Study adds to the growing body of evidence linking diabetes and 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 circulate throughout communities and schools causing upper respiratory symptoms including sneezing, runny nose, body aches, and occasionally fevers.
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.
“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,” said ashraf
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, said Schaffner.
“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.
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.
Parvathy Sukumaran 
