**8. Epilogue**

It is a an actuality that significant advances have been made in the clinical care of T1DM, which ultimately improved the clinical outcomes. However much more need to be done to find a cure for T1DM. In the absence of an ideal therapy Diabetes will always be a hurdle in the quality of life of these children. Moreover the increasing incidence is of concern because of its health and resource implications. There is a great research potential and more studies are required to identify the environmental factors that trigger the autoimmune destruction of the pancreatic beta cell particularly in some populations and individuals, who are not genetically predisposed to develop T1DM. These environmental triggers if ever identified could potentially be targeted for new preventive strategies and optimal intervention.

#### **9. References**


to a genetically susceptible subgroup of the population (48). The heightened proportion of lower risk hapltotypes and decreased median age at onset of T1DM within the subgroup are

It is a an actuality that significant advances have been made in the clinical care of T1DM, which ultimately improved the clinical outcomes. However much more need to be done to find a cure for T1DM. In the absence of an ideal therapy Diabetes will always be a hurdle in the quality of life of these children. Moreover the increasing incidence is of concern because of its health and resource implications. There is a great research potential and more studies are required to identify the environmental factors that trigger the autoimmune destruction of the pancreatic beta cell particularly in some populations and individuals, who are not genetically predisposed to develop T1DM. These environmental triggers if ever identified could potentially be targeted for new preventive

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**8. Epilogue** 

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**Genetic Testing of Newborns for Type 1** 

Kjersti S. Rønningen

*Norway* 

*Department of Pediatric Research* 

 *Oslo University Hospital, Rikshospitalet, Oslo* 

 **Diabetes Susceptibility – The MIDIA Study** 

Type 1 Diabetes (T1D) is one of the most common chronic diseases with childhood onset, and the disease has increased two to threefold over the past half century by yet unknown means. Recently it was showed that if the present trend continues, the prevalence of cases

Type 1 Diabetes (T1D) is a T-cell mediated autoimmune disease that develops in genetically susceptible individuals whose immune system destroys the majority of insulin-secreting βcells in pancreatic islets (Eizirik et al., 2009). The incidence of T1D has increased more than two- to threefold over the past half century, the most striking example being Finland where it has risen from 12 to 63/100,000 (Knip & Siljander, 2008; Patterson et al., 2009). This increase in incidence has not been paralleled by an increase in the frequency of major risk genes, including HLA class II, insulin, PTPN22, CTLA-4 and IL2RA (Barrett et al., 2009). Indeed, the prevalence of the classical HLA class II genes, which account for approximately 40% of genetic risk, appears to be decreasing (Gillespie et al., 2004; Fourlanos et al., 2008). There are now more than 40 risk loci associated with T1D with the majority of non-HLA genes displaying odds ratio <1.2. (Barrett et al., 2009). Moreover, most individuals who possess T1D risk genes do not develop the disease. Importantly, the concordance rate among monozygotic twins ranges from as low as 25 to 65% (Redendo et al., 1999, 2008; Hyttinen et al., 2003) and is approximately 6% in siblings. A common explanation has been that changes in environment must contribute to the increase in the disease. In particular, environmental exposures to dietary antigens and microbes have been implicated (Knip et al., 2005; Lefebvre et al., 2006). However, no single pathogenic environmental agent has been identified that explain all cases. In all likelihood, T1D develops by various combinations of

younger than 5 years of age will rise by 70% within year 2020 (Patterson et al., 2009).

pathways in response to commonly encountered environmental exposures.

The Norwegian Institute of Public Health is currently running two large prospective cohort studies; "Environmental Triggers of Type 1 Diabetes" (MIDIA) (www.fhi.no/midia) and "The Norwegian Mother and Child Cohort Study" (MoBa) (www.fhi.no/morogbarn). In MIDIA we will be able to study the impact of the dietary intake in children as well as

**1.2 Nutritional related factors and type 1 diabetes risk** 

**1. Introduction** 

**1.1 Background and status of knowledge** 

[69] Maahs, D.M., et al., *Epidemiology of type 1 diabetes.* Endocrinol Metab Clin North Am, 2010. 39(3): p. 481-97. **17** 
