OBJECTIVE Childhood-onset type 1 diabetes (T1D) is associated with perinatal factors, but data related to adult-onset T1D are scarce. This study aimed at investigating the association between early-life factors and adult-onset T1D in a Swedish nationwide cohort and family-based study. RESEARCH DESIGN AND METHODS We included 1,813,415 individuals aged ≥18 years, born in Sweden 1983 to 2002, followed until 2020. T1D diagnosis (n = 3,283) was identified from the National Diabetes, Patient and Prescribed Drugs Registers, and perinatal exposures were obtained from the Medical Birth Register. We performed Cox proportional hazard (hazard ratio [95% CI]) regression with mutual adjustment for perinatal exposures, sex, birth year, and parental sociodemographic background and history of diabetes. We also compared T1D risks among siblings’ groups identified from the Multiple Generation Register. RESULTS The incidence rate of adult-onset T1D was 18.8 per 100,000 person-years. Year of birth (1.06 [1.01–1.10], per five additional years) and history of maternal (4.10 [3.09–5.43]) and paternal (6.24 [5.10–7.64]) T1D were associated with a higher incidence of adult-onset T1D, whereas female sex (0.69 [0.64–0.74]) and having parents born outside Sweden were associated with a lower incidence. Regarding perinatal exposures, only non–full-term birth (<39 weeks vs. ≥39 weeks) was associated with a higher incidence of adult-onset T1D (1.12 [1.04–1.22]). The sibling cohort results were consistent with the full cohort analysis. CONCLUSIONS Perinatal factors seem to play a minor role in the development of adult-onset T1D compared with childhood-onset T1D, suggesting that triggers or accelerators of autoimmunity occurring later in life are more significant.

中文翻译：

---

与成人发病 1 型糖尿病相关的早年因素：瑞典全国队列和家庭研究


目的 儿童期发病的 1 型糖尿病 (T1D) 与围产期因素相关，但与成人发病的 T1D 相关的数据很少。本研究旨在通过瑞典全国队列和家庭研究调查早期生活因素与成人发病的 T1D 之间的关联。研究设计和方法 我们纳入了 1,813,415 名年龄≥18 岁的个体，1983 年至 2002 年出生于瑞典，随访至 2020 年。T1D 诊断 (n = 3,283) 是从国家糖尿病、患者和处方药登记册中确定的，围产期暴露来自于医学出生登记册。我们进行了 Cox 比例风险（风险比 [95% CI]）回归，并对围产期暴露、性别、出生年份、父母的社会人口背景和糖尿病史进行了相互调整。我们还比较了多代登记册中确定的兄弟姐妹群体之间的 T1D 风险。结果 成人发病的 T1D 发病率为每 10 万人年 18.8 例。出生年份（每增加五年 1.06 [1.01–1.10]）以及母亲（4.10 [3.09–5.43]）和父亲（6.24 [5.10–7.64]）T1D 病史与成人发病 T1D 的较高发病率相关，而女性（0.69 [0.64–0.74]）和父母出生在瑞典境外的发病率较低。关于围产期暴露，只有非足月出生（<39 周 vs. ≥39 周）与成人发病 T1D 的较高发生率相关（1.12 [1.04–1.22]）。兄弟姐妹队列结果与完整队列分析一致。结论 与儿童期发病的 T1D 相比，围产期因素似乎在成人发病的 T1D 的发展中发挥次要作用，这表明晚年发生的自身免疫的触发因素或加速因素更为重要。