If type 1 diabetes cannot be cured, can it be identified during its preclinical state? Over the years, several intriguing epidemiologic clues have emerged. For example, the risk of developing type 1 diabetes depends on where you live. It is a rare condition in India, China and Venezuela. Compared with neighboring Estonia, being a resident of Finland raises one’s risk of type 1 diabetes three-fold.6 In many different countries, children under the age of 5 who were born in the spring carry the greatest risk of developing the disease.
Could the development of type 1 diabetes be related to a dietary issue? A Finnish study identified 230 infants with a first-degree relative with type 1 diabetes and randomly assigned infants to receive a hydrolyzed infant formula or conventional formula whenever breast milk was not available during the first 6 to 8 months of life. The investigators sought to measure the development of autoantibodies to islet cells, a finding that is strongly correlated with the subsequent development of diabetes. Children who received the hydrolyzed formula were less likely to develop two or more islet autoantibodies, compared with those who received the conventional formula, with a hazard ratio of 0.52.9
Among the autoantibodies targeting islet cells is one of particular interest that also targets the neuronal enzyme, glutamic acid decarboxylase (GAD). Antibodies to GAD are detected not only in individuals with a strong susceptibility to developing diabetes or in their first-degree relatives, but it is intriguing to note that about two-thirds of individuals afflicted with the rare autoimmune movement disorder, stiff person syndrome, carry this antibody, too, albeit in far higher concentrations.10 Knocking out neuronal pathways that are critical to inhibiting motor function is analogous to losing the brake mechanism that prevents our muscles from overcontracting and developing severe spasm. These patients often have great difficulty performing simple motor activities. Many of them develop type 1 diabetes and an assortment of other autoimmune conditions, including pernicious anemia, vitiligo and Hashimoto’s thyroiditis.
Why GAD, an enzyme that is restricted to the central nervous system, has found its way into the pancreas where it serves as an antigen target in the prediabetic state remains a mystery of human development.
Because diabetes is no longer a fatal illness, scant pathological material exists to study & the enzyme-laden pancreas does not take kindly to needle biopsy procedures.
Linking Fat with Inflammation
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