Understanding Genetic Vs. Lifestyle Factors In Childhood Diabetes

Raising a child with diabetes is not an easy task for parents. Popularly known as juvenile diabetes or childhood-onset diabetes, it is a condition where the body produces little to no insulin, a hormone that controls blood sugar levels. Diabetes is a metabolic disorder and has become one of the fastest-growing lifelong chronic diseases worldwide. At one time, it used to be a concern for adults only, but with the changing lifestyle and genetic factors, it is now a severe condition in children also.

As this year, Diabetes Day and Children’s Day coincide, we bring a topic that is important, relevant, and requires attention in lieu of the increasing incidences of childhood diabetes across the globe.

The question of which factor, among genetics and lifestyle, is the major cause for both Type 1 and Type 2 diabetes keeps many in a dilemma. To understand this, we spoke to Dr Ravi Malik, Director, Malik Radix Healthcare in Delhi.

Diabetes In Children

As mentioned in a study published in the JAMA Network Journal, in 2019, India received the highest number of childhood diabetes cases (43,932) and deaths (625) in the world. This includes both Type 1 and Type 2 diabetes.

Type 1 Diabetes (T1D) is an autoimmune condition where the body’s immune system attacks and destroys insulin-producing beta cells in the pancreas. Type 2 Diabetes (T2D) in children is a complex, multifactorial condition resulting from the interplay of a strong genetic predisposition and environmental/lifestyle factors.

Children are at risk of both Type 1 and Type 2 diabetes, and in both cases, the risk factors vary on a case-by-case basis. Both genetics and lifestyle play a vital role in diabetes, but have different degrees of influence.

According to Dr Ravi Malik, “Genetics plays the primary role in T1D, particularly for children. On the other hand, strong genetic predisposition and significant lifestyle factors interact to cause T2D.

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Genetics Vs Lifestyle Factor In Childhood Diabetes

In Type 1 Diabetes, Genetic Factors are the primary cause, taking precedence over lifestyle conditions. It is a crucial component and accounts for approximately 50% of the risk. Dr Mailk shared, “The major susceptibility genes are in the Human Leukocyte Antigen (HLA) complex, which accounts for 30 to 50% of the total genetic risk. Over sixty other gene variations have been identified, each with smaller effects, which contribute to overall risk.” Here is the role of Genetics and the lifestyle factors explained by Dr Mailk:

Type 1 Diabetes In Children

• Family history significantly increases the diabetes risk. Dr Mailk stated that having a parent or sibling with T1D raises the risk from a general population rate of about 0.4% to 5 to 10%.
• Potential triggers under investigation include viral infections (mumps, enteroviruses), early diet (lack of exclusive breastfeeding), and environmental toxins.
• The increasing incidence of T1D worldwide suggests a role for changing environmental factors.
• Identical twins have a concordance rate of around 50% (increasing to 65% over a lifetime), indicating that genetics are very important but not the sole factor in childhood diabetes.
• T1D is not caused by diet or lifestyle choices. However, environmental triggers are believed to initiate the autoimmune process in genetically susceptible individuals. The increasing incidence of T1D worldwide suggests a role for changing environmental factors.
• Potential lifestyle triggers include viral infections such as mumps, enteroviruses, early diet such as lack of exclusive breastfeeding, and consuming environmental toxins in any way.

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Type 2 Diabetes In Children

• As mentioned by Dr Mailk, an individual has a 40% lifetime risk if one parent has T2D, and up to a 70% risk if both parents are affected.
• Numerous genetic variants have been identified that increase susceptibility by affecting beta-cell function or insulin sensitivity, and among them, the TCF7L2 variant is considered the strongest risk factor.
• A smaller percentage of cases are also due to highly penetrant single-gene mutations causing monogenic diabetes (MODY), which is often misdiagnosed as T1D or T2D.
• When it comes to lifestyle factors, obesity is the most significant risk factor for the onset of T2D in children.
• Physical inactivity and a diet high in saturated fats, refined grains, and sugar-sweetened beverages significantly increase risk.
• A few other factors include maternal diabetes during pregnancy, low or high birth weight, sedentary behaviours such as excessive TV watching, and poor sleep patterns.

Bottomline

The cases of childhood diabetes have not only become common in India, but the severity of the cases has also increased. Diabetes not only causes blindness, kidney failure, but it also raises the risk of heart attacks, stroke, and lower limb amputation. When it comes to genetics vs lifestyle factors, for Type 1 diabetes, genetics plays the major role, but in Type 2 diabetes, both play an equal role in redirecting the risk of various diseases and determining long-term health conditions.