Genetics of Diabetes and Its Complications

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Abstract
Type 1 diabetes is the third most prevalent chronic disease of childhood, affecting up to 0.4% of children in some populations by age 30 yr, with an overall lifetime risk of nearly 1% (1,2). It is believed that a large proportion of cases of type 1 diabetes result from the autoimmune destruction of the pancreatic β cells, leading to complete dependence on exogenous insulin to regulate blood glucose levels (3). Type 1 diabetes is strongly clustered in families with an overall genetic risk ratio (the prevalence in siblings of a proband relative to the population prevalence, λS) of approximately 15 (4). (This compares with the less familial but more prevalent type 2 diabetes with λS of approximately 2). At least one locus that contributes strongly to this familial clustering resides within the MHC on chromosome 6p21, which accounts for nearly 40% of the observed familial clustering of type 1 diabetes, with a locus-specific genetic risk ratio (λS) of approximately 3 (5). In a recent analysis of data from three previous genomewide scans (United States, United Kingdom, and Scandinavia) as well as new families collected for the Type 1 Diabetes Genetics Consortium (http://www.t1dgc.org), 1435 multiplex families provided evidence for linkage of type 1 diabetes to the MHC (IDDM1), insulin (INS, IDDM2), a region that contains several genes, including CTLA4 (2q31-q33 [IDDM12 and IDDM7]) and seven other chromosome regions (6).
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