Six Questions for the Author of Diabetes Rising
By Dan Hurley
In the two months since publication of my book, Diabetes Rising: How a Rare Disease Became a Modern Pandemic, And What To Do About It, the "usual suspects" in the media have given it plenty of coverage, including National Public Radio, Parade magazine and ABC's Nightline. But nobody knows type 1 like the folks here at CWD, and I've really enjoyed the many feisty discussions that have popped up, such as here and here. Jeff Hitchcock, founder of the site, has been good enough to give me this opportunity to answer five of the questions that have popped up about the book, and along the way to offer some links to many of the studies that are quoted in the book.
1. Is type 1 diabetes really rising, or are people just more open about it these days?
Many people with diabetes, and their parents, have asked me hether type 1 just seems more common because people are no longer trying to hide it. But the published studies are based on official records. And those studies show that the rise is real, substantial and worldwide. A 2002 study in the journal Diabetologia reviewed dozens of studies showing that a substantial rise in the incidence of type 1 began in many countries in the middle of the 20th century. A 2007 study in the journal Diabetes Care reported that the incidence of type 1 in Colorado had jumped from an annual rate of 14.8 new cases per 100,000 youth in 1978-1988, to 23.9 in 2002-2004. And an article last October in the journal Nature Reviews Endocrinology reported on the EURODIAB study, tracking type 1 rates in 17 European countries, which has found an average annual increase in incidence rates of 3.9%. (That might sound small, but over a 10-year period, it would amount to a 46% rise in the annual incidence of type 1!) Looking at these and many other studies from around the world, it seems pretty clear we're talking about a very real problem.
2. Okay, so it's rising, but is it fair to call type 1 diabetes a "pandemic"?
At the suggestion of epidemiologists at the Centers for Disease Control and Prevention (CDC), with whom I worked closely in reporting my book, I used the term "modern pandemic," to indicate that it's not the traditional kind of infectious pandemic that we're used to seeing with measles, H1NI or HIV. Even so, the key aspects of the word "pandemic," as defined here on Medicinenet.com, is that a sharp rise of a disease has occurred in many countries or the entire world. And that is certainly true of type 1 diabetes.
3. What about these five hypotheses you describe for why type 1 might be rising? Do they have any evidence to back them up?
Many folks on CWD and elsewhere have heard me talking on the radio, or seen something on the Web, and begun debating these five hypotheses without reading my book or examining the many studies cited in support of them. I wouldn't have focused on these five hypotheses if they didn't each have a great deal of evidence behind them. These are not just "neat ideas" or half-baked theories; they are, as best as I could figure from talking to dozens and dozens of researchers around the world and reading hundreds and hundreds of studies, the strongest current scientific explanations for why the rise is occurring. For instance, the "accelerator hypothesis" suggests that the increased height and weight of children is raising their risk of developing type 1. This sounds surprising to many people, but take a look at this study that found support for it, or this one from 2008, or this one from last year. Likewise, low levels of vitamin D, the so-called "sunshine vitamin," have been linked to an increased risk of type 1 in many studies, including this one from 2001, which found that kids whose parents had given them 2,000 IU of vitamin D daily had about one-fifth the risk of developing type 1 compared to kids who had received no such supplement. Then there is the so-called "early feeding hypothesis," which says that giving infants formula containing cow's milk or soy milk before the age of six months increases their risk of developing type 1—unless the formula is "highly hydrolyzed" or hypoallergenic (which can be bought in just about any store). The TRIGR study has enrolled over 2,000 infants around the world to test whether those who receive regular cow's milk-based formula develop type 1 at a higher rate than those given a highly hydrolyzed formula.
4. But my kid was skinny and received only breast milk. So are these theories bogus?
None of the five theories pretend to offer a single "cause" of type 1 diabetes. All they say is that certain things might increase the risk of developing it, and offer the hope that we might be able to prevent many cases by controlling those risk factors. We all know that cigarette smoking, for instance, increases the risk of lung cancer, but then again, many people smoke their whole lives and never get it. So smoking doesn't "cause" lung cancer, but it's still a major risk factor. In the same way, if lack of vitamin D, or exposure to standard cow's milk formula in infancy, are proved by more studies to raise the risk of type 1, we will then have valuable knowledge to prevent many cases of this disease. And since type 1 appears to have doubled in the past 20 years or so ... that's a lot of cases we might be able to prevent!
5. What about these "clusters" of type 1 that you describe in the Boston suburbs? Are they real or just a statistical fluke?
As described in this article from a newspaper in Wellesley, Mass., there have now been 18 cases of type 1 diagnosed in a two-and-a-half-mile-wide area there during the past 32 months. (That many cases in such a short period, in such a small area, appears to be about 10 times higher than the national average.) The Massachusetts state department of health is investigating this cluster, which I describe in the opening pages of my book. Other suburbs in the Boston area have also seen remarkably high rates, and here on CWD, I learned about clusters in Arizona, Colorado, Michigan and Georgia. So far, no investigators have found any pollutants or any other local environmental factor that might be playing a role in these places. Instead, I believe these clusters are "leading indicators," showing us just how much more common type 1 has become in recent years across the United States and elsewhere.
6. How can parents and people with diabetes learn more about these rising rates?
First, I suggest you inform yourself about these five major hypotheses, whether by reading my book or reading the original studies. (Discover magazine will be publishing an excerpt of the book in its May issue.) Then you should ask yourself: why doesn't your state track new cases of type 1 diabetes just as it does new cases of measles, cancer and other diseases? Doing so would allow researchers to track exactly how many cases are occurring in every town. So-called "mandated case reporting" of type 1, as called for in a recent editorial in the Journal of the American Medical Association, would help us learn exactly how fast type 1 is rising, and permit us to see local patterns and clusters that might shed light on environmental factors behind the rise. The reports are totally anonymous, just as they are for measles and other "reportable" illnesses. If parents would begin asking their state legislators to pass a state law, we would all know much more about the rising rates of type 1 ... and how we might turn back the tide!
Originally published on April 6, 2010
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