I recently attended the Capitol Area Juvenile Diabetes Research Foundation's (JDRF) annual gala to help raise funds to finance research that will lead to a cure for insulin dependant diabetes. Indeed, as I was thinking that I will hopefully be able to retire having been able to help administer the eventual cure/cures that are yet to be discovered, I came across an article in Parade Magazine. "A Troubling Trend in Diabetes," by Dr. Ranit Mishori, described a recent study in a prestigious British Medical journal. After reviewing the original article in The Lancet (Incidence Trends for childhood type 1 diabetes in Europe during 1989-2003 and predicted new cases 2005-2020: a multicentre prospective registration study), the authors (Patterson, Dahlquist, Gyurus, Green and Soltesz) noted that an increase in the number of new cases in type 1 diabetes in European children increased yearly and is beyond what would be expected. In an analysis of 17 European diabetes registries, it was noted that T1DM in children under the age of 15 is increasing by about 4 percent per year with higher rates in children under the age of 4 (5.4 percent) and for those ages 5 to 9, 4.3 percent respectively. The authors of the study predicted a doubling of new cases by 2020. (The Lancet, Volume 373, Issue 9680, Pages 2027 - 2033, 13 June 2009)
The following is 2007 data from the United States (the most recent year for which data is available):
Total prevalence of diabetes, less than 20 years of age:
- 186,300, or 0.22 percent of all people in this age group has diabetes (About one in every 400 to 600 children and adolescents has type 1 diabetes)
- 2 million adolescents (or 1 in 6 overweight adolescents) aged 12 to 19 have pre-diabetes
The unanswered question is why? There are many hypotheses. Clearly, as has been extensively written in multiple blogs, there has to be an underlying genetic risk to develop autoimmune type 1 diabetes. This risk lies in the Histocompatibility Locus (HLA) on chromosome #6 and confirms low risk, moderate or high risk depending on the genetic alleles inherited from both parents (DR/DQ genes). However, to actually develop T1DM there has to an environmental trigger that initiates the autoimmune process that destroys the Beta islet cells in the pancreas. We are aware of a fraction of these environmental insults. Those triggers that are known to begin destruction of pancreatic beta cells include viral infections such as Varicella, Mumps, and Rubella, all of which can be prevented by vaccination. Other viruses that are known to instigate the development of diabetes include Coxsackie virus and influenza. Indeed, one of my greatest concerns is that we may see a major increase in the rise of new onset type 1 diabetes as a result of the H1N1 influenza virus: another reason to consider vaccination (if available, of course) in otherwise well children and siblings of those with T1DM. Other purported culprits that were considered in the past were dairy products (milk protein), and lately a recent possibility, gluten. (Some researchers have suggested in families with T1DM children that siblings avoid gluten products, based on some preliminary evidence in the Zonulin studies conducted at The University of Maryland.) Once again, let me reiterate that this is not proven, but a hypothesis, nonetheless. I am sure that there are other suspected triggers in which current research is underway.
Another hypothesis of which I believe has some merit is the hygiene hypothesis. The theory states that the increased incidence of autoimmune T1DM is related to our ability to sustain an increase in cleanliness and the ability to decrease exposure to common viruses and other antigens in the environment due to modern technology. Because our body does not need to mount an attack on these offending organisms/environmental agents, the body's immune system attacks itself. Thus, the suspicion is that we are developing more and more autoimmune diseases.
Could this be one of the reasons for the rise in type 1 Diabetes and other autoimmune diseases such as Hashimoto's thyroiditis, Celiac disease, juvenile rheumatoid arthritis, and inflammatory bowel disease, and even common allergic disease? Intriguing, at best...
So, when I attended the JDRF gala and marveled at the dedicated people who work so hard to finance diabetes research and discover a cure, I thought that perhaps our collective advocacy will find a means to both "cure" diabetes after onset and find the culprits that may trigger new cases of diabetes, and thus prevent the predicted increase in T1DM as discussed in The Lancet.
Published On: December 01, 2009