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The Emerging Global Epidemic of Type 1 Diabetes

  • Diabetes Epidemiology (SH Golden, Section Editor)
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Abstract

Type 1 diabetes mellitus (T1D) can occur at any age, with a peak in incidence around puberty. Classification between T1D and type 2 diabetes becomes more challenging with increasing age of onset of T1D over time develops in genetically predisposed individuals. The main susceptibility is conferred with human leukocyte antigen (HLA) genes. Some of the geographic variation in incidence and familial aggregation is explained by differences in HLA haplotypes. In many populations, the incidence is somewhat higher in males than in females, and a 1.3- to 2.0-fold male excess in incidence after about 15 years of age exists in most populations. The incidence of childhood-onset T1D varies markedly among countries. East Asian and native American populations have low incidences (approximately 0.1–8 per 100 000/year), while the highest rates are found in Finland (>60 per 100 000/year), Sardinia (40 per 100 000/year), and Sweden (47 per 100 000/year). The risk is highest in European-derived populations. About 10 %–20 % of newly diagnosed childhood cases of T1D have an affected first-degree relative. Those with an affected sibling or parent have a cumulative risk of 3 %–7 % up to about 20 years of age, as compared with <1 % in the general population. The cumulative incidence among the monozygotic co-twins of persons with T1D is less than 50 %. Thus, the majority of genetically predisposed people do not develop T1D. Studies assessing temporal trends have shown that the incidence of childhood-onset T1D has increased in all parts of the world. The average relative increase is 3 %–4 % per calendar year. For instance, in Finland, the incidence today is 5 times higher than 60 years ago. At the same time, the age at onset of T1D in children has become younger. It is strongly believed that nongenetic factors are important for the development of T1D and its increase, but the causative evidence is missing. The causes for this increasing trend and current epidemic still remain unknown.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. • Gale EA. How to survive diabetes. Diabetologia. 2009;52:559–67. This is a good review of the advances in diabetes care that has resulted in a dramatic reduction of mortality due to type 1 diabetes during the past 8 decades.

    Article  PubMed  CAS  Google Scholar 

  2. Beran D, Yudkin JS. Diabetes care in sub-Saharan Africa. Lancet. 2006;368:1689–95.

    Article  PubMed  Google Scholar 

  3. • Orchard TJ, Secrest AM, Miller RG, Costacou T. In the absence of renal disease, 20 year mortality risk in type 1 diabetes is comparable to that of the general population: a report from the Pittsburgh Epidemiology of Diabetes. Complications Study. Diabetologia. 2010;53:2312–9. This study provides for the first time evidence that excess mortality no longer exists in childhood-onset type 1 diabetes, as compared with the nondiabetic population, if diabetic patients do not develop diabetic renal disease.

    Article  PubMed  CAS  Google Scholar 

  4. •• International Diabetes Feferation. IDF Diabetes Atlas. 5th edition. Brussels 2012. IDF updates the global estimates for each country nowadays every year and provides projections for the future numbers of people with diabetes in the world. A very important and useful document.

  5. Green MS, Swatz T, Mayshar E, et al. When is an epidemic an epidemic? Isr Med J. 2002;4:3–6.

    Google Scholar 

  6. • Dabalea D, Pihoker C, Talton JW, et al. Etiological approach to characterizationof diabetes type. The SEARCH for diabetes in youth study. Diabetes Care. 2011;34:1628–33. This is a well-done evaluation of the current difficulties in distinguishing between type 1 and type 2 diabetes in young people.

    Article  Google Scholar 

  7. DIAMOND Project Group. Incidence and trends of childhood type 1 diabetes worldwide 1990–1999. Diabet Med. 2006;23:857–66.

    Article  Google Scholar 

  8. Green A, Gale EAM. Patterson CC for the EURODIAB ACE study group. Incidence of childhood-onset insulin-dependent diabetes mellitus: the EURODIAB ACE study. Lancet. 1992;339:905–9.

    Article  PubMed  CAS  Google Scholar 

  9. Patterson CC, Dahlquist G, Gyürüs E, et al. Incidence trends for childhood type 1diabetes in Europe during 1989–2003 and predicted new cases 2005–20: a multicentre prospective registration study. Lancet. 2009;373:2027–33.

    Article  PubMed  Google Scholar 

  10. Slingerland AS, Nuboer R, Hadders-Algra M, et al. Improved motor development and good long-term glycaemic control with sulfonylurea treatment in a patient with the syndrome of intermediate developmental delay, early-onset generalised epilepsy and neonatal diabetes associated with the V59M mutation in the KCNJ11 gene. Diabetologia. 2006;49:2559–63.

    Article  PubMed  CAS  Google Scholar 

  11. Christau B, Kromann H, Christy M, et al. Incidence of insulin-dependent diabetes mellitus (0–29 years at onset) in Denmark. Acta Med Scand Suppl. 1979;624:54–60.

    PubMed  CAS  Google Scholar 

  12. Gamble DR. The epidemiology of insulin dependent diabetes, with particular reference to the relationship of virus infection to its etiology. Epidemiol Rev. 1980;2:49–70.

    PubMed  CAS  Google Scholar 

  13. Joner G, Søvik O. The incidence of type 1 (insulin-dependent) diabetes mellitus 15-29 years in Norway 1978–1982. Diabetologia. 1991;34:271–4.

    Article  PubMed  CAS  Google Scholar 

  14. Pundziute-Lyckå A, Dahlquist G, Nyström L, et al. The incidence of type I diabetes has not increased but shifted to a younger age at diagnosis in the 0–34 years group in Sweden 1983 to 1998. Diabetologia. 2002;45:783–91.

    Article  PubMed  Google Scholar 

  15. Kyvik KO, Nystrom L, Gorus F, et al. The epidemiology of type 1 diabetes mellitus is not the same in young adults as in children. Diabetologia. 2004;47:377–84.

    Article  PubMed  CAS  Google Scholar 

  16. • Harjutsalo V, Sjöberg L, Tuomilehto J. Time trends in the incidence of type 1 diabetes in Finnish children: a cohort study. Lancet. 2008;371:1777–82. The study demonstrated that even in the country with the highest incidence of type 1 diabetes, the incidence continues to increase.

    Article  PubMed  Google Scholar 

  17. Bruno G, Runzo C, Cavallo-Perin P, et al. Incidence of type 1 and type 2 diabetes in adults aged 30–49 years: the population-based registry in the province of Turin, Italy. Diabetes Care. 2005;28:2613–9.

    Article  PubMed  Google Scholar 

  18. Weets I, De Leeuw IH, Du Caju MV, et al. The incidence of type 1 diabetes in the age group 0–39 years has not increased in Antwerp (Belgium) between 1989 and 2000: evidence for earlier disease manifestation. Diabetes Care. 2002;25:840–6.

    Article  PubMed  Google Scholar 

  19. Pundziute-Lyckå A, Urbonaite B, Ostrauskas R, et al. Incidence of type 1 diabetes in Lithuanians aged 0–39 years varies by the urban–rural setting, and the time change differs for men and women during 1991–2000. Diabetes Care. 2003;26:671–6.

    Article  PubMed  Google Scholar 

  20. Henriksen OM, Roder ME, Prahl JB, Svendsen OL. Diabetic ketoacidosis in Denmark incidence and mortality estimated from public health registries. Diabetes Res Clin Pract. 2007;76:51–6.

    Article  PubMed  Google Scholar 

  21. Lammi N, Taskinen O, Moltchanova E, et al. A high incidence of type 1 diabetes and an alarming increase in the incidence of type 2 diabetes among young adults in Finland between 1992 and 1996. Diabetologia. 2007;50:1393–400.

    Article  PubMed  CAS  Google Scholar 

  22. Lammi N, Blomstedt PA, Moltchanova E, et al. Marked temporal increase in the incidence of type 1 and type 2 diabetes among young adults in Finland. Diabetologia. 2008;51:897–9.

    Article  PubMed  CAS  Google Scholar 

  23. Arnqvist HJ, Littorin B, Nyström L, et al. Difficulties in classifying diabetes at presentation in theyoung adult. Diabet Med. 1993;10:606–13.

    Article  PubMed  CAS  Google Scholar 

  24. Littorin B, Sundkvist G, Hagopian W, et al. Islet cell and glutamic acid decarboxylase antibodies present at diagnosis of diabetes predict the need for insulin treatment: a cohort study in young adults whose disease was initially labeled as type 2 or unclassifiable diabetes. Diabetes Care. 1999;22:409–12.

    Article  PubMed  CAS  Google Scholar 

  25. Fourlanos S, Dotta F, Greenbaum CJ, et al. Latent autoimmune diabetes in adults (LADA) should be less latent. Diabetologia. 2005;48:2206–12.

    Article  PubMed  CAS  Google Scholar 

  26. Leslie RD, Kolb H, Schloot NC, et al. Diabetes classification: grey zones, sound and smoke: Action LADA 1. Diabetes Metab Res Rev. 2008;24:511–9.

    Article  PubMed  CAS  Google Scholar 

  27. Swai ABM, Lutale J, McLarty DG. Diabetes in tropical Africa: a prospective study 1981–7. BMJ. 1990;300:1103–6.

    Article  PubMed  CAS  Google Scholar 

  28. Omar MAK, Asmal AC. Patterns of diabetes mellitus in young African and Indians in Natal. Trop Geogr Med. 1984;36:133–8.

    PubMed  CAS  Google Scholar 

  29. Kalk WJ, Huddle KRL, Raal FJ. The age of onset and sex distribution of insulin-dependent diabetes mellitus in Africans in South Africa. Postgrad Med J. 1993;69:552–6.

    Article  PubMed  CAS  Google Scholar 

  30. Lester FT. The clinical pattern of diabetes mellitus in Ethiopians. Diabetes Care. 1984;7:6–11.

    Article  PubMed  CAS  Google Scholar 

  31. Marshall SL, Edidin D, Sharma V, et al. Current clinical status, glucose control, and complication rates of children and youth with type 1 diabetes in Rwanda. Pediatr Diabetes. 2013;14:217–26.

    PubMed  Google Scholar 

  32. •• Mbanya JCN, Motala AA, Sobngwi E, et al. Diabetes in sub-Saharan Africa. Lancet. 2010;375:2254–66. An excellent and comprehensive review of many aspects of diabetes in sub-Saharan Africa. It also summarizes the interesting ketosis-prone phenotype that reacts well to lifestyle intervention and oral antidiabetic drugs and can be managed without insulin for long periods.

    Article  PubMed  Google Scholar 

  33. Sobngwi E, Mauvais-Jarvis F, Vexiau P, et al. Diabetes in Africans, part 2: ketosis prone atypical diabetes mellitus. Diabetes Metab. 2002;28:5–12.

    PubMed  CAS  Google Scholar 

  34. Umpierrez GE, Smiley D, Kitabchi AE. Narrative review: ketosis-prone type 2 diabetes mellitus. Ann Intern Med. 2006;114:350–7.

    Article  Google Scholar 

  35. Balasubramanyam A, Nalini R, Hampe CS, Maldonado M. Syndromes of ketosis-prone diabetes mellitus. Endocr Rev. 2008;29:292–302.

    Article  PubMed  CAS  Google Scholar 

  36. Osei K, Schuster DP, Amoah AG, Owusu SK. Diabetes in Africa: pathogenesis of type 1 and type 2 diabetes mellitus in sub-Saharan Africa—implications for transitional populations. J Cardiovasc Risk. 2003;10:85–96.

    Article  PubMed  Google Scholar 

  37. American Diabetes Association. Expert Committee on the diagnosis and Classification of Diabetes Mellitus. Report of the experts committee on the diagnosis and classification of Diabetes Mellitus. Diabetes Care. 2003;26:S5–S20.

    Article  Google Scholar 

  38. Hawa MI, Kolb H, Schloot N, et al. Adult-onset autoimmune diabetes in Europe is prevalent with a broad clinical phenotype: action LADA 7. Diabetes Care. 2013;36:908–13.

    Article  PubMed  Google Scholar 

  39. Karvonen M, Pitkäniemi M, Pitkäniemi J, et al. Sex-difference in the incidence of insulin-dependent diabetes mellitus (IDDM). An analysis of the recent epidemiological data. Diab Metab Rev. 1997;13:275–91.

    Article  CAS  Google Scholar 

  40. Karvonen M, Tuomilehto J, Libman I, LaPorte R. A review of the recent epidemiological data on the worldwide incidence of type 1 (insulin-dependent) diabetes mellitus. World Health Organization DIAMOND Project Group. Diabetologia. 1993;36:883–92.

    Article  PubMed  CAS  Google Scholar 

  41. Patrick SL, Kadohiro JK, Waxman SH, et al. IDDM incidence in a multiracial population. The Hawaii IDDM Registry, 1980-1990. Diabetes Care. 1997;20:983–7.

    Article  PubMed  CAS  Google Scholar 

  42. • Newhook LA, Penney S, Fiander J, Dowden J. Recent incidence of type 1 diabetes mellitusin children 0–14 years in Newfoundland and Labrador, Canada climbs to over 45/100,000: a retrospective time trend study. BMC Res Notes. 2012;5:628. Yet another demonstration from a high-incidence population where the incidence is moving up.

    Article  PubMed  Google Scholar 

  43. • Derraik JBG, Reed JW, Jefferies C. Increasing incidence and age at diagnosis among children with Type 1 diabetes mellitus over a 20-Year Period in Auckland (New Zealand). PlosOne. 2012;7:e32640. Together with earlier data from Hawaii, this study demonstrates that childhood-onset type 1 diabetes is not uncommon in Pacific island populations.

    Article  CAS  Google Scholar 

  44. • Panamonta O, Thamjaroen J, Panamonta M, et al. The rising incidence of type 1 diabetes in the northeastern part of Thailand. J Med Assoc Thai. 2011;94:1447–50. Although the incidence in Thailand is increasing, it still remains low, as is usual in oriental, Mongoloid populations.

    PubMed  Google Scholar 

  45. Gill GV, Mbanya JC, Ramaiya KL, Tesfaye S. A sub-Saharan African perspective of diabetes. Diabetologia. 2009;52:8–16.

    Article  PubMed  CAS  Google Scholar 

  46. Afoke AO, Ejeh NM, Nwonu EN, et al. Prevalence and clinical picture of IDDM in Nigerian Igbo school children. Diabetes Care. 1992;15:1310–2.

    Article  PubMed  CAS  Google Scholar 

  47. Elamin A, Omer MI, Hofvander Y, Tuvemo T. Prevalence of IDDM in school children in Khartoum, Sudan. Diabetes Care. 1989;12:430–2.

    Article  PubMed  CAS  Google Scholar 

  48. • Hjern A, Söderström U, Aman J. East Africans in Sweden have a high risk for type 1 diabetes. Diabetes Care. 2012;35:597–8. The incidence in east Africans is similar to that in Arab populations, probably due to the genetic admixture between European-derived Arabs and Africans.

    Article  PubMed  Google Scholar 

  49. Lipman TH, Jawad AF, Murphy KM, et al. Incidence of type 1 diabetes in Philadelphia is higher in black than white children from 1995 to 1999: epidemic or misclassification? Diabetes Care. 2006;29:2391–5.

    Article  PubMed  Google Scholar 

  50. Grzywa MA, Sobel AK. Incidence of IDDM in the province of Rzeszow, Poland, 0- to 29-year-old age-group, 1980–1992. DiabetesCare. 1995;18:542–4.

    CAS  Google Scholar 

  51. Bruno G, Merletti F, Biggeri A, et al. Increasing trend of type I diabetes in children and young adults in the provice of Turin (Italy): analysis of age, period and birth cohort effects from 1984 to 1996. Diabetologia. 2001;44:22–5.

    Article  PubMed  CAS  Google Scholar 

  52. Gale EA. Spring harvest? Reflections on the rise of type 1 diabetes. Diabetologia. 2005;48:2445–50.

    Article  PubMed  CAS  Google Scholar 

  53. Krolewski AS, Warram JH, Rand LI, Kahn CR. Epidemiologic approach to the etiology of type 1 diabetes mellitus and its complications. N Engl J Med. 1987;317:1390–8.

    Article  PubMed  CAS  Google Scholar 

  54. Gale EA. The rise of childhood type 1 diabetes in the 20th century. Diabetes. 2002;51:3353–61.

    Article  PubMed  CAS  Google Scholar 

  55. Onkamo P, Väänänen S, Karvonen M, Tuomilehto J. Worldwide increase in incidence of type 1 diabetes: the analysis of the data on published incidence trends. Diabetologia. 1999;42:1395–403.

    Article  PubMed  CAS  Google Scholar 

  56. Tuomilehto J, Virtala E, Karvonen M, et al. Increase in incidence of insulin-dependent diabetes mellitus in Finnish children. Int J Epidemiol. 1995;24:984–92.

    Article  PubMed  CAS  Google Scholar 

  57. Tuomilehto J, Karvonen M, Pitkäniemi J, et al. Record high incidence of type 1 (insulin-dependent) diabetes mellitus in Finnish children. Diabetologia. 1999;42:655–60.

    Article  PubMed  CAS  Google Scholar 

  58. • Harjutsalo V, Sund R, Knip M, Groop PH. Incidence of Type 1 diabetes in Finland. JAMA. 2013;310:427–8. This report claims that the increase in incidence of type 1 diabetes has leveled off. However, a more careful look at the data over the entire period shows that the long-term trend in incidence rise has really not changed.

    Article  PubMed  CAS  Google Scholar 

  59. Feltbower RG, McKinney PA, Parslow RC, et al. Type 1 diabetes in Yorkshire, UK: time trends in 0–14 and 15–29-year-olds, age at onset and age-period-cohort modelling. Diabet Med. 2003;20:437–41.

    Article  PubMed  CAS  Google Scholar 

  60. Charkaluk ML, Czernichow P, Lévy-Marchal C. Incidence data of childhood-onset type I diabetes in France during 1988-1997: the case for a shift toward younger age at onset. Pediatr Res. 2002;52:859–62.

    PubMed  Google Scholar 

  61. Karvonen M, Pitkäniemi J, Tuomilehto J. The Finnish childhood diabetes registry group. The onset age of type 1 diabetes in Finnish children has become younger. Diabetes Care. 1999;22:1066–70.

    Article  PubMed  CAS  Google Scholar 

  62. Imperatore G, Boyle JP, Thompson TJ, Case D, et al. Projections of type 1 and type 2 diabetes burden in the U.S. population aged <20 years through 2050: dynamic modeling of incidence, mortality, and population growth. Diabetes Care. 2012;35:2515–20.

    Article  PubMed  Google Scholar 

  63. Hyöty H, Hiltunen M, Reunanen A, et al. Decline of mumps antibodies in Type I (insulin-dependent) diabetic children and a plateau in the rising incidence of Type 1 diabetes after introduction of mumps-measles-rubella vaccine in Finland. Diabetologia. 1993;36:1303–8.

    Article  PubMed  Google Scholar 

  64. Miettinen M, Kinnunen L, Keinänen-Kiukaanniemi S, et al. Prevalence of vitamin D insufficiency in Finnish adult population. Suomen Lääkäril. 2013;68:29–33. in Finnish with English Summary.

    Google Scholar 

  65. • Berhan Y, Waernbaum I, Lind T, et al. Swedish childhood diabetes study group. Thirty years of prospective nationwide incidence of childhood type 1 diabetes: the accelerating increase by time tends to level off in Sweden. Diabetes. 2011;60:577–81. As with the Finnish report, the long-term trend in incidence rise has really not changed, and no leveling off can be confirmed.

    Article  PubMed  CAS  Google Scholar 

  66. Cinek O, Kulich M, Sumnik Z. The incidence of type 1 diabetes in young Czech children stopped rising. Pediatr Diabetes. 2012;13:559–63.

    Article  PubMed  Google Scholar 

  67. Harron KL, Feltbower RG, McKinney PA. Rising rates of all types of diabetes in south asian and non-south asian children and young people aged 0–29 years in West Yorkshire, U.K., 1991–2006. Diabetes Care. 2011;34:652–4.

    Article  PubMed  Google Scholar 

  68. Rewers M. Challenges in diagnosing type 1 diabetes in different populations. Diabetes Metab J. 2012;36:90–7.

    Article  PubMed  Google Scholar 

  69. Lorenzen T, Pociot F, Hougaard P, Nerup J. Long-term risk of IDDM in first-degree relatives of patients with IDDM. Diabetologia. 1994;37:321–7.

    Article  PubMed  CAS  Google Scholar 

  70. Gillespie KM, Gale EA, Bingley PJ. High familial risk and genetic susceptibility in early onset childhood diabetes. Diabetes. 2002;51:210–4.

    Article  PubMed  CAS  Google Scholar 

  71. Harjutsalo V, Podar T, Tuomilehto J. Cumulative incidence of type 1 diabetes in 10,168 siblings of Finnish young-onset type 1 diabetic patients. Diabetes. 2005;54:563–9.

    Article  PubMed  CAS  Google Scholar 

  72. Warram JH, Krolewski AS, Gottlieb MS, Kahn CR. Differences in risk of insulin-dependent diabetes in offspring of diabetic mothers and diabetic fathers. N Engl J Med. 1984;311:149–52.

    Article  PubMed  CAS  Google Scholar 

  73. Tuomilehto J, Podar T, Tuomilehto-Wolf E, Virtala E. Evidence for importance of gender and birth cohort for risk of IDDM in offspring of IDDM patients. Diabetologia. 1995;38:975–82.

    Article  PubMed  CAS  Google Scholar 

  74. Harjutsalo V, Reunanen A, Tuomilehto J. Differential transmission of type 1 diabetes from diabetic fathers and mothers to their offspring. Diabetes. 2006;55:1517–24.

    Article  PubMed  CAS  Google Scholar 

  75. Tuomilehto-Wolf E, Tuomilehto J. HLA antigens in insulin-dependent diabetes mellitus. Ann Med. 1991;23:481–8.

    Article  PubMed  CAS  Google Scholar 

  76. Undlien DE, Lie BA, Thorsby E. HLA complex genes in type 1 diabetes and other autoimmune diseases: which genes are involved? Trends Genet. 2001;17:93–100.

    Article  PubMed  CAS  Google Scholar 

  77. Todd JA, Walker NM, Cooper JD, et al. Robust associations of four new chromosome regions from genome-wide analyses of type 1 diabetes. Nat Genet. 2007;39:857–64.

    Article  PubMed  CAS  Google Scholar 

  78. Noble JA, Valdes AM. Genetics of the HLA region in the prediction of type 1 diabetes. Curr Diab Rep. 2011;11:533–42.

    Article  PubMed  CAS  Google Scholar 

  79. Wellcome Trust Case Control Consortium. Genome-wide association study of 14,000 cases of seven common diseases and 3,000 shared controls. Nature. 2007;447:661–78.

    Article  Google Scholar 

  80. •• Barrett JC, Clayton DG, Concannon P, et al. Genome-wide association study and meta-analysis find that over 40 loci affect risk of type 1 diabetes. Nat Genet. 2009;41:703–7. The most comprehensive genome-wide analysis of the type 1 diabetes susceptibility genes.

    Article  PubMed  CAS  Google Scholar 

  81. Rønningen KS, Keiding N, Green A. Correlations between the incidence of childhood-onset type I diabetes in Europe and HLA genotypes. Diabetologia. 2001;44 Suppl 3:B51–9.

    Article  PubMed  Google Scholar 

  82. Kondrashova A, Viskari H, Kulmala P, et al. Signs of beta-cell autoimmunity in nondiabetic schoolchildren: a comparison between Russian Karelia with a low incidence of type 1 diabetes and Finland with a high incidence rate. Diabetes Care. 2007;30:95–100.

    Article  PubMed  CAS  Google Scholar 

  83. Tienari PJ, Tuomilehto-Wolf E, Tuomilehto J, et al. HLA haplotypes in Type 1 (insulin-dependent) diabetes mellitus: molecular analysis of the HLA-DQ locus. Diabetologia. 1992;35:254–60.

    Article  PubMed  CAS  Google Scholar 

  84. Kyvik KO, Green A, Beck-Nielsen H. Concordance rates of insulin dependent diabetes mellitus: a population based study of young Danish twins. Br Med J. 1995;311:913–7.

    Article  CAS  Google Scholar 

  85. Hyttinen V, Kaprio J, Kinnunen L, et al. Genetic liability of type 1 diabetes and the onset age among 22,650 young Finnish twin pairs: a nationwide follow-up study. Diabetes. 2003;52:1052–5.

    Article  PubMed  CAS  Google Scholar 

  86. Kumar D, Gemayel NS, Deapen D, et al. North-American twins with IDDM: genetic, etiological, and clinical significance of disease concordance according to age, zygosity, and the interval after diagnosis in first twin. Diabetes. 1993;42:1351–63.

    Article  PubMed  CAS  Google Scholar 

  87. Redondo MJ, Yu L, Hawa M, et al. Heterogeneity of type I diabetes: analysis of monozygotic twins in Great Britain and the United States. Diabetologia. 2001;44:354–62.

    Article  PubMed  CAS  Google Scholar 

  88. Tuomilehto-Wolf E, Tuomilehto J, Hitman GA, et al. Genetic susceptibility to non-insulin dependent diabetes mellitus and glucose intolerance are located in HLA region. BMJ. 1993;307:155–9.

    Article  PubMed  CAS  Google Scholar 

  89. • Sjöberg L, Pitkäniemi J, Haapala L, et al. Fertility in people with childhood-onset type 1 diabetes. Diabetologia. 2013;56:78–81. The study shows that fertility among type 1 diabetic men and women have increased over the last years.

    Article  PubMed  Google Scholar 

  90. Stene LC, Harjutsalo V, Moltchanova E, Tuomilehto J. Epidemiology of Type 1 diabetes. In: Holt R, Goldstein B, Flyvbjerg A, Cockram C, editors. Textbook of diabetes. 4th ed. Oxford: Blackwell Publishing; 2010. p. 1–3.12.

    Google Scholar 

  91. • Stene LC, Gale EA. The prenatal environment and type 1 diabetes. Diabetologia. 2013;56:1888–97. A full review about the epidemiology of type 1 diabetes.

    Article  PubMed  CAS  Google Scholar 

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Tuomilehto, J. The Emerging Global Epidemic of Type 1 Diabetes. Curr Diab Rep 13, 795–804 (2013). https://doi.org/10.1007/s11892-013-0433-5

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