Type 1 diabetes: recent developments

Type 1 diabetes is one of the most common chronic childhood illnesses, affecting 18 to 20 per 100 000 children a year in the United Kingdom.1 The American Diabetes Association committee recommends the term type 1A diabetes for immune mediated diabetes with its destruction of the islet β cells of the pancreas.2 Non-immune mediated diabetes with severe insulin deficiency is termed type 1B. In this review, we will use the term type 1 diabetes to refer to immune mediated type 1A diabetes. At present, the development of type 1 diabetes is a life sentence to a difficult therapeutic regimen that is only partially effective in preventing acute and chronic complications. We will concentrate here on recent advances in our understanding of the epidemiology, pathogenesis, prediction, and prevention of type 1 diabetes and new treatments for the disease. This review is based on information obtained from a recent Medline search with type 1 diabetes, pathogenesis, prediction, prevention, and treatment as key words. We also consulted summaries of the literature on type 1 diabetes (available with teaching slides at www.barbaradaviscenter.org/). Although most attention has focused on the increase in type 2 diabetes, a parallel rise in type 1 diabetes has occurred (1).1 Type 1 diabetes has always been known as a disease of childhood, but more recent epidemiological studies have indicated that the incidence is comparable in adults.3 The enormous international variation in incidence is now recognised. A child in Finland is almost 40 times more likely to develop type 1 diabetes than a child in Japan and almost 100 times more likely to get the disease than a child in the Zunyi region of China.1 The EURODIAB collaborative study, a registry involving 44 countries in Europe, indicates an annual rate of increase in incidence …