title: Environmental determinants of type 1 diabetes: a role for overweight and insulin resistance.
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.
authors.affiliation: Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, New South Wales, Australia; School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.
authors.forename: Sadia T
authors.initials: ST
authors.lastname: Islam
authors.forename: Shubha
authors.initials: S
authors.lastname: Srinivasan
authors.forename: Maria E
authors.initials: ME
authors.lastname: Craig
mesh_terms: D000293:Adolescent; D017677:Age Distribution; D001315:Australia / Q000453:epidemiology; D001724:Birth Weight; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology* / Q000209:etiology* / Q000503:physiopathology; D004032:Diet; D004777:Environment; D019317:Evidence-Based Medicine; D005260:Female; D020022:Genetic Predisposition to Disease / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007333:Insulin Resistance; D008297:Male; D008429:Maternal Welfare; D020380:Needs Assessment; D009765:Obesity / Q000150:complications* / Q000175:diagnosis; D011379:Prognosis; D018570:Risk Assessment; D017678:Sex Distribution
keywords: aetiology; birthweight; environmental; obesity; type 1 diabetes mellitus