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WHO GETS TYPE 1 DIABETES?

Up to 1,000,000 people in the US are estimated to have type 1 diabetes, with about 30,000 new cases diagnosed each year. It is much less common than type 2, however, consisting of only 7% to 10% of all cases of diabetes. Nevertheless, like type 2 diabetes, the incidence in type 1 has been rising over the past few decades in certain regions of the US and some European countries, particularly in Finland and England.

Risk Factors in Children

Type 1 can occur at any age but usually appears between infancy and the late 30s, most typically in childhood or adolescence. Boys and girls are equally vulnerable. Studies report the following may be risk factors for developing diabetes type 1:

  • Being ill in early infancy.

  • Not being breast fed and drinking cow's milk in infancy. One study found that children fed cow's milk in the first eight days of life had twice the risk as those on breast milk. The risk is still very low and likely to develop in children who have a genetically impaired immune response to dietary proteins. Breast milk contains factors that may help regulate the immune response and prevent diabetes in such children. A major study is underway to determine if avoiding cow's milk for the first six to eight months will prevent type 1 diabetes. National differences in risk also suggest that not all cow's milk is the same and some proteins carry higher risks than others.

  • Having an older mother.

  • Having a mother with type 1 diabetes.

  • Having a mother who had preeclampsia during pregnancy.

  • Obesity in children has long been linked to a higher risk for type 2 diabetes. Two 2001 studies reported an association between high weight at birth and obesity during childhood as risk factors for type 1 diabetes as well. The common risk factor may be an increase in insulin secretion, which occurs with obesity. This theoretically could overstress the beta cells so that they become susceptible to damage by overactive immune factors (particularly cytokines), and eventually destruction in children genetically vulnerable to type 1 diabetes.

Until recently, diabetes in children was almost always type 1 diabetes. Of major concern, however, are estimates that between 8% and 45% of new diabetes cases in children are now type 2, most likely because of the increase in childhood obesity. [ See Well-Connected Report #60, Diabetes Type 2.]

Having Other Immune Abnormalities

Autoimmune Diseases. The incidence of type 1 is higher than average among people with other autoimmune diseases, including Grave's disease, Hashimoto's thyroiditis, Addison's disease, multiple sclerosis (MS), and pernicious anemia. Research, in fact, has raised the possibility that all autoimmune diseases share a common genetic basis. A 2001 study found, for example, that the T-cell immune factors in type 1 diabetes target the same self-antigens as in multiple sclerosis (MS). And both diseases have been associated with cow's milk protein. Many questions are unanswered, however. It is not known why the diseases develop in different locations to cause separate disorders or why some autoimmune events occur in everyone but not everyone develops an autoimmune disease.

Asthma and Allergies. There has been some work suggesting that people with asthma and allergic diseases are less likely to develop diabetes type 1. Both these conditions and diabetes type 1 are on the increase and all are triggered by abnormal T-cell responses. The specific T cells involved, however, differ between diabetes and the asthmatic or allergic responses. (T-cells are important immune cells that produce factors causing inflammation.) It is possible, then, that all of the conditions occur when common environmental assaults trigger an immune response, but the specific T-cells involved would depend on individual genetic factors.

Ethnicity

There is a very wide variation in incidence of type 1 among population groups. Type 1 diabetes appears to be most common in people of northern European descent and in specific Mediterranean groups (such as Sardinians). It is less common among Asians and African Americans. Still, African Americans with type 1 diabetes are 50% more likely to die from it than Caucasians are, mostly due to lower-quality health care.