New data shows that Type 1 diabetes diagnoses are increasing at an alarming rate in the United States, particularly among children and children of ethnic and racial minorities. However, for some reason, no one seems to be talking about it.
ASweetLife was one of the few news outlets to report on the latest developments: According to a CDC report, type 1 diabetes has increased by 30% since 2017. We're still perplexed as to why this isn't a bigger story. (Perhaps the ongoing coronavirus outbreak has our country's medical reporters preoccupied.)
The story begins with the Centers for Disease Control and Prevention in the United States (CDC). The Centers for Disease Control and Prevention (CDC) released some startling statistics about the rise in Type 1 diabetes diagnosis in February. The National Diabetes Statistics Report (PDF) revealed that the overall incidence of Type 1 diabetes was increasing across the board, across all ages and ethnicities. More crucially, the rate of diagnoses among US children and adolescents has “significantly increased.” The CDC followed up with a report that goes into additional depth about the rise in youths.
Between 2002 and 2015, the number of children and adolescents increased by +1.9 percent every year. Surprisingly, “racial/ethnic minority populations” saw an even faster rate of change. T1D incidences climbed 19 percent among African-American, Hispanic, and Asian/Pacific Island children over the study period. Despite the fact that white children are the slowest growing population, there was still a 14 percent gain.
How? Why? The CDC report demurs: “reasons for this recent increase are unknown.”
These figures should be both mind-boggling and alarming, as they appear to defy our common perception of Type 1 diabetes as a genetic illness that strikes at random. These alterations cannot be explained solely by genetics. Environmental factors have long been known to have an impact on T1D development, but could environmental factors alone explain for such a rapid surge, one that affects various groups differently in such a geographically diverse country as the United States?
T1D does not strike at random, as researchers have known for years. Setting aside the known role of genetics on T1D frequency, environmental factors appear to explain some aspect of T1D risk, but identifying the proper ones has proven difficult. Faculty from the University of Colorado School of Public Health reviewed the research on a wide range of putative triggers, from air pollution to breast-feeding duration, and found none that could come close to accounting for T1D increase in a recent paper for The Lancet:
“While various factors have been linked to type 1 diabetes, none of them are large enough to explain the significant rise in occurrence on their own,” Norris said. “Moreover, there is no persuasive or consistent evidence of the changing prevalence of these same exposures over time.”
Dr. David Leslie, a researcher at the Blizard Institute in London who has spent much of his career investigating non-genetic causes of diabetes, told me that he believes there are two key non-genetic culprits: virus and diet.
“Dietary or viral variables are the most common non-genetic variables. Because parents believe you're criticizing them, I've gotten in trouble for saying "dietary" on the radio. And I'm usually pessimistic about viruses because doctors always blame them on viruses when they don't know what they're doing. But, in actuality, I believe it is most likely a virus.”
The relationships between all of these diverse aspects will almost certainly be impossible to understand. If a viral infection triggers beta cell loss (which could happen years before diagnosis), environmental, genetic, and lifestyle factors will all play a role in the progression in ways that scientists can only speculate about.
However, in a society where Type 2 diabetes is on the rise, particularly among children from racial/ethnic minorities, it's logical to question if the triggers for that disease are also involved in the advancement of Type 1 diabetes.
We all know that bad diet choices can lead to serious health problems. We also know that in the United States, ethnic and racial minorities had “poorer nutritional profiles and eating behaviors” than whites. The reasons for this are beyond the scope of this article, although cultural variables such as eating traditions and financial issues (proximity to fast food, distance from healthy shopping options, etc.) are possibilities. Could dietary inequity play a role in the increased prevalence of T1D diagnosis in these groups?
It's not out of the question. Excess sugar intake has been shown to “exacerbate the later stage of type 1 diabetes development” in children who already have a high genetic risk of developing the disease, and that “higher energy intake and larger body size were independently associated with increased [Type 1] diabetes risk,” according to studies.
The beta-cell stress hypothesis is one mechanism that has been proposed to explain how this might function. The theory is that beta cells, which are already under attack from autoimmunity in the early stages of T1D, are eventually exhausted and made unusable by other factors. Inflammation, stress, and infection could be among the main reasons, but also obesity, insulin resistance, and dietary glucose overload.
Simply put, metabolic dysfunction caused by a poor diet and obesity may hasten the onset of T1D and, in borderline situations, may even determine whether or not a patient develops full-blown T1D.
To be clear, poor eating is likely only one of many factors that may have a role in the development of T1D, the majority of which are unpredictable and beyond anyone's control. However, the unchecked spread of T1D in the United States should be a serious source of concern. Diet and lifestyle choices are within our power, and if there's anything we can do as a society to slow the rate of increase, it's certainly worth considering.