Medically reviewed and verified by Kate Burke, MD, MHA
Estimated reading time: 8 minutes
Diabetes is the 8th leading cause of death in the United States. About 38 million people have the condition, and experts estimate 1 in 5 do not know they have it. Type 2 diabetes accounts for 90-95% of all cases, but type 1 diabetes (T1D) is an autoimmune disorder with symptoms that can appear suddenly and cause serious health problems. Understanding who it affects, and how, is a crucial part of managing the disease!
The incidence of type 1 diabetes is increasing worldwide. In 2021, there were approximately 8.4 million people with this condition worldwide. By 2040, that number is projected to reach between 13.5 and 17.4 million. Type 1 diabetes can affect anyone, regardless of race, ethnicity, age, or socioeconomic background. While its exact causes remain unknown, researchers have identified several risk factors that may increase an individual's likelihood of developing the disease. Here, PatientsLikeMe will explain the most prevalent risks you need to be aware of.
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Genetic Factors
Family History
Having a family member with type 1 diabetes is the most significant risk factor for developing the condition. If a parent, sibling, or child has T1D, your risk of developing the disease increases up to 15-fold. In the United States, about 1 in 300 children develop T1D by age 20. When the mother of the child had the disease, that rate increased to 1 in 40. When the father had the disease, it went to 1 in 15. Sibling risk ranges from 1 in 12 to 1 in 35. However, it is important to note that nearly 85% of diagnoses occur in people with no family history of the disease.
Age
While type 1 diabetes can show up at any age, many people are diagnosed during early childhood or adolescence. There are two noticeable peaks. The highest occurrence of diagnoses observed is between ages 10 and 14. The second is in children between 4 and 7 years old.
Infectious Agents
A leading theory is that certain environmental triggers can occur early in life. T1D incidence in children is higher in the colder seasons in both hemispheres, which is similar to how viral infections trend. Researchers have yet to find proof of this, however. T1D can have a long incubation period, making it hard to detect traces of infectious triggers.
Viral Agents
A few viruses have been associated with type 1 diabetes over the years. Human Enteroviruses (HEVs), have the strongest body of evidence. These viruses enter the gut and spread because of poor hygiene or sanitation. Studies have found traces of HEVs in samples from newly diagnosed T1D patients and those who have been living with the condition for years. Again, all of this is still theoretical. No one knows exactly what the cause of type 1 diabetes is. The leading theories regarding HEV are:
- HEVs might look similar to parts of insulin producing cells in the pancreas, causing the immune system to mistakenly attack the cells.
- HEV infections might expose insulin producing cells to the immune system in an unusual way, leading to an attack.
- HEV infections might change how insulin producing cells work, making them appear as a threat to the immune system.
Other Viruses
Congenital rubella syndrome is an illness in infants that comes from the mother. If the mother has the rubella virus during pregnancy, they can infect the child. It has been found that type 1 diabetes develops in between 12-20% of patients with a congenital rubella infection.
Rotavirus is one of the most common infections worldwide. It causes diarrhea and other intestinal problems, and while there is no cure we have medications that can manage the symptoms. Studies have also found that a decrease in exposure to the virus is associated with a lower risk of developing T1D. It should be noted that the exact relationship between the two conditions is still unclear.
Cytomegalovirus (CMV) is another common virus. This can be passed from mother to child during pregnancy. Most healthy people with the virus may experience no symptoms, or very minor ones. It has been hypothesized that there is a connection between CMV and the triggering of an autoimmune-mediated destruction of beta cells. This has not, however, been proven.
Toxins and Chemical Compounds
Environmental toxins are harmful substances in the air, our food, and water. Over time, these substances can build up in our bodies. This leads to health complications. Two toxins in particular, arsenic and dioxin, could be tied to a higher risk of developing T1D. Arsenic in particular promotes beta cell apoptosis. This is the primary driver behind the loss of beta cells in the pancreas, which produce insulin.
Arsenic is commonly carried in water. It can also be found in the soil but is typically ingested through drinking. Dioxin is a family of compounds and builds up in the food chain. This toxin is fat-soluble, so it can store up in meats like chicken, beef, pork, fish and eggs.
Dietary Factors
One theory is that diet during childhood can increase the risk of developing type 1 diabetes. Researchers often look at a few common substances: cows' milk, gluten, cereals, omega-3, vitamin D, and breast milk. The evidence, however, is often contradictory! This has made it hard to pinpoint which factors could be the most important, both in protecting people from developing Type 1 or increasing the risk.
Cows' Milk
This is one of the only dietary links that has been found to increase the risk of developing type 1 diabetes. Researchers compared infants who received formula versus cows' milk while also being breastfed. They found that at 3 months, infants exposed to cows' milk had a higher immune response to bovine insulin. They produced more of an immunoglobulin antibody that limits insulin production. Because of this reaction, they had a higher risk of developing type 1 diabetes.
Breastfeeding
For mothers with type 1 diabetes, you can and should plan to breastfeed for at least six months. Research has found that breast-fed babies have a lower risk of developing T1D. Their risk of obesity also decreases. Asthma, eczema, respiratory disease, and ear infections are also less common.
Gluten
A study in 2018 found that a pregnant woman who eats a diet high in gluten could raise the chances of their child developing type 1 diabetes significantly. However, a Systematic Literature Review in 2023 concluded more research is needed in this area. Of note, people with the condition celiac disease have an increased risk of developing other immune diseases, such as T1D.
Vitamin D
For children with T1D, it is very common to find a vitamin D deficiency. Vitamin D helps the body absorb calcium and phosphorus, but also aids in immune health, muscle function, and brain activity. While more research is needed, it is believed that supplementing the diet of a patient diagnosed with T1D with vitamin D could help manage the condition. A study in Finland found that children who took supplements were 80% less likely to develop T1D.
Omega-3 Fatty Acids
Omega-3s are fats that help the cells in your body function. They are found throughout the body but are heavily concentrated in the eyes and brain. Several studies have investigated how supplementing diets with omega-3s could help control T1D. The results are inconclusive, but one found omega-3s may help regenerate beta cells. These cells produce insulin in the pancreas. The study, done on mice, suggests that omega-3s could be a new therapy for treating type 1 diabetes.
Ethnic and Geographic Factors
Here are the rates of diagnosed diabetes in adults by race and ethnic background. This includes both type 1 and type 2 diabetes.
- 13.6% of American Indians/Alaskan Native adults
- 12.1% of non-Hispanic Black adults
- 11.7% of Hispanic adults
- 9.1% of Asian American adults
- 6.9% of non-Hispanic White adults
Certain racial and ethnic groups are at a higher risk of developing diabetes. From 2002 to 2018, non-Hispanic Asian or Pacific Islander children and adolescents saw the greatest jump in diagnosis. Across all years, non-Hispanic White children and adolescents had the highest incidence rate. The greater issue to consider is how to treat the condition. Studies have found a large racial and ethnic inequity in the treatment of T1D for young adults. Non-Hispanic Black participants, in particular, were found to be affected. The promotion of diabetes technology, social programs, and disease support are needed.
Geographically, certain regions do have a higher prevalence of T1D. Generally, the further from the equator you travel, the higher the rate of T1D. Many studies around type 1 diabetes come out of Nordic nations. Part of the reason why is because they have some of the highest rates of the condition worldwide. Genetic factors play a more significant role in determining individual risk. Researchers continue to look at the relationship between genetics and environmental influences in T1D development.
While type 1 diabetes risk factors vary, awareness of these factors can help you identify when you are at a higher risk and implement preventive measures. Ongoing research is still trying to unravel the underlying mechanisms of T1D development. Ultimately, the goal is to be able to prevent, reverse, and cure the disease.
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