What can the epidemiological approach to type 1 diabetes contribute to the unravelling of autoimmune pathological mechanisms?

Abstract

Epidemiology is the biomedical scientific discipline that concerns the occurrence of diseases in populations and the factors that control the development and the course of diseases. Thus, in epidemiological research the focus is on populations and groups of subjects. In contrast, clinical biomedical research is focused on individual subjects, frequently in close connection with the provision of health care. This fundamental difference in nature between epidemiology and other types of biomedical research has left many scientists with the opinion that epidemiology is a theoretical discipline that must be dealt with separately before concentrating on real biomedical scientific issues. Fortunately, during the last decades it has become increasingly evident that epidemiological principles and methods play an important role in interaction with clinical and laboratory research in a better understanding of the causation, natural history and treatment of diseases. Type 1 diabetes represents in this respect an excellent disease model because of a complex and most likely heterogeneous causation, involving genetic and non-genetic factors in interaction within the framework of an immune pathological process. Furthermore, by means of the associated risk of developing disabling chronic complications and premature death, Type 1 diabetes represents a major health problem in most societies. This paper reviews the epidemiological contribution to past and current research into the aetiology and pathogenesis of Type 1 diabetes.