Q:  What possible factors could be influencing this rise in type 1 diabetes?

A:  This increase is likely not genetic but environmental. For example, infections could influence diabetes development in two opposing ways:

• On one hand, it is certainly possible that the lower incidence of childhood infections today has led to an increase in autoimmunity and asthma (the so-called ‘hygiene hypothesis’) leaving the human-developing immune system more idle.² Why? The immune system does not get enough “exercise” due to our modern lifestyles. We drink cleaner water, stay indoors often, and are not exposed to as much bacteria. Our immune system lies dormant and needs to be “re-tuned.” The result is an earlier onset of type 1 diabetes. Thus the higher incidence of diabetes might be due to lower degrees of infections, not only viruses but also for example parasites.
• On the other hand, environmental factors such as viral infections could also contribute to the disease process since viral infections can accelerate autoimmune diseases such as type 1 diabetes in genetically susceptible individuals.³ This can augment aberrant (autoimmune) responses in which the beta cells that produce insulin are slowly destroyed by the body's own immune system.⁴ From our current understanding, it is clear that the severity of a given infection will determine, whether it ameliorates or accelerates diabetes, where more severe infections are more likely to worsen the disease.⁵
• Last, general changes in life-style and nutrition might contribute to the raise in diabetes in industrialized countries. A newly emerging area of study is in particular our gut and its colonization and subsequent effects on our immune function.

Q:  In what ways does type 1 diabetes pose a greater risk than type 2 diabetes?

A:  In people with type 1 diabetes, the immune system attacks the beta cells in the pancreas, stopping a person's ability to detect glucose and produce insulin. Type 1 diabetes has a stronger genetic component compared to type 2 diabetes, but genetic risk only accounts for a part of the susceptibility for type 1 diabetes.⁷ In type 1 - an immune-meditated form of diabetes - the body’s immune system destroys or attempts to destroy the cells in the pancreas that produce insulin. →

Unfortunately, type 1 diabetes is generally diagnosed in children, teenagers, or young adults, thus it has to be managed throughout life, leaving the possibility for more side effects through high blood sugars, such as vascular complications.⁷ Type 2 diabetes – the most common form - is based more on nutrition, lifestyle and obesity factors. People can develop type 2 at any age including childhood.⁷

Q:  Is it possible to reduce or reverse this trend and if so how?

A:  If more severe infections with certain viruses were responsible for the raise in diabetes incidence, a vaccine to this virus might help. Some investigators are currently working on this.

More universally, it might be possible to re-tune the immune system to better regulate itself and not attack beta cells by protein immunizations⁶ (i.e. vaccines) – a promising approach that Novo Nordisk’s new type 1 diabetes research and development center in Seattle will explore. The key is using immunization with beta-cell proteins to dampen inflammation around the beta cells in the pancreas, but only at that location.⁶ The crucial goal here is to not suppress all immune responses, which could cause side effects such as more severe infections and other diseases.⁶ Ideally, this strategy could result in a universal childhood vaccine against diabetes.

The Novo Nordisk Type 1 Diabetes R&D Center is driven by the Company’s mandate to find a cure for type 1 diabetes – something that is unusual for the pharmaceutical industry today.