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Is Type 1 diabetes linked to lower exposure to bacteria in early life?

23 Mar, 13 | by Dr Dean Jenkins

One of the posters at the Society for Endocrinology 2013 conference in Harrogate was from a team in Malta who claimed Type 1 diabetes is related to reduced exposure to bacteria in early life [1]. They pulled together three sources of data the WHO DiaMond Project (reported cases of Type 1 diabetes), the WHO estimates of mortality, and the Alexander Project [2] (antimicrobial susceptibility). The Society for Endocrinology also published a press release from the conference.

In their abstract the authors concluded:

“We found a negative correlation between country incidence of T1DM and its mortality from infectious diseases. Mortality from infectious diseases is a strong marker of the total infective burden. Incidence of T1DM was found to be positively correlated with the susceptibility of S. pneumoniae to all antibiotics studi Increased antibiotic susceptibility of a given organism may be an indirect marker of a low degree of exposure of the community to it. Our results provide support for the hygiene hypothesis, namely that diminished bacterial exposure in early post-natal life results in increased risk of developing T1DM.”

Whilst there is not a great deal that can be extrapolated from this abstract – which has the potential of compounding the errors of observation within the three different surveys – it is, perhaps, a signal worthy of further study. The hygiene hypothesis has a long history and seeks to explain the higher incidence of Type 1 diabetes where societies have lost their ‘old friends’ – co-evolutionary organisms – and their immune systems develop abnormal responses. [3]


1. Abela A-G, Fava S. Association of the incidence of type 1 diabetes with markers of infection and antibiotic susceptibility at country level. Presented at Society for Endocrinology BES 2013, Harrogate, UK. Endocrine Abstracts (2013) 31 P223 | DOI:10.1530/endoabs.31.P223. Available from:

2. Felmingham D, White AR, Jacobs MR, Appelbaum PC, Poupard J, Miller LA, Grüneberg RN. The Alexander Project: the benefits from a decade of surveillance. J. Antimicrob. Chemother. 2005 Oct;56 Suppl 2:ii3–ii21. Available from:

3. Gale, E.A.M. Hygiene hypothesis [internet]. 2012 [cited 2013 Mar 23]; Diapedia 21040851207 rev. no. 30. Available from:

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