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What Is New in Type 1 Diabetes?
My name is Åke Lernmark.
I am at Lund University,
Clinical Research Center
in Malmö, Sweden.
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My disclosures are
that I am a member
of the Scientific Advisory
Board of Diamyd Medical
in Stockholm, Sweden,
and also the European Advisory
Board of ProventionBio,
in the United States.
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This is the map of
incidence rates
of type 1 diabetes in the world.
The color coding is such that
countries with a high incidence
rate are marked black.
As you can see,
the highest incidence
rates of this disease
are in the Scandinavian
countries,
Saudi Arabia, Algeria,
and North America.
And the disease is increasing
by three to five
percent per year.
It is noted that in all these
countries throughout the world,
only 10 percent have a first-degree
relative with type 1 diabetes.
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The cause and effect are
important to understand
in the research of
type 1 diabetes.
There are two events that
need to be kept in mind
when attempting to understand
the development of
type 1 diabetes.
One event is the trigger
and the other event is the
effect of the trigger.
The first event is
referred to as etiology,
which is defined as the
cause or origin of disease.
It can be divided
into two parts.
One is the genetic etiology,
illustrated by the
family to your right.
As you can see,
there are four children
but only one of the children
will inherit from the parents
the risk of developing
type 1 diabetes.
You inherit the risk,
not the disease.
The other factor is
environmental factors,
and I'm illustrating that with
three different types of viruses,
but it could also be other
environmental factors
yet to be determined.
Pathogenesis is the natural
progression of the disease
that will take place once the trigger
has initiated the autoimmunity
against the pancreatic
beta cells.
The diagnosis of type 1
diabetes is a late endpoint
after years of
symptom-free disease,
which is eradicating the
pancreatic islet beta cells.
The result of the pathogenesis
leading to the diagnosis
is that the patient is going to
require daily insulin therapy
because most of the beta cell
and the beta cell
function is lost.
