Diabetes Self-Management Blog

Here at Diabetes Self-Management, we tend to focus — as our name implies — on how people who already have diabetes can best manage their condition. But now and then, we report on ways to prevent diabetes in the first place. These stories nearly always focus on Type 2 diabetes, which studies suggest might be delayed or prevented through diet, exercise, and certain drugs. Type 1 diabetes — the autoimmune variety that tends to begin in childhood or young adulthood — is widely viewed, by both medical professionals and the informed public, as unrelated to lifestyle. Since we don’t fully know why the immune system attacks the beta cells of the pancreas in people with Type 1 diabetes, the risk of acquiring it is often attributed simply to genetics and chance.

But the landscape of risks for autoimmune diabetes is more complicated than that, as a recent study published in the journal Diabetes Care indicates. According to a Reuters article, the study found — based on data from 56,296 Norwegian adults collected over 24 years — that adults who reached college were almost twice as likely as those who didn’t finish high school to develop latent autoimmune diabetes in adults (LADA), which is very similar to Type 1 diabetes. Only 122 adults in the study developed this form of diabetes, compared with over 1,500 who developed Type 2 diabetes in the same period. The study’s lead author noted that education did not actually cause the increased rate of LADA among adults who received higher education; rather, the higher risk came either from a lifestyle stemming from higher education or from a factor that made higher education more likely in the first place. The study did, however, adjust results to correct for differences based on obesity, smoking, exercise level, and family history of diabetes, among other factors.

Ultimately, however, it is a mystery why an association between education level and LADA exists. These results mirror those of studies in which children with a higher socioeconomic background exhibit a higher risk of developing Type 1 diabetes. One theory is that children from a higher socioeconomic background — and perhaps also those who go on to higher education — experience less exposure to microbes, which may somehow increase the likelihood of an immune system malfunction. Testing such a hypothesis, however, is difficult, and any number of unknown factors could be responsible for the changes in autoimmune diabetes risk seen at different education and socioeconomic levels.

What do you think — could education lead to a higher rate of autoimmune diabetes, possibly through increased stress or other lifestyle changes? Do you put stock in the idea that a too-clean upbringing could lead to an underdeveloped immune system? If so, have you done anything in response (vacuuming less, taking kids swimming in lakes)? How much should we worry about how our actions affect our diabetes risk — both Type 1 and Type 2? Leave a comment below!

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Comments
  1. Less education, more likely to do more physical labor type work vs sedentary office/manager type work for more educated people.

    Posted by Wade L. Sims |
  2. I can see some corralations with higher education and type 2 in people I know who have type 2. Many of my friends are RN’s who sit all day, year after year at computers. They enjoy large lunches and dinners and consume most of their calories in the evening or at night. Exercise is something they tell other people to do. They have great responsibilities and with that even more stresses.
    Again, from examples around me I know three type 1’s who were the youngest of 7-8 sibblings in households of lower social economic families with lots of dirt, microbes, cats and dogs. Its strange but the last child seems to get the type 1. I can’t figure it out.

    Posted by Sue P |
  3. I do not know what portion of the Norwegian population experiences military service. Lacking this, communal living in dormitories during college may provide the greatest opportunity in that population for the spread of any infectious agent contributing to autoimmune disorders.

    Posted by Dan Watts |
  4. I think it has to do with stress. I was in a very stressful, abusive marriage and then had a child who was born with a congenital disorder that was also very stressful. I did not have gestational diabetes; however, three years after my son was born I was diagnosed with type 1 diabetes (LADA) at 32.

    Posted by Lisa Hannigan |
  5. I have struggled with this hypothesis for many years. I have had type 1 diabetes for over 25 years. I went to school, was exposed to viruses and bacteria and grew up in a house in the 1970’s, that while it was clean and tidy, was not privy to antibacterial soaps and sterile conditions. We had dogs and cats, carpeted flooring and (yes, mom) dust! All of this exposure to “contaminants” did not prevent me from being diagnosed with Type 1 diabetes at the age of 15 after a particular nasty bout with the flu. My grandmother’s sister was also a T1. She came over to America on a ship from Italy. Her living conditions in Italy were also less than sterile. Her accommodations aboard ship were just slightly better than steerage. Her exposure to these conditions didn’t prevent her autoimmune system from attacking itself, either. Nor did my grandmother’s multiple sclerosis come from lack of exposure to common childhood illnesses/germs.

    While this article is primarily based upon conjecture regarding how our immune systems need to be stimulated to build strength, I do feel it is missing one extremely important mention: GENETICS. If there is a strong genetic predisposition towards ANY ailment, chances are more likely that one MAY develop it. Look at breast cancer. One may say that cells mutating into a malignancy are also due to a person’s familial predisposition. The genetic stage must be set in order for the roulette wheel of disease to line up correctly and provide a welcoming environment for said disease to take hold.

    Yes, since T1 is an “autoimmune” disease, we should focus on building strong immune systems to possibly help offset the genetic predisposition. However, my family history certainly disproves the author’s conclusion that one must have lived in a sterile environment for the system to backfire and attack itself. I also take issue with the implied assumption that inoculations have weakened immunities. If this were indeed the case, there would be no record of disease or illness prior to these vaccines being manufactured. If the author wishes to explore this theory, he/she should also look at including the link between immune-compromised people and their consumption of manufactured multiple vitamins at a young age.

    I reiterate, disease is something we all try to prevent. However, I do not feel there is one particular “cause” of ANY disease. Rather, it is a combination of genetics, environment, exposure to natural (bacterial and viral) and chemical compounds and just plain chance. Herein lies the inherent fault in this publication. For the author to state that clean living conditions is the cause of autoimmune diseases, I will debate the assumption due to the fact that the thesis is not all-encompassing. For someone to make a scientific hypothesis such as this, one must be willing to analyze the backgrounds of all Type 1 diabetics (their socio-economic and educational backgrounds included)as well as their living conditions at a young age. I know many well-off people who live like pigs in filth, and I know many poorer people who have immaculate homes. There are several faults with this publication due to the stereotyping and false generalizations made. I urge the author to accept “chance,” in conjunction with other factors, as a precursor to certain diseases, before making such a specific claim.

    Posted by Lucy |
  6. I am of Norwegian descent with adult onset insulin dependent diabetes which I was diagnosed with at 46. I was raised in a large family, exposed to lots of germs and surrounded by animals inside and outside so I am one who totally blows the cleanliness or lack of germs theory out of the water.

    My money would be on the “stress” factor rather than either the sedentary or lack of germs ideas if level of education is a risk factor.

    However, I am far more intrigued by the research regarding gut bacteria which University of FL is working on. Prior to being diagnosed, I complained about having a sour stomach off and on for some time which was totally out of character for me. It wasn’t enough to send me to the doctor, but my daughter remembered my complaints when she read about their research and forwarded the article to me a few weeks ago.

    Posted by Sharon W. |
  7. I was dx with Type 1 at age 37. No family history but later a 2nd cousin developed type 1 and a couple of relatives with type 2. Had completed 2 years of college and was actively working as a bedside nurse - no sedentary lifestyle. Hiked adn biked in leasure time. Middle of 6 children, lower middle class home - lots of germs! Had measles and chicken pox as a child - no vaccines back then.
    I agree - no one cause is likely. Still we can’t ignore studies that show such large results. interesting study.

    Posted by Michele |
  8. I was raised on a farm and was exposed to many germs. My mother kept a very tidy house bit was not always around to be sure that I was clean, I am the youngest of five children and was diagnosed with type one at the age of 37. I did attend college but not until much later in life. I am the only person in my family with T1. I find the study to be very interesting.

    Posted by Rena |
  9. I agree that extreme, long-term stress could be a contributing factor in the development of Type 1 as an adult — I feel certain it played a role in my situation.

    Another factor that I suspect is Vitamin D deficiency. Because of being indoors a lot from my college days onward and because of living several years in a very cold climate, my exposure to sunlight was limited. Shortly after my Type 1 diagnosis, we discovered that my Vitamin D levels were very low. I’ve always wondered whether there might have been a correlation.

    I had also added a new medication about six months prior to my diagnosis. Although I’ve never seen a study linking that particular drug to autoimmune disorders, I believe it might have been the “straw that broke the camel’s back.”

    Posted by Lisa |

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