Abstract

Sami T. Azar,1,2 Hala Tamim,3 Hayfa N. Beyhum,4 M. Zouhair Habbal,5 and Wassim Y. Almawi6,* Departments of Internal Medicine,1 Biochemistry,4 and Clinical Pathology & Laboratory Medicine,5 American University of Beirut, Faculty of Health Sciences, Balamand University,3 and Department of Laboratory Medicine, St. George Hospital,6 Beirut, and Diabetes Unit, Chronic Care Center, Hazmieh,2 Lebanon Type I (insulin-dependent) diabetes (IDDM) is an autoimmune disease with an unknown etiology but with a definite outcome, resulting in the progressive misdirected immunologic destruction of insulin-secreting pancreatic islet cells by autoreactive leukocytes and their mediators (3). Even though the precise cause of the disease remains unclear, a combination of genetic, immunologic, and nongenetic factors contributes to the onset and progression of IDDM (3, 52). Specific HLA antigens, in particular DR3 and DR4, have been associated with increased risk for IDDM development (52, 89), while DR2 alleles generally have been described as "protective" of IDDM (86). In addition to HLA predisposing factors, viral infection (8), psychological factors (73), and dietary factors (8), among others, have been described as predisposing factors. Other investigators failed to demonstrate a strong cause-and-effect link between these factors and IDDM, which highlighted the need for further investigation and identification of causative