The Environmental Determinants of Diabetes in the Young (TEDDY) in Sweden

The TEDDY study key outcomes include: 1)Revealing two trajectories – or endotypes – of pathogenesis following the appearance of either IAA in young children or GADA in older children as the first appearing autoantibody suggestive of two different disease entities; 2) IAA-first may be related to Enterovirus B infection and prolonged shedding as possible environmental trigger; 3) GADA-first may be related to other virus such as adenovirus but further data is needed; 4) Studies of gene expression in whole blood, metabolomics, dietary markers, dietary intake of amino acids and life events during pregnancy support the view of two different triggers and responders; 5) Celiac disease has been found to have a distinct etiological pattern: intake of high levels of gluten and enterovirus infection. Each component alone does not seem to increase the risk but the two together does it. Analysis of the virome prior to CDA seroconversion should prove important to test this hypothesis.