Why is type 1 diabetes increasing?

Philip J. Goscienski, M.D.

August 2013

Type 1 diabetes is known as juvenile onset diabetes in order to distinguish it from adult onset diabetes. Pediatricians now encounter the latter, presently known as type 2 diabetes, in children as young as six years.

Untreated type 1 diabetes has a rapid downhill course. Before the discovery of insulin in the 1920s, most children succumbed in a matter of weeks or months. Decades-long survival is now the expected outcome. Most of these persons live normal lives, often making it to the highest levels of every career field, including professional sports.

There has been an increase in patients with type 1 diabetes in most countries. In the state of Colorado it increased by an average of 2.3 percent per year between 1978 and 2004.

There is a strong genetic tendency toward type 1 diabetes; children with a certain genetic pattern account for nearly 50 percent of patients. There are also several known environmental factors that interact with those genetic tendencies. As research uncovers more details of these interactions there is hope that it will be possible to prevent the disease.

Autoimmune diseases are those in which the body's immune system turns on itself. In the case of type 1 diabetes cells within the pancreas that are responsible for the production of insulin are destroyed as if they were foreigners. Viruses that are responsible for usually minor illnesses such as gastroenteritis may trigger this response. Some viruses actually protect against the disease, a finding that should be pursued further.

Intense research has uncovered other associations. Gluten is the new villain on the block. It is the cause of an autoimmune disease known as celiac disease, whose incidence is highest in Scandinavian countries where there is also a high incidence of type 1 diabetes. Infants who are exposed to gluten-containing cereal grains in the first three months of life appear to be at greater risk while those that are exclusively breastfed, in some studies, are less so.

Physicians have recognized for decades that type 1 diabetes is more common in those latitudes that are farthest from the equator and where vitamin D levels are low. Patients with type 1 diabetes tend to have low levels of vitamin D, which plays a role in other autoimmune diseases such as rheumatoid arthritis, multiple sclerosis and psoriasis.

Genes matter but so do environmental and lifestyle factors. We may soon reverse the trend of type 1 diabetes.

Philip J. Goscienski, M.D. is the author of Health Secrets of the Stone Age, Better Life Publishers 2005. Contact him at drphil@stoneagedoc.com.