Risk Factors for Type 1 Diabetes in Pediatric Patients

Elaine M. Apperson, MD: Type 1 diabetes is found in about 1 of 500 children. Some studies will say 1 of 450. We certainly know that it has been increasing in its prevalence in more recent years. We don’t know exactly why. Basically, there are a host of risk factors for it. We know there’s a genetic basis for it, but a genetic risk does not confer complete risk. For decades, we’ve been studying type 1 diabetes and why it happens to children. We think of it as a 2-hit process. For example, if you have identical twins with the exact same genetic makeup, only 50% of the time will both twins get type 1 diabetes. We know there’s another reason why type 1 diabetes develops. It’s not genetics alone. We believe that there are environmental factors, perhaps dietary factors, perhaps risk of or exposure to different viruses, that may play a part.

In terms of family history, if you have a parent with diabetes, that can certainly confer risk. Interestingly, if your father has diabetes, you’re at greater risk for developing diabetes than if your mother does. You have a 1 of 17 risk if your father has diabetes vs 1 of 25 if your mother has diabetes. You have a 5% risk if your sibling has diabetes. With regard to environmental factors, we’re learning so much in this day and age about the gut microbiome. It may be pollutants, maternal age, and stress, and there seems to be some seasonal variation with development of diabetes.

In terms of complications, thankfully with better tools for keeping glycemic control, we see fewer complications. Historically, we’ve looked at complications in terms of microvascular complications. It’s not so much the high blood sugars. It’s what the high blood sugars do to the walls of capillaries that cause the morbidity you see in all sorts of diabetes, including type 1. It’s a matter of perfusion. When capillaries get too stiff and close, you can’t get blood to the nether regions of the body. You can’t feed the nerves in the most remote places in the body, including your feet. You develop neuropathy, paresthesia, foot drop, etc. If you develop an infection and it’s still part of your body, you can’t get antibiotics; therefore, you come across things like need for amputation. If your capillaries can’t feed all your renal tissue, you may develop kidney problems or kidney failure. The same thing happens with the tiniest reaches of tissue with your retina. You may have vision loss.

Fortunately, with the tools we have in this day and age, and the goals that we have for glycemic control, we rarely see those complications in children, especially young, healthy children. We monitor for those complications, and once we see evidence of those complications beginning, especially any degree of retinopathy, with strict control we’re sometimes able to reverse them if we catch them early.

Transcript edited for clarity