Type 1 diabetes: a disease of developmental origins

Trends in type 1 diabetes diagnosis in Ghana

BACKGROUND

Despite the fact that the rate of type 1 diabetes (T1D) is increasing worldwide, there exists a dearth of information on the disease in most sub-Saharan African countries. The goal of this study was to determine the enrolment trend of T1D using data compiled over 28 y from a teaching hospital in Kumasi, Ghana.

METHODS

Information collected included sex, age at diagnosis and date of T1D diagnosis. We identified trends from 1992 to 2018, divided into 3 y intervals.

RESULTS

From 1992 to 2018, 1717 individuals with T1D were enrolled in the diabetes clinic at the Komfo Anokye Teaching Hospital. The male:female ratio was 1:1.2. The number of individuals diagnosed with T1D decreased among the 10-19 y age group during the 1992-1994 period, followed by a progressive increase within the same age group during the subsequent period (from 35.4% in 1995-1997 to 63.2% in 2016-2018). There was a decline in the proportion of children 0-9 y of age diagnosed during the study period (from 5.1% in 1992-1994 to 3.6% in 2016-2018).

CONCLUSIONS

In our study population, a decreasing trend of T1D enrolments was observed in general while among adolescents an increasing trend was observed.

Maternal prepregnancy BMI and physical activity and type 1 diabetes in the offspring

BACKGROUND

Previous studies showed conflicting results on the association between maternal prepregnancy body mass index (BMI) and type 1 diabetes in the offspring, and the role of maternal prepregnancy physical activity is unclear. We aimed to assess whether maternal prepregnancy BMI and physical activity predict type 1 diabetes in their offspring.

METHODS

Prospective study including women participating in the Nurses' Health Study II with follow-up from 1989 to 2011. Women repeatedly reported their BMI and physical activity, from which prepregnancy exposures were derived; and retrospectively reported their BMI at age 18 and physical activity at ages 18-22, considered early adulthood exposure. We estimated risk ratios (RR) and 95% confidence intervals (95%CI) using generalized estimating equations, adjusted for covariates. Findings at p < 0.05 were considered statistically significant.

RESULTS

We identified 276 cases of type 1 diabetes among offspring (n = 70,168) with maternal prepregnancy information and 448 cases among offspring (n = 111,692) with maternal early adulthood information. Prepregnancy and early adulthood maternal BMI and physical activity were not associated with offspring type 1 diabetes. The RR comparing overweight to normal weight mothers was 1.08 (95%CI: 0.73-1.59) and comparing obese to normal weight was 0.94 (95%CI: 0.49-1.79, p-trend: 0.98). Comparing highest to lowest quartile of maternal physical activity the RR was 0.90 (95%CI: 0.61-1.32; p-trend: 0.73). Maternal type 2 diabetes was associated with an increased risk of type 1 diabetes in the offspring (RR = 1.87; 95%CI: 1.25-2.80).

CONCLUSIONS

Our findings do not support a relationship between maternal prepregnancy BMI or physical activity and the risk of type 1 diabetes in the offspring.

Endocrine Pancreas Development and Dysfunction Through the Lens of Single-Cell RNA-Sequencing

A chronic inability to maintain blood glucose homeostasis leads to diabetes, which can damage multiple organs. The pancreatic islets regulate blood glucose levels through the coordinated action of islet cell-secreted hormones, with the insulin released by β-cells playing a crucial role in this process. Diabetes is caused by insufficient insulin secretion due to β-cell loss, or a pancreatic dysfunction. The restoration of a functional β-cell mass might, therefore, offer a cure. To this end, major efforts are underway to generate human β-cells de novo, in vitro, or in vivo. The efficient generation of functional β-cells requires a comprehensive knowledge of pancreas development, including the mechanisms driving cell fate decisions or endocrine cell maturation. Rapid progress in single-cell RNA sequencing (scRNA-Seq) technologies has brought a new dimension to pancreas development research. These methods can capture the transcriptomes of thousands of individual cells, including rare cell types, subtypes, and transient states. With such massive datasets, it is possible to infer the developmental trajectories of cell transitions and gene regulatory pathways. Here, we summarize recent advances in our understanding of endocrine pancreas development and function from scRNA-Seq studies on developing and adult pancreas and human endocrine differentiation models. We also discuss recent scRNA-Seq findings for the pathological pancreas in diabetes, and their implications for better treatment.

Neonatal hyperbilirubinaemia is associated with a subsequent increased risk of childhood-onset type 1 diabetes

Background: Type 1 diabetes (T1D) is one of the most common chronic diseases of childhood. Whether neonatal hyperbilirubinaemia increases the risk of T1D remains unclear.Aim: To estimate the association between neonatal hyperbilirubinaemia and phototherapy and the risk of T1D using a large nationwide population-based cohort.Methods: This retrospective study was conducted using data from the National Health Insurance Research Database in Taiwan from 2001 until 2005. Altogether, 23,784 neonates aged <30 days diagnosed with hyperbilirubinaemia and 47,568 neonates without hyperbilirubinaemia were enrolled and frequency-matched to the hyperbilirubinaemia group by gender, age, parental occupation and urbanisation. Cox regression analysis was performed to estimate hazard ratios (HRs) and 95% confidence intervals (CI).Results: Of the 71,352 neonates included, those with hyperbilirubinaemia had a higher incidence of T1D (4.76 vs 2.68 per 10,000 person-years, p < 0.001) and an earlier mean age at onset of T1D [4.13 (2.80) vs 5.80 (2.67) years, p < 0.001] than those without hyperbilirubinaemia. After adjusting for confounding factors in multivariable analysis, the neonates with hyperbilirubinaemia had a 66% increased risk of developing T1D (HR 1.66, 95% CI 1.26-2.18). Girls had a 1.41-fold (HR 1.41, 95% CI 1.10-1.82) greater risk of T1D than boys. Additionally, neonates with a history of perinatal complications (HR 1.66, 95% CI 0.99-2.80) and neonatal infections (HR 2.13, 95% CI 1.45-3.15) had an increased subsequent risk of T1D.Conclusions: The results suggest that neonatal hyperbilirubinaemia is associated with a subsequently increased risk of childhood-onset T1D.Abbreviations: T1D, type 1 diabetes; CI, confidence interval; NHI, national health insurance; NHIA, National Health Insurance Administration; NHIRD, National Health Insurance Research Database; ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification; G6PD, glucose-6-phosphate dehydrogenase; LBW, low birthweight; HRs, hazard ratios.

Epigenetic studies and pediatric research

The 2020 Annual Review Issue, "Preventing Disease in the 21st Century" was selected by the Editors-in-Chief of Pediatric Research to include a variety of disease entities that confront health-care practitioners entrusted to the care of infants and children. In keeping with this mandate, this article reviews the subject of epigenetics, which impacts pediatric research from bench to bedside. Epigenetic mechanisms exert their effects through the interaction of environment, various susceptibility genes, and immunologic development and include: (1) DNA methylation; (2) posttranslational modifications of histone proteins through acetylation and methylation, and (3) RNA-mediated gene silencing by microRNA (miRNA) regulation. The effects of epigenetics during fetal life and early periods of development are first reviewed together with clinical applications of cardiovascular and metabolic disorders in later life. The relationships of epigenetics to the allergic and autoimmune diseases and cancer are next reviewed. A specific focus of the article is directed to the recent recognition that many of these disorders are driven by aberrant immune responses in which immunoregulatory events are often poorly functioning and where through interventive epigenetic measures prevention may be possible by alterations in programming of DNA during fetal and early periods as well as in later life.

Temporal trend of newly diagnosed type 1 diabetes children and adolescents identified over a 35-year period in a Brazilian institution

AIMS

To evaluate the temporal trend of newly diagnosed Type 1 Diabetes cases over a 35-year period in a reference Pediatric Endocrinology service in the city of Belo Horizonte, Brazil.

METHODS

Subjects were all children and adolescents diagnosed with Type 1 Diabetes in the Federal University of Minas Gerais Hospital. Information collected included: gender, age and date of Type 1 diabetes diagnosis. Temporal trends were analyzed between 1980 and 2014 and divided in 5-year intervals.

RESULTS

During this period 642 children and adolescents were diagnosed with Type 1 diabetes. From 1980 to 1994 there was an increase in the proportion of children diagnosed between 0 and 4 years old, followed by progressive decrease in the subsequent decades (47% in 1990-1994 to 20% in 2010-2014; p = 0.01). There was an increase in the proportion of children diagnosed between 10 and 18 years old (13% in 1990-1994 to 54% in 2010-2014; p = 0.01). There was no statistical difference in the proportion of children diagnosed between 5 and 9 years old through the studied time.

CONCLUSIONS

In the studied population Type 1 Diabetes in infants and toddlers seems to be decreasing throughout the years while in the age group older than 10 years, it seems to be increasing.

Early life origin of type 1 diabetes

Type 1 diabetes (T1D) is perceived as a chronic immune-mediated disease with a subclinical prodromal period characterized by selective loss of insulin-producing beta cells in the pancreatic islets in genetically susceptible subjects. The incidence of T1D has increased manifold in most developed countries after World War II in parallel with a series of other immune-mediated diseases. T1D results from gene-environmental interactions. The appearance of disease-associated autoantibodies into the peripheral circulation is the first detectable sign of the initiation of the disease process leading to clinical T1D. The first autoantibodies may appear already before the age of 6 months and the seroconversion rate peaks during the second year of life. This implies that exogenous factors involved in the pathogenesis of T1D must be operative in early life, some of them most likely already during pregnancy. Here, we discuss putative endogenous factors that may contribute to the development of T1D during fetal and early postnatal life. Many environmental factors operative in early life have been implicated in the pathogenesis of T1D, but relatively few have been firmly confirmed.

Xanthohumol Restores Hepatic Glucolipid Metabolism Balance in Type 1 Diabetic Wistar Rats

Diabetes exhibits increased inflammation, angiogenesis, and apoptosis, three processes attenuated by xanthohumol (XN). Herein, we evaluate the effect of XN-enriched stout beer consumption in hepatic glucolipid metabolism imbalance seen in type 1 diabetes (T1D). Five groups of Wistar rats were established: streptozotocin-induced diabetic rats drinking water, treated with 5% ethanol, stout beer, and stout beer supplemented with 10 mg of XN/L and healthy rats drinking water. Hepatic periodic acid-Schiff, reticulin, sirius red, and oil red O histological staining was performed. Lipogenic enzymes and glucose transporter 2 (GLUT2) expression was evaluated by western blotting. Increased fibrosis in T1D animals was significantly decreased to control levels by XN (3.85 ± 0.38 in T1D-beer versus 1.78 ± 0.27 in controls, p < 0.05; 2.27 ± 0.69 in T1D-beer + XN versus 1.78 ± 0.27 in controls, p > 0.05). XN reduced T1D hepatic reticulin staining (9.74 ± 3.78 in T1D-beer, p < 0.05 versus control) to healthy levels (4.45 ± 1.05 in T1D-beer + XN versus 4.60 ± 0.20 in healthy controls, p > 0.05). XN consumption interfered with the T1D liver catabolic state, reversing glycogen depletion (22.09 ± 7.70 in T1D-beer + XN versus 4.68 ± 4.84 in T1D-beer, p < 0.05) and GLUT2 upregulation (1.71 ± 0.46 in T1D-beer + XN versus 2.13 ± 0.34 in T1D-beer, p < 0.05) and enhancing lipogenesis (1.19 ± 0.11 in T1D-beer + XN versus 1.96 ± 0.36 in T1D, p < 0.05 for acetyl-CoA carboxylase; 1.10 ± 0.04 in T1D-beer + XN versus 0.44 ± 0.31 in T1D, p < 0.05 for fatty acid synthase). These findings reveal that XN can be a therapeutic agent against liver metabolic changes in T1D, playing a possible role in the insulin receptor pathways.

Natural Killer Cells in the Orchestration of Chronic Inflammatory Diseases

Inflammation, altered immune cell phenotype, and functions are key features shared by diverse chronic diseases, including cardiovascular, neurodegenerative diseases, diabetes, metabolic syndrome, and cancer. Natural killer cells are innate lymphoid cells primarily involved in the immune system response to non-self-components but their plasticity is largely influenced by the pathological microenvironment. Altered NK phenotype and function have been reported in several pathological conditions, basically related to impaired or enhanced toxicity. Here we reviewed and discussed the role of NKs in selected, different, and “distant” chronic diseases, cancer, diabetes, periodontitis, and atherosclerosis, placing NK cells as crucial orchestrator of these pathologic conditions.