A systematic review and meta-analysis found that attending kindergarten is associated with a reduced risk of developing type 1 diabetes. As reported in JAMA Pediatrics, the risk was reduced by 32 percent.
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, which produce insulin. It's likely that diabetes will not develop without an external trigger that initiates an autoimmune reaction. While the autoimmune pathophysiology of type 1 diabetes is well understood, the nature of the environmental factors that trigger 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. Preschool provides social interactions during early childhood, when the immune system is developing. Previous analyses have shown a link between preschool attendance and a reduced risk of diabetes. However, several new studies have since been published on this connection.
A research team led by Susanna Tall from the University of Helsinki conducted a systematic review and meta-analysis of studies examining 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 revealed 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 to 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 suggest that exposure to microbial exposure 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 discussed how a group of children can behave like a liquid when freely moving on a playground, meaning their behavior is subject to the laws of thermodynamics.
