Psychological Stressors Up Type 1 Diabetes Risk in Kids

Miriam E Tucker

April 10, 2015

Psychologically stressful life events can raise the risk for developing type 1 diabetes (T1D) in children, a new study finds.

Maria Nygren, a PhD student at Linköping University, Sweden, and colleagues published the results of the study online April 9 in Diabetologia.

Previous studies that have identified a link between stressful events and type 1 diabetes onset were retrospective and potentially suffered from recall bias, the authors say.

"For the first time, this unbiased prospective study shows that the experience of serious life events increases the risk for T1D. Our results gives us strong reason to believe that psychological stress can play a part somewhere in the immunological process leading to the onset of type 1 diabetes," Ms Nygren told Medscape Medical News.

She noted that the results represent "one new piece of the answer" to the question, "What environmental factors that together with genetics may cause type 1 diabetes?"

While there are no direct clinical implications, she said the findings are "more of a reminder of the importance to give support to children who have experienced traumatic life events, not only for mental-health reasons, but also to reduce risk of disease."

However, the authors caution that heredity is still a stronger risk factor for the development of type 1 diabetes than is psychological stress. And, Ms Nygren told Medscape Medical News, "Even though we found an increase in risk, the absolute risk [of developing] type 1 diabetes is still small."

An Independent Risk Factor

The findings come from the All Babies in Southeast Sweden study, aimed at determining environmental factors associated with obesity and both type 1 and type 2 diabetes in children.

Researchers invited 10,495 families with infants born between October 1997 and September 1999 in Southeast Sweden to participate in the study. The questionnaires were repeated at four time points in conjunction with clinic visits until the children reached 14 years of age.

Parents were asked about psychological stress in the family and whether any serious, stressful, or negative life events such as death of a relative, parental divorce, parental loss of a job, or serious accidents had occurred since birth or since the time of the previous questionnaire.

Over the course of the study, 58 of the children were diagnosed with type 1 diabetes. After adjustment for heredity — defined as at least one close family member with type 1 diabetes — and age at study entry, there was a threefold increased risk for developing type 1 diabetes for the children who had experienced a stressful life event compared with those who had not. After adjustment for body mass index, the risk was fivefold greater.

In their discussion, the authors note that the risk associated with serious life events appears to be comparable to that of other identified T1D risk factors such as infant nutrition factors and enterovirus infection. However, they emphasize, "When comparing single risk factors, heredity is still much more important. In our study sample, the increase in risk for a child from a family in which another first-degree member has type 1 diabetes (hazard ratio 12) is about four times higher than the increase in risk associated with [a serious life event]."

The Role of Stress

One possible mechanism for the association of psychological stress with T1D is that it may increase levels of cortisol, which promote insulin resistance. In addition, stress might promote immune responses that could act against the pancreatic beta cells, the authors say.

Ms Nygren told Medscape Medical News that stress might represent one of many tie-ins between genetics and environment in the etiology of T1D, noting that although heredity is the single highest risk factor for T1D, most children who develop T1D don't have close family members with the condition.

And on the flip side, between 30% and 40% of the population has the high-risk HLA gene profile associated with T1D, yet less than 1% with the genes actually develop the condition. "Then, it is most logical to believe there are environmental factors that trigger the beta-cell destruction to begin and proceed. One such factor may be psychological stress, maybe in combination with other factors….Future research should investigate more in detail where in the process stress may be important and if other environmental factors interact with stress."

The current study was funded by the Swedish Research Council and the Swedish Child Diabetes Foundation. The All Babies in Southeast Sweden study is also supported by the JDRF Wallenberg Foundation, Medical Research Council of Southeast Sweden, and the Swedish Council for Working Life and Social Research. The authors have no relevant financial relationships.

Diabetologia. Published online April 9, 1015. Article


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