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doi:10.1111/jpc.12616
REVIEW ARTICLE
Environmental determinants of type 1 diabetes: A role for overweight and insulin resistance Sadia T Islam,1,2 Shubha Srinivasan1 and Maria E Craig1,2,3 1 3
Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, 2School of Women’s and Children’s Health, University of New South Wales and Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia
Abstract: Rates of type 1 diabetes are rising globally, with a decreasing proportion of high-risk genotypes and twin concordance rates below 50%. Therefore, environmental factors such as viruses, nutrition and overweight have been examined as putative aetiological agents. The accelerator hypothesis proposes that overweight and insulin resistance are central to both type 1 and type 2 diabetes and may explain, in part, the rise in type 1 diabetes incidence. The temporal rise in body mass index at type 1 diabetes onset and the observation that pre-diabetic children are heavier and more insulin resistant than their peers suggests convergence of type 1 and type 2 diabetes phenotypes. The influence of insulin resistance may begin in utero, although the aetiological role of birthweight in type 1 diabetes remains unclear. Further research to elucidate the role of these modifiable risk factors in today’s obesogenic environment may provide future potential for diabetes prevention. Key words:
aetiology; birthweight; environmental; obesity; type 1 diabetes mellitus.
Multiple-choice questions 1. The most common form of childhood diabetes in Caucasian populations is a. Type 1 diabetes (CORRECT – represents 90% of childhood diabetes) b. Type 2 diabetes (INCORRECT – represents ∼10%) c. Monogenic diabetes (INCORRECT – represents
doi:10.1111/jpc.12616
REVIEW ARTICLE
Environmental determinants of type 1 diabetes: A role for overweight and insulin resistance Sadia T Islam,1,2 Shubha Srinivasan1 and Maria E Craig1,2,3 1 3
Institute of Endocrinology and Diabetes, The Children’s Hospital at Westmead, 2School of Women’s and Children’s Health, University of New South Wales and Discipline of Paediatrics and Child Health, University of Sydney, Sydney, New South Wales, Australia
Abstract: Rates of type 1 diabetes are rising globally, with a decreasing proportion of high-risk genotypes and twin concordance rates below 50%. Therefore, environmental factors such as viruses, nutrition and overweight have been examined as putative aetiological agents. The accelerator hypothesis proposes that overweight and insulin resistance are central to both type 1 and type 2 diabetes and may explain, in part, the rise in type 1 diabetes incidence. The temporal rise in body mass index at type 1 diabetes onset and the observation that pre-diabetic children are heavier and more insulin resistant than their peers suggests convergence of type 1 and type 2 diabetes phenotypes. The influence of insulin resistance may begin in utero, although the aetiological role of birthweight in type 1 diabetes remains unclear. Further research to elucidate the role of these modifiable risk factors in today’s obesogenic environment may provide future potential for diabetes prevention. Key words:
aetiology; birthweight; environmental; obesity; type 1 diabetes mellitus.
Multiple-choice questions 1. The most common form of childhood diabetes in Caucasian populations is a. Type 1 diabetes (CORRECT – represents 90% of childhood diabetes) b. Type 2 diabetes (INCORRECT – represents ∼10%) c. Monogenic diabetes (INCORRECT – represents
