Testing the Accelerator Hypothesis: Body Size, β-Cell Function, and Age at Onset of Type 1 (Autoimmune) Diabetes
Response to Dabelea et al.
- Terence J. Wilkin, MD1
- 1Department of Endocrinology and Metabolism, Peninsula Medical School, Plymouth, U.K.
- Address correspondence to Terence Wilkin, Professor of Endocrinology and Metabolism, Peninsula Medical School, University Medicine, Level 7, Derriford Hospital, Plymouth PL6b 8DH, U.K. E-mail: t.wilkin{at}pms.ac.uk
The contribution by Dabelea et al. (1) to the growing debate on the accelerator hypothesis is an important one, but I wonder if there is a confounder that has not been accounted for in the reasoning. The report revolves principally around Fig. 2, which shows, after appropriate adjustments, a clear inverse relationship between age at diagnosis and BMI (the acceleration predicted) among those whose fasting C-peptide (FCP) levels lay below the median, but none among those whose FCP lay above. The difference is interpreted to mean that any relationship to insulin resistance applies only to a subset of type 1 diabetic children with low β-cell reserve.
The accelerator hypothesis argues that “type 1 and type 2 diabetes are the …
