Many factors suggest that environmental factors are important determinants of Type 1 diabetes. It has already been noted that environmental factors are implicated by the discordance rate in monozygotic twins and the higher prevalence of autoimmunity in non-diabetic twins than in other first-degree relatives. Other indicators that environmental factors are involved include the seasonal variation in disease onset (15) and the rising incidence of Type 1 diabetes in Europe and many other parts of the world over the past 20-30 years (16,17). Although in most areas, there has been an overall increase in incidence rates, in two studies— one in Finland and one in England—there has been a marked increase amongst children aged under 5 years (18,19).

The rapid changes in incidence seen in populations that are for the most part genetically stable suggests a major role for environmental factors encountered early in life, e.g. before birth or in early postnatal life.

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