The convergence of type 1 and type 2 diabetes in childhood

Abstract

It seems likely that type 1 and type 2 diabetes lie at different points of the same spectrum, separated by the misunderstanding that one belongs to childhood and the other to adulthood. The spectrum is that of tempo – the rate at which beta cell function is lost over time. A combination of beta cell upߚregulation (insulin demand, largely determined by obesity) and the geneticallyߚdetermined immune response to it (‘autoimmunity’) determines tempo, ranging from slow to fast with every variant in between. There is good evidence that people who go on to develop type 1 (fast) diabetes are, like those who develop type 2 (slow diabetes), insulin resistant, and overwhelming evidence that body mass plays a key role. The prevention of type 1 diabetes may lie in weight restriction from an early age.