Zeroing in on type 1

Identifying the likely environmental triggers behind the rapid rise of childhood-onset type 1 diabetes

Type 1 diabetes has been described as an invisible disease. Those untouched by type 1 diabetes rarely see or understand the 24-hour a day balancing act that goes on behind the scenes.

A person living with type 1 diabetes must constantly monitor their intake of carbohydrates, insulin, exercise, stress and a multitude of other factors that affect blood glucose levels. It’s a constant burden that, so far, cannot be removed and the consequences of having blood glucose levels that are too low or too high can be dire. Even more worryingly, over the past 20 years the rate of childhood-onset type 1 diabetes in Australia and around the world has doubled.

Recently, some good news has emerged. A team led by the University of Adelaide’s Robinson Research Institute and the Women’s and Children’s Hospital is conducting a landmark Australia-wide study that it hopes will reveal the disease’s pre- and post-birth environmental triggers, and inform its prevention and cure.

Called the Environmental Determinants of Islet Autoimmunity (ENDIA) study, it’s the largest of its kind in the world to include early pregnancy observations in the natural history of type 1 diabetes.

“We believe the modern environment that the child is exposed to in early life holds the key to understanding the increase in type 1 diabetes,” said lead researcher Professor Jenny Couper.

“Factors such as nutrition, weight gain, chronic inflammation, viral infections and the bacteria colonisation of our bodies (the microbiome) may drive or protect against the development of type 1 diabetes. Importantly, children are exposed to these factors in-utero, which is where the origins of type 1 diabetes may lie. This seems likely as the first detectable sign of diabetes developing is commonly in the first year of life, long before the disease presents clinically. Our research aims to identify the early life exposures that lead to type 1 diabetes and the genes that are involved.”

The potential of the ENDIA study to accelerate the global understanding of type 1 diabetes has been recognized internationally and the study was recently awarded an $8m grant from US-based charity The Helmsley Charitable Trust in partnership with JDRF Australia’s Type 1 Diabetes Clinical Research Network.

Professor Couper and her team are following the development of 1,400 children in great detail across Australia from pregnancy to early childhood. All participants have a first-degree relative with type 1 diabetes.
“There are many reasons why the environment has firmed as a suspect in the rise of type 1 diabetes,” said Professor Couper.
“For example, the proportion of sufferers who have ‘high risk’ genes is actually decreasing and the increase in incidence is accounted for by people with ‘medium risk’ genes”.

“We’re hopeful that identifying the environmental factors that increase or decrease risk could lead to effective new prevention strategies.”

In addition to the recent funding boost, the ENDIA study is being conducted through a Centre for Research Excellence based at the University of Adelaide with $2.5 million in funds from the National Health and Medical Research Council and JDRF Australia. Other contributing institutions are the Walter and Eliza Hall Institute, Royal Melbourne Hospital, University of New South Wales, University of Sydney, University of Western Australia and University of Queensland.

Related links: 
Robinson Research Institute
Prof Jennifer Couper
Dr Megan Penno
Media release
ENDIA study

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