Children who attend day care less likely to develop type 1 diabetes

Key takeaways:

• Children who went to day care were 32% less likely to develop type 1 diabetes.
• This could be due to increased exposure to microbes at day care, as well as increased physical activity and healthier eating.

Children who attend day care are 32% less likely to develop type 1 diabetes compared with children who do not go to day care, according to a systematic review and meta-analysis published in JAMA Pediatrics.

The researchers believed this is due to children being exposed to more microbes at day care than at home.

“The hygiene hypothesis states that the increased incidence of type 1 diabetes results from low microbial exposure due to increased hygiene,” Susanna Tall, PhD, and colleagues wrote. “Consistent with the hygiene hypothesis, some previous studies revealed a reduced risk of type 1 diabetes in environments with a higher number of social interactions.”

Tall and colleagues performed a systematic review and meta-analysis of 22 observational studies conducted in Asia, Australia, Europe and North America between 1989 and 2022. There were 3,693 participants with type 1 diabetes and 96,882 without who served as controls, according to Tall and colleagues. Most were case-control studies, whereas three were prospective cohort studies.

Compared with the control group, the odds for developing type 1 diabetes were 32% lower for children who attended day care (adjusted OR = 0.68; 95% CI, 0.58-0.79).

In the cohort studies alone, the researchers found a nonsignificant reduced risk for developing diabetes among the participants who attended day care. The researchers wrote that results were similar across all of the studies included in the meta-analysis (P < .001).

“In contrast to our expectations, the association was consistent and equally evident in the group that attended day care at ages 3 to 5 years compared with the group that was assigned to day care at ages 0 to 2 years,” Tall and colleagues wrote.

The researchers provided several possible reasons why day care attendance is associated with lower odds for developing diabetes. First, children who attend day care are exposed to more microbes; they are 2 to 3 times more likely to contract infections than children who do not go to day care, according to Tall and colleagues. Second, children who attend day care tend to get more physical activity, eat more fruits and vegetables and have lower BMI, they wrote.

“These factors, particularly nutrition and physical activity, but also weight gain, have been associated with risk of type 1 diabetes in previous research,” Tall and colleagues wrote.