If the rising incidence and earlier presentation of diabetes were to be explained by an ever heavier population at all ages, weight gain would have as much a role in the changes of demography of type-1 diabetes as it does in that of type 2. Ascribing the rising incidence of type-1 diabetes to metabolic, rather than to immunological, factors has novel and important implications. Clinical research over the past 30 years has focused almost exclusively on exogenous factors (viruses, toxins, allergens) deemed able to initiate, facilitate or intensify autoimmune damage to the p cell. Although many have been proposed , none has been confirmed. The prevalence of obesity meanwhile has trebled. Insulin resistance, resulting from a combination of obesity and physical inactivity, is a serious candidate for the 'elusive' environmental factor responsible for the rising incidence of type-1 diabetes and, as such, a true accelerator.
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