Objective: The incidence of type 1 diabetes shows a large variation worldwide, but whether the causes are environmental or genetic has not been settled. We examine here the incidence of type 1 diabetes among second-generation immigrants and adoptees from abroad to disentangle genetic/ethnic vs. environmental influence, assuming adoptees from abroad have similar environmental exposures compared with the native Swedes, with the only difference in their genetic background. Methods: Second-generation immigrants and adoptees from abroad were retrieved from the MIGMED2 database, and they were followed up until the diagnosis of type 1 diabetes, death, or the end of study. Standardized incidence ratios (SIRs) were calculated for type 1 diabetes among these immigrants compared with native Swedes. Results: A total of 1,050,569 children were defined as second-generation immigrants and the overall SIR of type 1 diabetes was significantly decreased. A decreased risk was observed for all countries of origin, with an exception for children with parents from Finland. A total of 51,557 children born in foreign countries were adopted by Swedes. Adoptees from Eastern Europe, Soviet countries, India, Pakistan, Afghanistan, East and Southeast Asia, Chile, and other Central and South American countries had a significantly decreased SIR. Conclusions: The decreased incidence of type 1 diabetes observed in some second-generation immigrants and adoptees from abroad strongly suggests that ethnic genetic heterogeneity could play an important role on type 1 diabetes. Copyright © 2010 by The Endocrine Society.

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Pakistan Afghanistan immigrant Finland India insulin dependent diabetes mellitus human priority journal USSR Eastern Europe Central America Sweden ethnic difference environmental factor Southeast Asia South America environmental exposure genetic heterogeneity Incidence Article heredity Chile