- A new research review found those with type 1 diabetes were 8 times more likely to have an illness caused by an enterovirus compared to those without diabetes.
- In T1D the immune system attacks cells within the pancreas that make insulin, a hormone that is used to regulate the body’s blood sugar levels.
- If there’s not enough insulin, sugar levels tend to be uncontrolled resulting in a diagnosis of diabetes.
Type 1 diabetes and a common virus family have been strongly linked together according to new research. This adds to mounting evidence that vaccines can play a role in diabetes prevention.
Researchers from Australia analyzed data and presented their findings at the annual meeting of the European Association for the Study of Diabetes in Stockholm Sweden.
This comprehensive research review found that those with type 1 diabetes (T1D) were eight times more likely to have an illness caused by an enterovirus, a common family of viruses, compared to those without diabetes.
Type 1 diabetes is a medical condition that is most often diagnosed in children. It is the most common form of diabetes in children.
Over the past several decades its incidence has been increasing and while not directly linked, there may be associations with enterovirus.
In T1D the immune system attacks cells within the pancreas that make insulin, a hormone that is used to regulate the body’s blood sugar levels. If there’s not enough insulin, sugar levels tend to be uncontrolled resulting in a diagnosis of diabetes.
Study adds to the growing body of evidence linking diabetes and enterovirus
“Significant associations between enterovirus infection and type 1 diabetes have been published,” said Dr. Ambika Ashraf, Director of Pediatric Endocrinology and Diabetes at UAB and Children’s of Alabama and Associate Director of the UAB Comprehensive Diabetes Center in Birmingham, Alabama.
Ashraf was not part of the research review.
“The causality has not been established because it is difficult to obtain complete enterovirus genomes from patients at the time of T1D diagnosis,” Ashraf told Healthline.
Although the exact reason why the immune system attacks pancreatic cells is not fully understood, health experts believe it is caused by both genetics and an environmental trigger such as a virus.
“The contribution of these authors is that they systematically have surveyed the world’s literature and have concluded that the family of enteroviruses are the leading candidates for such a role in provoking type 1 diabetes. This is both provocative and challenging because numerous questions remain,” said Dr. William Schaffner, an infectious disease expert at Vanderbilt University Medical Center in Tennessee, who was also not part of the research review.
Schaffner told Healthline there are many different enteroviruses, but questions if “all of them have the capacity to predispose to type 1 diabetes or is this restricted to only certain strains of enteroviruses?”
Understanding which viruses and how those viruses which are predominantly in the respiratory and intestinal tracts affect the function of the pancreas “would open the door to further avenues of prevention and treatment,” Schaffner told Healthline.
What is an enterovirus?
Enterovirus is a family of viruses that causes many of the upper respiratory symptoms that children face throughout the year. The Centers for Disease Control and Prevention reports that each year enteroviruses cause approximately 10 to 15 million infections each year.
“Enteroviruses are a large class of viruses, including poliovirus, coxsackievirus, and echovirus. They cause [upper respiratory infection,] hand foot and mouth disease, aseptic meningitis, acute flaccid myelitis (EV- D68),” says Ashraf.
Enteroviruses circulate throughout communities and schools causing upper respiratory symptoms including sneezing, runny nose, body aches, and occasionally fevers.
School-age children are also more vulnerable than adults because adults have had previous exposures to the virus to protect them.
Sonia Isaacs with the Department of Paediatrics in Child Health at the University of South Wales in Australia conducted the largest meta-analysis in this field which included 12,077 participants from over 60 observational studies.
About half of the participants in this study had type 1 or islet autoimmunity which typically progresses to type 1 diabetes. And in these individuals, the odds of enterovirus infection is eight times greater than in those without type 1 diabetes.
Similarly, individuals with type 1 diabetes were also 16 more likely to have an enterovirus detected in the month of their diagnosis.
Ashraf agrees that while this study is compelling, it should not be a worry for parents regarding an increased risk of T1D.
“Enteroviruses are extremely common (akin to the common cold), and the vast majority of people infected will not develop autoimmunity or T1D,” said Ashraf.
More study still needed
This information can help researchers in understanding if vaccines can help lower the rates of T1D.
If they can be used to reduce enterovirus infections they may lower the incidence of T1D.
“If a virus were conclusively shown to have a role in inducing type 1 diabetes, that raises the possibility that a vaccine might have a role in prevention,” said Schaffner.
Although there are no vaccines currently available for enterovirus, the US National Library of Medicine reports that there are several underway including the PREMISE trial.
“Unfortunately, other than the vaccine for poliovirus, no other enterovirus vaccines are available,” Ashraf told Healthline.
COVID-19 also a risk factor for T1D
Although a different family of viruses, research suggests that COVID-19 infections may also increase the risk of type 1 diabetes in children and adolescents. This leads to the idea that infection prevention may help prevent the onset of type 1 diabetes if viruses are a stronger cause of triggering T1D.
Schaffner encourages healthy habits for children to prevent the spread of contagious viruses like enteroviruses. “Good hand hygiene always is important and, of course, if your child develops a fever or any abdominal symptoms, contact your pediatrician or family doctor.”
Although it’s not entirely understood why the immune system attacks pancreatic cells causing type 1 diabetes, the complication of diabetes is well documented.
Uncontrolled diabetes can lead individuals to several life-threatening conditions. Diabetes increases someone’s chance of heart disease, stroke, and kidney failure, and can even cause a change in vision and numbness and tingling of one’s fingers or toes.
A recent study projects the number of people with type 1 diabetes will increase significantly to as many as 17.4 million people in 2040 – a rise from 8.4 million people in 2021.
This increase in cases comes at a challenging time as there are barriers to T1D care such as the availability and cost of insulin, strips, lancets, blood glucose monitoring, and insulin pumps. “The implications of increased incidence of T1D by 2040 are worrisome, especially in resource-limited countries since the cost of care is prohibitive,” warns Ashraf.
Rajiv Bahl, MD, MBA, MS, is a board-certified emergency medicine physician and health writer. You can find him at RajivBahlMD.com.
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