Type 1 diabetes on rise.

• Author: Brody, Jane E.
• Position: Living

Byline: Jane E. Brody

With mounting concern over the explosive rise in Type 2 diabetes, mostly among overweight and obese Americans, it is easy to forget that Type 1 diabetes, which is far less common, can be a much more serious disease that often seems to arise out of nowhere for no apparent reason.

Type 1 diabetes is an autoimmune disorder in which the body attacks its own insulin-producing pancreatic cells. Most patients must be treated with insulin for their entire lives to prevent the blood sugar glucose from reaching levels that damage tissues and threaten life. Although it accounts for only 5 to 10 percent of all diabetes cases, it usually affects many more years of patients' lives than the Type 2 variety.

Long called juvenile diabetes because the majority of cases are diagnosed in children and teenagers, it can also start in adulthood, prompting the name change to Type 1. Now there is an international movement to change that name, too, to reduce confusion and stigma. Many adults with Type 1 diabetes feel obliged to explain that, unlike most cases of Type 2, the disease is not something they brought on themselves, say, by overeating and underexercising.

Like Type 2, however, the incidence of Type 1 diabetes is also rising, in this case for reasons experts cannot yet explain. Often there is a genetic predisposition, which can raise a person's risk of the disease twelvefold. But genetics alone cannot account for all those affected; even identical twins may not both develop the disease.

Studies have suggested various environmental factors, including infections by enteroviruses that can invade insulin-producing cells in the pancreas; high birth weight and rapid infant weight gain; and the feeding of complex proteins like cow's milk and gluten early in an infant's life.

Now, Dr. Johnny Ludvigsson, a pediatric specialist at Linkoping University in Sweden, and colleagues have zeroed in on the role of serious life stress in provoking the onset of Type 1 diabetes in children, an idea he raised nearly a decade ago. The study, directed by Maria Nygren, a doctoral candidate in epidemiology at the university, is the first such study in which data was collected prospectively, eliminating potential distortion because of inaccurate parental recall or stress induced by diagnosis of the disease.

The study involved nearly 10,500 healthy children, enrolled at age 2 and followed for more than a decade. It found that the experience of a serious stress...