Rates of childhood Type 1 diabetes are exploding. Why aren’t we freaking out about this?
New statistics show that diagnoses of Type 1 diabetes in America are growing with terrifying speed, especially among children, and especially among the children of ethnic and racial minorities. But for some reason, nobody’s talking about it.
ASweetLife was one of very few media organizations to address the latest news on this front: Type 1 Diabetes Up 30% Since 2017, According to CDC Report. And we’re still trying to figure out why this isn’t a bigger story. (Perhaps our nation’s medical reporters are understandably distracted by the ongoing coronavirus pandemic).
The story begins with the United States Center for Disease Control and Prevention (CDC). In February, the CDC released some jaw-dropping statistics on the increase of Type 1 diabetes diagnoses. The first report, the National Diabetes Statistics Report (PDF), showed that the overall incidence of Type 1 diabetes was up across the board, cutting across ages and ethnicities. More importantly, the rate of diagnosis “significantly increased” among US children and adolescents. The CDC followed up with a report that directly addresses the increase in youths in much greater detail.
The number of children and adolescents increased annually by +1.9% between 2002 and 2015. Strikingly, that rate of change was even greater among “racial/ethnic minority populations.” T1D cases among African-American, Hispanic and Asian / Pacific Island children all increased roughly 19% over the sample. White children, the slowest growing demographic, still saw a 14% increase.
How? Why? The CDC report demurs: “reasons for this recent increase are unknown.”
These numbers should be mind-blowing and terrifying, as they seem to contradict our usual understanding of Type 1 diabetes as a genetic disease that strikes essentially at random. Genetics alone cannot account for these changes. It has long been known that environmental factors have some effect on T1D development, but could environmental factors alone account for such a dramatic rise, and one affecting different populations differently in a country as geographically diverse as the US?
Researchers have known for years that T1D doesn’t strike truly at random. Setting aside the known influence that genetics have on T1D frequency, environmental factors seem to explain some element of T1D risk, but it has been next to impossible to identify the right factors. In a recent article for The Lancet, faculty from the University of Colorado School of Public Health considered the literature on a huge range of potential triggers, from air pollution to duration of breast feeding, and found none that could come close to accounting for growth of T1D:
“While several factors have been associated with type 1 diabetes, none of the associations are of a magnitude that can explain the rapid increase in incidence alone,” Norris said. “Moreover, evidence of the changing prevalence of these same exposures over time is not convincing nor consistent.”
When I spoke with Dr. David Leslie, a researcher at the Blizard Institute in London who has devoted much of his career to exploring the non-genetic causes of diabetes, he told me that he thought there were likely to be two major non-genetic culprits: virus and diet.
“Non-genetic factors tend to be dietary or viruses. I’ve gotten in trouble for saying ‘dietary’ on the radio, because parents think that you’re blaming them. And I am usually very negative about viruses, because whenever a doctor doesn’t know what he’s doing, he always says it’s a virus. But the reality is that I think it probably is a virus.”
The interactions between all these different factors are likely to be impossibly complex. If beta cell destruction can be touched off by an initial viral infection (which may occur years previous to diagnosis), environmental, genetic and lifestyle factors will then contribute to the progression in ways that experts can only begin to guess at.
But in a country that has also seen precipitous increases in Type 2 diabetes, especially among children of racial/ethnic minority populations, it is natural to wonder if the triggers of that related malady can be involved in the progression of Type 1 diabetes.
We already know that poor food choices can have dramatic health consequences. We also know that ethnic and racial minority populations in the US tend “to have poorer nutrient profiles and dietary behaviors” relative to whites. It’s well beyond the scope of this article to examine the reasons why, but possibilities include cultural factors such as food traditions and socioeconomic factors (proximity to fast food, distance from healthier shopping options), among others. Could diet disparity help explain the greater rise of T1D diagnoses in these populations?
It’s not impossible. Studies have shown that excessive sugar intake can “exacerbate the later stage of type 1 diabetes development” among children who already have a high genetic risk of developing the condition, and that “higher energy intake and larger body size were independently associated with increased [Type 1] diabetes risk.”
There’s a mechanism to explain how this might work, often referred to as the beta-cell stress hypothesis. The idea is that beta cells, already beleaguered by the autoimmunity characterized by the earliest stages of T1D, are finally exhausted and eventually rendered inoperable by other factors. These other factors could involve inflammation, stress, and infections, but also obesity, insulin resistance, and dietary glucose overload.
Simply put, the metabolic dysfunction that results from a poor diet and obesity may hasten the speed with which T1D develops, and, in borderline cases, may even make the difference between developing full-blown T1D and not.
To be clear, poor diet is likely only one factor among the many that may contribute to the development of T1D, most of which are unpredictable and totally out of anyone’s control. But the unchecked rise of T1D in America should be a major cause of concern. Diet and lifestyle are not out of our control, and if there’s something we can do as a society to slow that rise, it’s well worth thinking about.