The aetiology of Type 1 diabetes

The aetiology of Type 1 diabetes involves both genetic and environmental factors. The genes implicated are ‘susceptibility genesʹ, which modify risk. Individual susceptibility genes may not be required and are not sufficient for disease development. The strongest genetic risk component is encoded within the major histocompatibility complex (MHC) and is designated IDDM1. The HLA-DQ genes contribute to the risk, but so may other MHC-encoded genes. The susceptibility encoded by IDDM2 refers to a variable number of tandem repeats in the insulin gene region. Many other genomic regions have been designated as susceptibility intervals potentially containing candidate genes. Environmental factors appear to be important in disease expression in either a causative or a protective role. Epidemiological data indicate that such factors operate from early in life. Viral infection(s) may have a disease-initiating and/or accelerating effect. A potential diabetogenic role for cowsʹ milk protein remains unconfirmed. Further research is necessary to elucidate fully the aetiological factors involved and how they interact.