Published online Jan 15, 2020. doi: 10.4239/wjd.v11.i1.13
Peer-review started: September 18, 2019
First decision: October 13, 2019
Revised: November 1, 2019
Accepted: November 25, 2019
Article in press: November 25, 2019
Published online: January 15, 2020
Processing time: 90 Days and 8.4 Hours
Type 1 diabetes (T1D) is an autoimmune disease that usually strikes early in life, but can affect individuals at almost any age. It is caused by autoreactive T cells that destroy insulin-producing beta cells in the pancreas. Epidemiological studies estimate a prevalence of 1 in 300 children in the United States with an increasing incidence of 2%-5% annually worldwide. The daily responsibility, clinical management, and vigilance required to maintain blood sugar levels within normal range and avoid acute complications (hypoglycemic episodes and diabetic ketoacidosis) and long term micro- and macro-vascular complications significantly affects quality of life and public health care costs. Given the expansive impact of T1D, research work has accelerated and T1D has been intensively investigated with the focus to better understand, manage and cure this condition. Many advances have been made in the past decades in this regard, but key questions remain as to why certain people develop T1D, but not others, with the glaring example of discordant disease incidence among monozygotic twins. In this review, we discuss the field’s current understanding of its pathophysiology and the role of genetics and environment on the development of T1D. We examine the potential implications of these findings with an emphasis on T1D inheritance patterns, twin studies, and disease prevention. Through a better understanding of this process, interventions can be developed to prevent or halt it at early stages.
Core tip: Type 1 diabetes (T1D) is one of the most common childhood chronic conditions with its incidence increasing annually. Its arduous management requires vigilance to avoid complications that impact quality of life and health care costs. A better understanding of how T1D develops can help find a way to prevent it from developing at all. In this review, we discuss the current understanding of the complex relationship between the roles of genetics and the environment in the development of T1D.