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Type 1 diabetes mellitus in childhood: a matched case control study in Lancashire and Cumbria, UK
A L Marshall1, A Chetwynd, J A Morris
1AstraZeneca Pharmaceuticals, Macclesfield, UK.
Insights
Environmental factors influence childhood Type 1 diabetes risk. Factors like parental history, maternal health during pregnancy, and early life social contact play significant roles in developing this immune-mediated disease.
Area of Science:
- Pediatric Endocrinology
- Environmental Epidemiology
- Immunology
Background:
- Childhood Type 1 diabetes mellitus (T1DM) is a significant immune-mediated disease with increasing incidence.
- Understanding environmental risk factors is crucial for prevention strategies.
Purpose of the Study:
- To identify environmental and familial risk factors associated with the development of childhood Type 1 diabetes mellitus.
Main Methods:
- A matched case-control study was conducted in the UK.
- 196 children diagnosed with Type 1 DM and 381 healthy controls were interviewed.
- Data were analyzed using logistic regression with the Breslow and Day technique for matched studies.
Main Results:
- Significant risk factors included parental history of diabetes, maternal thyroid disease, maternal infections/illnesses during pregnancy, and father's academic qualifications.
- Protective factors identified were sharing a room with a sibling, social contact with other children, and belonging to an Asian family.
- Consumption of sugary foods and milk, maternal smoking during pregnancy, and maternal age at birth were also associated with risk.
Conclusions:
- Findings align with the hygiene hypothesis, suggesting a link between improved living standards and increased risk of immune-mediated diseases like Type 1 DM.
- Results challenge the notion that hygiene exclusively impacts Th2-mediated atopic diseases, as Type 1 DM involves Th1 reactions.
- While recall bias is possible for maternal smoking, a causal link warrants further investigation.
Aims:
The aim of the study was to identify environmental risk factors for insulin-dependent diabetes mellitus (Type 1 DM) in childhood.
Methods:
A matched case-control study of Type 1 DM conducted in Lancashire and Cumbria, UK, using a structured interview. Cases (n=196, participation rate 83%) were children under 16 years of age diagnosed prior to October 1998 and attending diabetic clinics. Controls (n=381) were healthy children from the community matched by gender and by age (within a few days of birth). The data were analysed by logistic regression using the technique of Breslow and Day for matched case control studies.
Results:
The multivariate regression model showed that the following factors were significantly associated with the risk of developing Type 1 DM (odds ratio, 95% confidence intervals): sharing a room with a sibling (0.458, 0.290-0.721), social contact with other children when aged 6-11 months (0.439, 0.256-0.752), consumption of sugary food (0.080, 0.024-0.261), parental insulin dependent diabetes mellitus (10.651, 3.086-36.761), maternal thyroid disease (4.861, 1.681-14.058), consuming more than one pint of milk per day prior to school entry (0.498, 0.310-0.802), maternal smoking during pregnancy (0.373, 0.218-0.636), a father with no academic qualifications (0.504, 0.278-0.913), maternal age at time of birth (0.900, 0.854-0.948), maternal infections in pregnancy (2.453, 1.011-5.948), other maternal illnesses or conditions in pregnancy (2.007, 1.139-3.535), belonging to an Asian family (0.104, 0.028-0.394), and regular contact with pets and other animals (0.552, 0.309-0.987).
Conclusion:
Many of the results are consistent with the hygiene hypothesis which links improved living standards with decreased exposure to microorganisms and increased risk of immune mediated disease in childhood. These findings challenge the idea that improved hygiene acts exclusively through a Th2 mechanism leading to atopic disease as Type 1 DM is mediated by a Th1 reaction. The association with maternal smoking could be due to recall bias but a causal link cannot be excluded with confidence.
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