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Could Type 1 Diabetes Begin in Utero?

Infants might develop type 1 diabetes in the first 6 months of life and seems to be unrelated to known genetic risk factors; rather, it appears linked to low birth weight, say UK researchers.

They believe the discovery could mean the disease starts in utero.

Others are skeptical, however.

The team studied 166 infants with diabetes diagnosed before 6 months of age and compared them to babies with the more common neonatal diabetes and children diagnosed with type 1 diabetes at older ages.

The combination of high type 1 diabetes genetic risk score (T1D-GRS), presence of islet-specific autoantibodies, and evidence of a rapid loss of insulin secretion all suggest that the infants had type 1 diabetes.

And notably, they all had a lower median birth weight than international reference standards.

“This study proves that type 1 diabetes can present in the first few months of life, and in a tiny subset of infants may even begin before birth,” lead author Matthew B. Johnson, PhD, Institute of Biomedical and Clinical Science, University of Exeter Medical School, UK, said in a press release from Diabetes UK, which cofunded the research.

“We also found that diabetes diagnosed so young was associated with rapid progression to complete destruction of insulin producing beta cells,” he added.

Senior author Richard A. Oram, BMBCh, PhD, also from the Institute of Biomedical and Clinical Science, said the team now plans to study the immune system of the infants in greater detail. The hope is this will “help explain how it is possible for type 1 diabetes to develop so early and whether these insights could open up new ways to prevent or treat the condition in the future,” he added.

The research was published online on October 8 in Diabetologia.

Elizabeth Robertson, PhD, director of research at Diabetes UK, said: “These important findings rewrite our understanding of when the condition can strike and when the immune system can start to go wrong.”

“We now need to piece together how and why type 1 diabetes can develop at such a young age,” which could “unlock crucial insights into causes of type 1 diabetes more generally…and will be essential to develop treatments that stop or prevent this life-altering condition in babies,” she observed.

No Direct Evidence That Type 1 Diabetes Starts in the Womb

Asked to comment, Mikael Knip, MD, PhD, told Medscape Medical News that the study is “interesting” but the findings are “not perhaps as new as they claim,” nevertheless the research consists of “a large series of infants” and it is a “well done study.”

However, Knip doubts that type 1 diabetes develops in the womb.

“We have never seen diabetes-associated autoantibodies in a newborn infant in cord blood, except for those where the mother tests positive for autoantibodies,” said Knip, of the Children’s Hospital, University of Helsinki, Finland.

“These are IgG antibodies and that [type of immune reaction] is conferred from the maternal circulation to the fetal circulation during pregnancy, but we have never seen