Joel Steelman, M.D.I was researching on the Internet, in preparation for a presentation I am giving on diabetes later this month, when I came across an article reviewing a new book, “Diabetes Rising.” The author, Dan Hurley, is highly recognized for his work in medical journalism. He has an added personal connection to his book because of his own life struggle living with type 1 diabetes since his teen years.

Mr. Hurley’s book highlights important diabetes medical research from the past several years including research reported as recently as 2009. A trend of increasing incidence of type 1 diabetes has been recognized both in the US as well as worldwide. In this case, the term incidence refers to the number of cases of newly diagnosed type 1 diabetes in a year time period, standardized to a certain population number.

The most recent US incidence information comes from the SEARCH for Diabetes in Youth Study, a study funded by the Center for Disease Control. Whereas incidence reporting is only one aspect of the SEARCH study, a clearer understanding of incidence of type 1 diabetes will help us to understand the reasons behind this global surge of new cases.

The most recent reported US incidence of type 1 diabetes in white children age fourteen and younger is 27.5 new cases per 100,000 for the period of 2002-2005. This incidence is 1.7 times higher than incidence data collected in Colorado from seventeen years ago showing an incidence of 16.4 new cases per 100,000 in the population of children fourteen years and younger. There is similar information reported from Europe that shows a startling increase of nearly 1.5 times in type 1 diabetes incidence over a ten year period.

 I feel both concern and intense curiosity when I think about this information. As a parent, I am concerned by the higher risk of diabetes for my daughter, as well for all children. I am intensely curious to understand the reason behind this ominous trend and what we can do to protect our young from this debilitating disease. As I’ve said in the past, treatment of type 1 diabetes continues to advance, however, it remains a sometimes frustratingly chronic condition. The prospect of more children and families confronting this condition truly distresses me.  

Mr. Hurley’s book moves beyond simply reporting the rising incidence of type 1 diabetes and explores reasons why this is occurring. He reviews several of the leading theories, which were summarized nicely in the article. Here is an excerpt discussing those ideas:   

  • The “accelerator hypothesis,” which asserts that the rising weight and height of children over the past century has “accelerated” their tendency to develop type 1 by putting the insulin-producing beta cells in their pancreases under stress.
  • The “sunshine hypothesis,” which holds that the increased time spent indoors is reducing children’s exposure to sunlight, which in turn reduces their level of vitamin D (the “sunshine vitamin”). Reduced levels of vitamin D, and reduced exposure to sunshine, have each been linked to an increased risk of type 1 diabetes.
  • The “hygiene hypothesis,” which holds that lack of exposure to once-prevalent pathogens results in autoimmune hypersensitivity, leading to destruction of the body’s insulin-producing beta cells by rogue white blood cells.
  • The “cow’s milk hypothesis,” which holds that exposure to cow’s milk in infant formula during the first six months of life wreaks havoc on the immune system and increases the risk to later develop type 1.
  • The “POP hypothesis,” which holds that exposure to persistent organic pollutants increases the risk of both types of diabetes. “

It is becoming well understood that genetics plays a strong role in the determination of a child’s risk for diabetes. Genetic testing, available in research studies, can determine if a child has a high or low genetic profile risk for becoming a type 1 diabetic. However, the great unknown remains to be exactly what trigger(s) cause the immune system of a genetically at risk child to become misdirected into autoimmunity to its own insulin producing islet cells, ultimately leading to type 1 diabetes?  I believe that this new data on rising type 1 diabetes incidence creates an imperative to the pediatric diabetes care community to explore further the causes that underlie this frightening trend and work to reverse it.  

In the pediatric endocrine field of medicine, there has been a mission over the last couple of decades to find ways to prevent type 1 diabetes. Unfortunately, we have yet to see success. The focus of the endocrine group at Cook Children’s will remain on excellence and providing the highest level of care in the treatment of the disease. Our group, like many in the pediatric diabetes care community, recognizes the need to expand beyond our core focus into research and other innovations. Our recent participation in the Diamyd® vaccine trial represents one such step in expanding our quest. The trial’s primary investigation focus is to see if progressive destruction of insulin-producing islet cells in those children with newly diagnosed type 1 diabetes can be halted.  I believe the trial represents hope for a better life quality for children and their families who already live with type 1 diabetes and is a small step in the ultimate path to cure.