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children representing three birth cohorts (BCs): BC1 (1993\u20131998), BC2 (1999-August 2004), and BC3 (September 2004\u20132010). Cox models evaluated IA by BC, with time-varying coefficients, BC-HLA interaction, and stratification by type 1 diabetes family history. Mediation analyses examined age at gluten introduction, weight-for-age Z-score, and maternal smoking.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>IA increased across BC1\u2013BC3 (7.0%, 10.7%, and 12.7%). At age 1 year, moderate-risk HLA participants in BC2 and BC3 had, respectively, 2.57 and 6.19 times the IA risk of BC1. By age 5 years, effects attenuated. No selected environmental exposures mediated the increased incidence.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>IA increased among Colorado children born 1993\u20132010, with the strongest effects among moderate-risk HLA genotypes in later BCs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2337\/dc26-0659","type":"journal-article","created":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T14:57:33Z","timestamp":1782917853000},"page":"1700-1704","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":0,"title":["A Secular Increase in the Incidence of Islet Autoimmunity Among Colorado Children With Moderate-Risk HLA Genotypes"],"prefix":"10.2337","volume":"49","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6707-7913","authenticated-orcid":false,"given":"Kirk 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