A systematic review and meta-analysis found that attending daycare was associated with a reduced risk of developing type 1 diabetes, with the risk being reduced by 32 percent, as reported in JAMA Pediatrics.
Over the past 30 years, diabetes has become more common in children. Type 1 diabetes is considered the most common chronic disease in children (after allergies and asthma). As the disease progresses, the immune system destroys the beta cells of the pancreas that produce insulin. It is likely that without an external trigger that starts an autoimmune reaction, diabetes will not develop. And while the autoimmune pathophysiology of type 1 diabetes has been studied quite well, the nature of the environmental factors that provoke it remains poorly understood.
One hypothesis is that the predisposition to developing type 1 diabetes is due to low levels of microbiological exposure due to high levels of excessive sanitation. It is believed that exposure to various microbes early in life activates regulatory pathways in the immune system. This process may prevent the development of autoimmune diseases associated with type 1 diabetes. Child care provides social interactions in early childhood, when the immune system is developing. Previous analyses have shown a link between child care attendance and a reduced risk of developing diabetes. However, several new studies have since been published on this link.
A research team led by Susanna Tall from the University of Helsinki conducted a systematic review and meta-analysis of studies that examined the association between kindergarten attendance and the development of type 1 diabetes in children. The analysis included data from 22 observational studies involving 100,575 participants. Of these, 3,693 children had type 1 diabetes. The analysis included articles published between 1989 and 2022 in Asia, Australia, Europe, and North America. Three studies were prospective cohort studies, and 19 were case-control studies.
The analysis showed evidence of an inverse association between kindergarten attendance and the likelihood of developing type 1 diabetes. The risk of developing type 1 diabetes was 32 percent lower in children who attended kindergarten compared with the control group (relative risk 0.68; p < 0.001 adjusted for all available confounders). However, there was significant heterogeneity of results between the included studies (p for heterogeneity < 0.001; I2 = 58 percent). However, the researchers conclude that kindergarten attendance is associated with a reduced risk of developing type 1 diabetes. Potentially, these data indicate that exposure to microbial influences in kindergarten may play an important role in the pathogenesis of type 1 diabetes. Further prospective cohort studies are needed to confirm this association. Children are monitored not only by pediatricians, but also by physicists. The latter are interested in the process of movement in groups of children. We recently reported that a group of children can behave like a liquid when moving freely on a playground, that is, their behavior is subject to the laws of thermodynamics.