Objective: To assess whether the detection of enterovirus RNA in blood predicts the development of clinical type 1 diabetes in a prospective birth cohort study. Further, to study the role of enteroviruses in both the initiation of the process and progression to type 1 diabetes.
Research Design and Methods: This is a nested case-control study where all case children (N=38) have progressed to clinical type 1 diabetes. Non-diabetic control children (N=140) were pair-wise matched for gender, date of birth, hospital district and HLA-DQ conferred genetic susceptibility to type 1 diabetes. Serum samples, drawn at 3- to 12--month intervals, were screened for enterovirus RNA using RT-PCR.
Results: Enterovirus RNA positive samples were more frequent among the cases than among the controls. A total of 5.1% of the samples (17/333) in the case group were enterovirus RNA positive compared to 1.9% of the samples (19/993) in the control group (P<0.01). The strongest risk for type 1 diabetes was related to enterovirus RNA positivity during the 6-month period preceding the first autoantibody positive sample (OR 7.7 [95% CI 1.9-31.5]). This risk effect was stronger in boys than in girls.
Conclusions: The present study supports the hypothesis that enteroviruses play a role in the pathogenesis of type 1 diabetes, especially in the initiation of the β-cell damaging process. The enterovirus-associated risk for type 1 diabetes may be stronger in boys than in girls.
- Received March 2, 2010.
- Accepted September 25, 2010.
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