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From northern Michigan, USA:

My son is 3 years old, recently diagnosed with Type 1 diabetes. We have 4 other children.

I understand that Type 1 diabetes is much more common in the northern latitudes both in this country and others. If our other children have "high risk" haplotypes on genetic testing (they are antibody negative, thus far), is there any evidence to suggest that their risk of developing diabetes would diminish if we moved south? We currently live in the upper peninsula of Michigan which has a very high rate of diabetes (35-40 per 100,000).


The geographical distribution of Type 1 Diabetes is an intriguing and baffling question, but it is certain that some regional environmental factor can trigger actual immunopathology (as first indicated by the presence of antibodies) in genetically susceptible people. Differences in haplotypes may be a partial explanation, but it seems clear that something associated with a 'developed country' lifestyle is key. For example, Polynesian Islanders who emigrate from Rarotonga where there is very little Type 1 Diabetes to Aukland acquire the same incidence as the predominantly Caucasian population of the rest of New Zealand. The exception that Japan provides is presumably genetic.

Also, whilst it has been shown that moving from a 'primitive' lifestyle to a 'developed' one may increase the incidence of Type 1 Diabetes, the reverse has not been shown. In your own case for example, a move from Michigan to further south would be very unlikely to diminish the small risk of clinical diabetes in your other three children.

As you are almost certainly aware, if any of your unaffected children do develop two or more antibodies there is a big trial going on in the USA called DPT-1, for which they would be candidates, of giving low-dose insulin in the expectation of deferring long term complications of clinical diabetes. There is also a similar trial using oral insulin which has just begun. Finally there are plans, albeit at this stage only plans, for studies to see if some form of 'vaccination' using oral insulin or an injected fragment of the B-chain of insulin will prevent the autoimmune process.

So don't plan a move just because of diabetes!


Original posting 2 Dec 96


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Last Updated: Tuesday April 06, 2010 15:08:52
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