A recently concluded study by a team of researchers from China Medical University looked into the potential causal relationship between a prior enterovirus infection and the development of type 1 diabetes in children. Enterovirus is notorious for entering the body via the fecal-oral route, and oftentimes progresses to affecting the nervous system. Infections are more common during the summer and fall, and it is common for infected individuals to be asymptomatic. While this may be the usual case in older patients, enterovirus infections are particularly dangerous in infants and young children and can leave long-term or permanent effects.
Dr. Tsai Chung-Li and his team of investigators explain that the development of type 1 diabetes involves a number of complex factors such as genetics, one’s immune system, and environmental influences. While these potential causes have long-since been established, a considerable amount of new evidence is suggesting enterovirus involvement as well. This includes poliovirus, Coxsackievirus, and echovirus. Their findings reveal nearly half of children with history of an enterovirus infection were more at risk for developing type 1 diabetes. The study is published in the journal Diabetologia.
To help confirm this association, the researchers gathered nationwide patient data from the Taiwan national health insurance system. They noted the prevalence of type 1 diabetes in children up to 18 years old, regardless of incidence of EV infection, between 2000-2008.
Overall incidence of type 1 diabetes was higher in the EV-infected children than in the non-EV infected group (5.73 vs. 3.89 per 100,000 people per year, showing a 48% increased incidence rate in EV-infected versus non-EV-infected children). Hazard ratios of type 1 diabetes increased with age at diagnosis of EV infection, with a more than doubling of the risk of type 1 diabetes (2.18 times increased risk) for children aged over 10 years at entry. No relationship of allergic rhinitis or bronchial asthma to type 1 diabetes was found.
While this is an alarming finding, the authors also looked into Finland and Sweden having the highest prevalence of type 1 diabetes in the world, despite having significantly lesser incidences of EV infections. This suggests the strong influence of genetics in developing this type of diabetes. Developing regions such as in Africa, Asia, and South America experience an inverse with the two diseases, which supports the researcher’s hypothesis that environmental factors like EV contribute to increases in type 1 diabetes cases.
From these findings, the team concludes that there is a need for further study to firmly establish the link between EV infections and type 1 diabetes, and to explore the possibility of integrating an EV vaccine in future preventive measures.