Association of the incidence of type 1 diabetes with markers of infection and antibiotic susceptibility at country level
Alexia-Giovanna Abela1,2 & Stephen Fava1,2
Aim: To investigate the association between country incidence of type one diabetes (T1DM) and mortality from infectious disease as well as to antibiotic susceptibility
Materials and methods: An ecological study correlating data from the WHO DiaMond Project for the incidence of T1DM, the WHO estimates of mortality (2004) from communicable diseases and the Alexander Project for bacterial susceptibility to antimicrobial agents.
Results: There were statistically significant negative correlations between the incidence of T1DM and mortality from: infections and parasitic diseases (r=−0.34, P=0.01), respiratory infections (r=−0.29, P=0.03), tuberculosis (r=−0.36, P=0.007), diarrhoeal diseases (r=−0.32, P=0.02) and total infectious disease mortality (r=−0.35, P=0.008). There was a positive correlation between T1DM incidence and susceptibility of Streptococcus pneumoniae to penicillin (r=0.47, P=0.03), erythromycin (r=0.52, P=0.014), doxycycline (r=0.65, P≤0.002) and co-trimoxazole (r=0.58, P=0.007). We also found a positive correlation between T1DM incidence and the mean susceptibility (r=0.62, P=0.004), and lowest antibiotic susceptibility (r=0.73, P≤0.0001) of S. pneumonia.
Conclusion: 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 studied. 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.