The exact cause of Type 1 diabetes is not yet known, but we had an article about possible causes based on the comments of the author of the book Diabetes Rising. Check out the article here: What’s Causing an Increase in Type 1 Diabetes?
I have two questions.
1) Has anyone read the book?
2) Regardless of whether you have read the book or not, what do you think is the source of this disease?
A US Navy epidimeologist (sic) made a good case re vitamin D deficiency. But this would have been true 100 years ago when the rate of type 1 was much much lower. Yet seems to have some correlation with latitude both north and south of the equator.
My friend Gerry mentioned that many more babies are born overweight now than before. You wonder why? Growth hormones in all our food? The mommies blood sugar higher than 50 years ago?
Cleanliness?
Chemicals? The million or so released into the environment since WW1.
I would also like to point out that the article says that Type 1 diabetes is on the rise in children, but does not mention that Type 1 diabetes affects people of all ages–it is not a childhood disease. So is there a rise in cases of Type 1 diabetes in people of all ages?
My friend Gerry suggested a simple cause for the skyrocketing type 1 incidence. The mere fact that diabetic can survive and reproduce since Banting and Best may have a lot to do with it is genetics play a role. Before that it would have been a self limiting diseases.
Simply not the case. Note the number of women here on TuD who were diagnosed with autoimmune gestational diabetes–Type 1 that came on during pregnancy. Type 1 is diagnosed at all ages, always has been, so it is not and never was a “self limiting disease.” It’s important not to spread myths.
@Melitta: It is no myth that the likelyhood for type 1 manifestation is highest from 14-17 years. It is a reality. In less developed countries type 1 diabetes is a death sentence. These people have 2 dollars to buy the food for one week. Under these conditions they can not afford any medication. So it is and was a limiting disease.
I’ve read the book and the book does discuss the background statistics. The increase in t1 and t2 rates that would occur form simply increased survival rates is trival relative to the observed rates. The author considers a range of hypothesis and the studies and science behind these potential causes, mostly focusing on the potential triggers for diabetes. These include things like vitamin D, cows milk, wheat, etc. I found the book interesting, thoughtful and challenging. I would recommend it.
Type 1 or autoimmune diabetes was called juvenile diabetes but that name was dropped because so many adults are diagnosed with Type 1–it simply is not a childhood disease. The myth that Type 1 diabetes is a childhood disease is a relatively new-on-the-scene myth. In 1934 Dr. Elliot Joslin noted that the incidence of diabetes in lean individuals was relatively constant in each decade of life, but that diabetes in the obese was related to older age. A book published in 1958 (“How to Live with Diabetes” by Henry Dolger, M.D. and Bernard Seeman) that states that “[Type 1] diabetes is almost three times more frequent among young adults than among youngsters.” Since the 1980s the autoimmune nature of Type 1a diabetes has been known, and antibody testing (glutamic acid decarboxylase antibodies (GADA), islet cell antibodies (ICA), and insulinoma-associated (IA-2) autoantibodies) has been the gold standard for the diagnosis of Type 1a diabetes. In numerous scientific studies, approximately 10% of people diagnosed with Type 2 diabetes were found to be antibody positive and in fact had Type 1 autoimmune diabetes. A recent article in the July 2007 issue of “Diabetes Care” indicated that autoimmune gestational diabetes (new onset Type 1 diabetes) accounts for about 10% of all Caucasian women diagnosed with gestational diabetes. People are diagnosed with Type 1 at all ages, many after they have already had children, so it is not self-limiting.
Holger: In developing countries, people who are diagnosed with Type 1 as adults do die, but they may have already had children. There is a peak incidence at ~14, but there is also a Type 1 peak at age 40 (you left that part out). So it is not a self-limiting disease, and since two to three times more adults are diagnosed with Type 1 diabetes (including Manny Hernandez, TuD founder and Mary Tyler Moore, Chair of JDRF International) according to Jerry Palmer, MD (one of the leading T1 researchers in the U.S.), so yes it is a myth that Type 1 is a childhood disease.
JDRF’ s J still stands for Juvenile …as Terrie8 states:" a bit confusing " …I would add : A LOT confusing ( they are not listening to me or others…so we have to work some more on the " title " ) …I think Holger is very correct about the reality of the in less developed countries type 1 diabetes being a death sentence …IDF has the numbers .
What I don’t like about the vit D hypothesis is that it would have been a problem 100 years ago also. We have had insulin in the developed countries since the middle 1920 which is about 2 1/2 human generations so the extra survival rate could account for a large increase in type 1 of course assuming that there is some sort of predisposition passed on from diabetic parents.
Thank you for the detailed post Melitta. I can see that we are not on the same page.
When you said “Type 1 is diagnosed at all ages, always has been”, you meant Type 1(Child to Young Adult onset) and Type 1.5(Adult onset). Both autoimmune. These are not the same disease/condition because there are too many differences between them. That is why there is the .5 or the a added. They cannot be clumped simply as Type 1, since they are totally different experiences or branches on the Diabetes tree.
Back in 1958 young adults were considered Juvenile. Did they mention if these young adults developed Diabetes within days or months or did it take years for them to develop Diabetes? Why was Type 1a(.5) only discovered in 1980? Is it possible that Juvenile Diabetes mutated into autoimmune adult onset? What about Type 2? I thought they said it was only obese Adults who had Type 2. So where did these obese 4 year olds with Type 2 come from? Did Type 2 Diabetes mutate also?
There have been many errors made in the writings of Medical Professionals. I had heard some time ago, that some of the studies in the Medical Journals were flawed, so the findings were untrue after so many years. These Researchers are just Human and still in the learning process, as we are.
As you know, there have been so many studies saying that practically every food under the sun which used to be Good for People now causes this, that and the other disease. Then the next year these foods are Good for us again. They just want to look like they discovered “gold” when actually they are happily wasting tax-payers money.
Sorry Melitta, it seems that I went off on a vent. I just get so frustrated with these Professionals. I did not mean any of it at you or me. We just write their words that we presume to be true.
The history of diabetes classification is a confusing mess. In 1979, efforts were started to reclassify diabetes leading to the terms IDDM and NIDDM. This boneheaded effort really messed stuff up. IDDM covered what had formerly been called Type 1, and NIDDM covered what had formerly been Type 2. As one might imagine, an insulin dependent T2 does not fit, and how do you even deal with a slow onset T1? These terms still exist to this day in the diagnosis classification codes. Efforts in the late 90s started to put stuff back together, and we do have the terms T1 and T2 back again, and there have been more efforts to try to figure out classification. But nobody suggest today that juvenile autoimune T1 exists in any classification different than autoimmune T1 and while there is still wrangling over LADA and the other type 1.5 types, things are becoming pretty clear.
The JDRF was founded in 1970 in an effort to fund research out of the limited things pursued by the dominant ADA It is my impression that the organization latched onto “Juvenile” as a way of focusing attention and getting public support, not as a statement that it was only a childhood condition. Unfortunately, over the years things get confused.
And I have looked extensively in the literature. I have not found any real compelling evidence that slow onset adult onset autoimmune diabetes is any different than rapid onset child autoimmune diabetes. It is simply a spectrum of manifestation, and all of the symptoms and biomarkers appear to overlap (even the genes). The fact that children and adults have a different experience when they get diabetes is absolutely true, but the same thing could be said about the different experience children and adults have when they get chicken pox.
The following chart should visualize the Likelihood for T1 Manifestation in dependency of the Age. It is based on the facts I know and I have integrated the peak around 40 mentioned by Melitta. Based on this chart the disease has a juvenile character. After this phase the likelihood is not zero but significantly lower. In summary there is still a high amount of likelihood distributed after the juvenile phase. To call this LADA or T1.5 is really questionable to me. Actually the reason for the late onset development is less important because the outcome is T1 diabetes:
Hi Terrie8: The World Health Organization (WHO) and the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus define LADA/Type 1.5 as Type 1 autoimmune diabetes. Age of diagnosis is not relevant, etiology is. The Expert Committee states, “Although the specific etiologies of [Type 2] diabetes are not known, autoimmune destruction of beta-cells does not occur.” The National Institutes of Health (NIH (NIDDK)) defines LADA as a condition in which Type 1 diabetes develops in adults. Furthermore, the Expert Committee’s definition of Type 1 diabetes by the clearly encompasses all autoimmune diabetes, regardless of age, which includes LADA/Type 1.5 (“Type 1 diabetes results from a cellular-mediated autoimmune destruction of the beta-cells of the pancreas. In Type 1 diabetes, the rate of beta-cell destruction is quite variable, being rapid in some individuals (mainly infants and children) and slow in others (mainly adults).”
I was diagnosed with Type 1 diabetes (rapid onset with DKA) at age 35. I don’t have “Type 1.5”, I have Type 1 autoimmune diabetes. And yes my “experience” of getting Type 1 as an adult is different than a child, but it does not change that I have Type 1. And it really does matter that adults with Type 1 get the correct diagnosis, because an incorrect diagnosis results in undertreatment, rapid onset of diabetic complications, and potentially death. Perpetuating the myth of Type 1 as a childhood disease has that result.
Holger’s graph clearly shows that the disease is clearly occuring mostly before the age of 22. , based on the area under the curve. And assuming that it has some sort of genetic component then my friend Gerry’s hypothesis: survival of diabetics being a major cause for the increase is reasonable. The fact that type 1 can occur later in life accounts for the fact that the disease did not vanish.
