What we can conclude
Type 2 diabetes, while far from completely understood, is at least a little less mysterious than type 1. Risk factors for type 2 include higher obesity rates and lower activity rates, and there is also a clear correlation between living in poverty and being diagnosed with type 2. And while not everyone with type 2 diabetes identifies with these risk factors, we at least have some targets to aim at: reducing obesity, encouraging physical activity, increasing access to healthy food.
But we still don’t know what causes type 1, and while theories abound, there’s not one single cause we can fight against to curb a disease that’s affecting an increasing number of children. But the very fact that prevalence is increasing gives us some clues.
Gale theorizes, and he is not alone, that there must be some environmental or behavioral factors that are triggering the rise in type 1 (and possibly contributing to type 2 as well). If the percentage of children with a genetic predisposition has not changed, then it must be something external that is changing.
The National Institutes of Health tells us that development of type 1 likely follows exposure to an “environmental trigger” by those who are already genetically predisposed. Without reason to suspect a big change in genetic susceptibility, researchers are starting to take a harder look at those environmental triggers.
But what those triggers are remains elusive.
What’s the good news?
It seems the catchphrases of diabetes research are “in the next 5 or 10 years” or, “this brings us closer” or, “this is an exciting development.” For those dealing with the disease on a daily basis, these phrases become a sad song played on repeat. When will there be a real cure?
At least we need no longer think that diabetes is completely random with no external triggers. The evidence points to some trigger, and the search must shift to find what that trigger, or more likely triggers, are. Gale says, “Something has changed in the environment our children encounter or in the way they are reared. Understanding this historical change would open the way to rational forms of intervention… Seen from this perspective, the central task of diabetes prevention is to understand a historical trend, and to put it in reverse.” We agree, but before we can reverse the trend, we need to know what we’re looking for.
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What might the environmental factors triggering diabetes be?
Here’s where things become less clear. There are multiple theories on what might trigger diabetes. A review of possible theories published by Society for Endocrinology said, “The search for the triggering factor(s) has been going on for the past century, and yet they are still unknown.” So it’s appropriate to look at any theory that claims to have found the trigger for diabetes with scrutiny and wait for those theories to stand up to testing.
Several sources do point to a link between rising rates and hygiene—basically the theory is that early exposure to infective agents builds the immune system and that, without that exposure, those with genetic predisposition may not have an immune system robust enough to fight off diseases like diabetes, asthma, and allergies. Early exposure to certain infections may be protective, so while better hygiene practices have reduced infectious diseases such as tuberculosis, mumps, and measles, the percentage of youth with diabetes has gone up. Some scientists think there could be a connection.
But this is far from the only theory. Others include exposure to certain viruses, vitamin D deficiency, early exposure to cow’s milk, or insufficient breast milk.
The Society for Endocrinology begins, and essentially ends, their look at the theories with this thought: “A single factor is unlikely to cause an increase in the incidence of diabetes all over the world, which suggests that a multifactorial process might be involved.” The author calls for a shift from looking for a single factor that we can blame for the increase in diabetes to looking at a shift in several factors that has tipped the scale in favor of diabetes. When we understand that balance shift, and the factors that are pushing children toward diabetes, then we can start pushing back.
The search for definitive answers continues, but researchers are gathering clues, and breakthroughs in research and treatment options continue to give us hope that we are moving closer to a cure. Until then, stay strong, friends.