Finnish twin pairs. Diabetes. 2003;52:1052–5.CrossRefGoogle Scholar
  24. Insel RA, Dunne JL, Atkinson MA, et al. Staging presymptomatic type 1 diabetes: a scientific statement of JDRF, the Endocrine Society, and the American Diabetes Association. Diabetes Care. 2015;38:1964–74.CrossRefGoogle Scholar
  25. International Diabetes Federation (IDF). Atlas data. http://www.diabetesatlas.org/.
  26. Jaïdane H, Sauter P, Sane F, et al. Enterovirus and type 1 diabetes: towards a better understanding of the relationship. Rev Med Virol. 2010;20:265–80.CrossRefGoogle Scholar
  27. Kalliora MI, Vazeou A, Delis D, Bozas E, Thymelli I, Bartsocas CS. Seasonal variation of type 1 diabetes mellitus diagnosis in Greek children. Hormones (Athens). 2011;10:67–71.CrossRefGoogle Scholar
  28. Kibirige M, Metcalf B, Renuka R, et al. Testing the accelerator hypothesis: the relationship between body mass and age at diagnosis of type 1 diabetes. Diabetes Care. 2003;26:2865–70.CrossRefGoogle Scholar
  29. Knerr I, Wolf J, Reinehr T, et al. The ‘accelerator hypothesis’: relationship between weight, height, body mass index and age at diagnosis in a large cohort of 9,248 German and Austrian children with type 1 diabetes mellitus. Diabetologia. 2005;48:2501–4.CrossRefGoogle Scholar
  30. Knip M, Åkerblom HK, Becker D, Dosch HM, Dupre J, Fraser W, Howard N, Ilonen J, Krischer JP, Kordonouri O, Lawson ML, Palmer JP, Savilahti E, Vaarala O, Virtanen SM, TRIGR Study Group. Hydrolyzed infant formula and early β-cell autoimmunity: a randomized clinical trial. JAMA. 2014;311:2279–87.CrossRefGoogle Scholar
  31. Kyvik KO, Nystrom L, Gorus F, et al. The epidemiology of type 1 diabetes mellitus is not the same in young adults as in children. Diabetologia. 2004;47:377–84.CrossRefGoogle Scholar
  32. La Torre D, Seppänen-Laakso T, Larsson HE, et al. Decreased cord-blood phospholipids in young age–at–onset type 1 diabetes. Diabetes. 2013;62:3951–6.CrossRefGoogle Scholar
  33. Lado JJ, Lipman TH. Racial and Ethnic disparities in the incidence, treatment, and outcomes of youth with type 1 diabetes. Endocrinol Metab Clin N Am. 2016;45:453–61.CrossRefGoogle Scholar
  34. Lauria A, Barker A, Schloot N, et al. BMI is an important driver of b-cell loss in type 1 diabetes upon diagnosis in 10 to 18-year-old children. Eur J Endocrinol. 2015;172:107–13.CrossRefGoogle Scholar
  35. Leslie RD, Williams R, Pozzilli P. Clinical review: type 1 diabetes and latent autoimmune diabetes in adults: one end of the rainbow. J Clin Endocrinol Metab. 2006;91:1654–9.CrossRefGoogle Scholar
  36. Leslie RD, Kolb H, Schloot NC, et al. Diabetes classification: grey zones, sound and smoke: action LADA 1. Diabetes Metab Res Rev. 2008;24:511–9.CrossRefGoogle Scholar
  37. Liese AD, Lawson A, Song HR, et al. Evaluating geographic variation in type 1 and type 2 diabetes mellitus incidence in youth in four US regions. Health Place. 2010;16(3):547–56.CrossRefGoogle Scholar
  38. Mäkinen M, Mykkänen J, Koskinen M, et al. Serum 25-Hydroxyvitamin D concentrations in children progressing to autoimmunity and clinical type 1 diabetes. J Clin Endocrinol Metab. 2016;101:723–9.CrossRefGoogle Scholar
  39. Meah FA, DiMeglio LA, Greenbaum CJ, Type 1 Diabetes TrialNet Study Group, et al. The relationship between BMI and insulin resistance and progression from single to multiple autoantibody positivity and type 1 diabetes among TrialNet Pathway to Prevention participants. Diabetologia. 2016;59:1186–95.CrossRefGoogle Scholar
  40. Miettinen ME, Reinert L, Kinnunen L, et al. Serum 25-hydroxyvitamin D level during early pregnancy and type 1 diabetes risk in the off spring. Diabetologia. 2012;55:1291–4.CrossRefGoogle Scholar
  41. Miller LJ, Willis JA, Pearce J, et al. Urban-rural variation in childhood type 1 diabetes incidence in Canterbury, New Zealand, 1980–2004. Health Place. 2011;17:248–56.CrossRefGoogle Scholar
  42. Moltchanova EV, Schreier N, Lammi N, et al. Seasonal variation of diagnosis of type 1 diabetes mellitus in children. Diabet Med. 2009;26:673–8.CrossRefGoogle Scholar
  43. Muntoni S, Fonte MT, Stoduto S, et al. Incidence of insulin-dependent diabetes mellitus among Sardinian-heritage children born in Lazio region, Italy. Lancet. 1997;349:160–2.CrossRefGoogle Scholar
  44. Norris JM, Barriga K, Klingensmith G, et al. Timing of initial cereal exposure in infancy and risk of islet autoimmunity. JAMA. 2003;290:1713–20.CrossRefGoogle Scholar
  45. Nucci AM, Virtanen SM, Becker DJ. Infant feeding and timing of complementary foods in the development of type 1 diabetes. Curr Diab Rep. 2015;15:62.CrossRefGoogle Scholar
  46. Ostman J, Lönnberg G, Arnqvist HJ, et al. Gender differences and temporal variation in the incidence of type 1 diabetes: results of 8012 cases in the nationwide Diabetes Incidence Study in Sweden 1983–2002. J Intern Med. 2008;263:386–94.CrossRefGoogle Scholar
  47. Patterson CC, Dahlquist GG, Gyurus E, et al. Incidence trends for childhood type 1 diabetes in Europe during 1989–2003 and predicted new cases 2005–20: a multicentre prospective registration study. Lancet. 2009;373:2027–33.CrossRefGoogle Scholar
  48. Patterson CC, Gyürüs E, Rosenbauer J, et al. Trends in childhood type 1 diabetes incidence in Europe during 1989–2008: evidence of non-uniformity over time in rates of increase. Diabetologia. 2012;55:2142–7.CrossRefGoogle Scholar
  49. Patterson C, Guariguata L, Dahlquist G, Soltész G, Ogle G, Silink M. Diabetes in the young – a global view and worldwide estimates of numbers of children with type 1 diabetes. Diabetes Res Clin Pract. 2014;103:161–75.CrossRefGoogle Scholar
  50. Pociot F, Lernmark Å. Genetic risk factors for type 1 diabetes. Lancet. 2016;387:2331–9.CrossRefGoogle Scholar
  51. Portuesi R, Pozzilli P, Boehm B, Buzzetti R, Filippi S. Assessment of type 1 diabetes risk conferred by HLA-DRB1, INS-VNTR and PTPN22 genes using the Bayesian network approach. PLoS One. 2013;8:e79506.CrossRefGoogle Scholar
  52. Pozzilli P, Manfrini S, Picardi A. Cow’s milk and trials for prevention of type 1 diabetes. Diabet Med. 2003;20:871–2.CrossRefGoogle Scholar
  53. Redondo MJ, Yu L, Hawa M, et al. Heterogeneity of type I diabetes: analysis of monozygotic twins in Great Britain and the United States. Diabetologia. 2001;44:354–62.CrossRefGoogle Scholar
  54. Rewers M, Ludvigsson J. Environmental risk factors for type 1 diabetes. Lancet. 2016;387:2340–8.CrossRefGoogle Scholar
  55. Sane F, Caloone D, Gmyr V, et al. Coxsackievirus B4 can infect human pancreas ductal cells and persist in ductal-like cell cultures which results in inhibition of Pdx1 expression and disturbed formation of islet-like cell aggregates. Cell Mol Life Sci. 2013;70:4169–80.CrossRefGoogle Scholar
  56. Simpson M, Brady H, Yin X, et al. No association of vitamin D intake or 25-hydroxyvitamin D levels in childhood with risk of islet autoimmunity and type 1 diabetes: the Diabetes Autoimmunity Study in the Young (DAISY). Diabetologia. 2011;54:2779–88.CrossRefGoogle Scholar
  57. Soltesz G, Patterson CC, Dahlquist G. Worldwide childhood type 1 diabetes incidence – what can we learn from epidemiology? Pediatr Diabetes. 2007;8:6–14.CrossRefGoogle Scholar
  58. Sørensen IM, Joner G, Jenum PA, et al. Vitamin D-binding protein and 25-hydroxyvitamin D during pregnancy in mothers whose children later developed type 1 diabetes. Diabetes Metab Res Rev. 2016;32:883.CrossRefGoogle Scholar
  59. Stene LC, Oikarinen S, Hyöty H, et al. Enterovirus infection and progression from islet autoimmunity to type 1 diabetes: the Diabetes and Autoimmunity Study in the Young (DAISY). Diabetes. 2010;59:3174–80.CrossRefGoogle Scholar
  60. Svensson J, Carstensen B, Mortensen HB, et al. Gender-associated differences in type 1 diabetes risk factors? Diabetologia. 2003;46:442–3.CrossRefGoogle Scholar
  61. TRIGR Study Group. Study design of the Trial to Reduce IDDM in the Genetically at Risk (TRIGR). Pediatr Diabetes. 2007;8:117–37.CrossRefGoogle Scholar
  62. Tuomilehto J. The emerging global epidemic of type 1 diabetes. Curr Diab Rep. 2013;13:795–804.CrossRefGoogle Scholar
  63. Virtanen SM, Kenward MG, Erkkola M, et al. Age at introduction of new foods and advanced beta cell autoimmunity in young children with HLA-conferred susceptibility to type 1 diabetes. Diabetologia. 2006;49:1512–21.CrossRefGoogle Scholar
  64. Viskari H, Knip M, Tauriainen S, et al. Maternal enterovirus infection as a risk factor for type 1 diabetes in the exposed off spring. Diabetes Care. 2012;35:1328–32.CrossRefGoogle Scholar
  65. Walter M, Kaupper T, Adler K, Foersch J, Bonifacio E, Ziegler AG. No effect of the 1alpha, 25-dihydroxyvitamin D3 on beta-cell residual function and insulin requirement in adults with new-onset type 1 diabetes. Diabetes Care. 2010;33:1443–8.CrossRefGoogle Scholar
  66. Wen L, Ley RE, Volchkov PY, et al. Innate immunity and intestinal microbiota in the development of type 1 diabetes. Nature. 2008;455:1109–13.CrossRefGoogle Scholar
  67. Wilkin TJ. The accelerator hypothesis: weight gain as the missing link between type I and type II diabetes. Diabetologia. 2001;44:914–22.CrossRefGoogle Scholar
  68. You WP, Henneberg M. Type 1 diabetes prevalence increasing globally and regionally: the role of natural selection and life expectancy at birth. BMJ Open Diabetes Res Care. 2016;4:e000161.CrossRefGoogle Scholar
  69. Zhao Z, Sun C, Wang C, et al. Rapidly rising incidence of childhood type 1 diabetes in Chinese population: epidemiology in Shanghai during 1997–2011. Acta Diabetol. 2014;51:947–53.CrossRefGoogle Scholar
  70. Ziegler AG, Schmid S, Huber D, et al. Early infant feeding and risk of developing type 1 diabetes–associated autoantibodies. JAMA. 2003;290:1721–8.CrossRefGoogle Scholar
  71. Zipitis CS, Akobeng AK. Vitamin D supplementation in early childhood and risk of type 1 diabetes: a systematic review and meta-analysis. Arch Dis Child. 2008;93:512–7.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Chiara Guglielmi
    • 3
  • Richard David Leslie
    • 2
  • Paolo Pozzilli
    • 1
    • 2
    • 3
  1. 1.Department of Endocrinology and DiabetesUniversity Campus Bio-MedicoRomeItaly
  2. 2.Centre of Diabetes, Blizard InstituteBarts and the London School of Medicine and Dentistry, Queen Mary University of LondonLondonUK
  3. 3.Unit of Endocrinology and Diabetes, Department of MedicineUniversity Campus Bio MedicoRomeItaly

Personalised recommendations