Braking the Accelerator Hypothesis?

Excerpt

To the Editor: The accelerator hypothesis was first suggested in 2001 [1]. It postulates that Type 1 and Type 2 diabetes are not discrete but part of a spectrum of disease caused by three main processes or accelerators; insulin resistance, autoimmunity and constitution. It suggests that in Type 1 diabetes, obesity associated with insulin resistance is compounded by an autoimmune reaction that precipitates presentation. Support for the hypothesis comes from findings that excess weight gain in the first eighteen months of life could be associated with Type 1 diabetes in childhood [2]. A separate study has shown that, in children destined to develop diabetes, BMI SDS measured at birth and at preschool age, are greater than national standards. However local anthropometric data also showed this rise in BMI SDS suggesting that this could be accounted for by secular trend [3]. In Sweden, the incidence of childhood diabetes has increased whilst incidence decreased in young adults [4]. This suggests accelerated pathogenesis rather than an absolute increase in diabetes. …