The role of enterovirus infections in type 1 diabetes in Tunisia

Background: Enteroviral infections have long been suspected in having a role in beta cell destruction and therefore leading to the onset of clinical type 1 diabetes (T1D). The frequency of enterovirus (EV)-related T1D in North Africa is still unknown. The aim of the present study was to investigate the relationship between infection with EV and T1D in Tunisia. Methods: A total of 95 T1D patients (41 children and 54 adults) and 141 healthy control subjects (57 children and 84 adults) were tested for the presence of EV-RNA by a highly sensitive nested reverse transcription-polymerase chain reaction (RT-PCR) method. Results: EV-RNA was detected more frequently in plasma from diabetic patients than in plasma of controls (31.6% vs. 7.8%, p < 0.0001; OR = 5.45; 95% CI 2.44-12.43). RT-PCR revealed positive in 53.7% of T1D children and 14.8% of T1D adults. There was a statistically significant difference between children and adults with T1D (p < 0.0001). Positivity of EV-RNA according to the time after the occurrence of the disease did not show any significant difference (p = 0.34). Anti-glutamic acid -decarboxylase (GAD) antibodies were not associated with EV-RNA (p = 0.65). Conclusions: EV-RNA is associated with T1D mellitus in the Tunisian population especially in children. These results support the hypothesis that EV act as environmental risk factors for T1D.