Written by Kimiko Dunbar
Spoon Feed
Daycare attendance is associated with a decreased risk of type 1 diabetes.
Why germs are good for you
Type 1 diabetes (TID) is the most common serious chronic disease of childhood outside of allergies and asthma. Previous studies have shown an inverse relationship between daycare attendance and risk of TID, using daycare as a proxy for “social mixing” and exposure to microbes. This systematic review and meta-analysis examined the association between daycare attendance and the risk of TID across 22 observational studies (n=100,575; 3,693 T1D cases). Daycare attendance was associated with a 32% lower risk of T1D (OR 0.68, 95%CI 0.58-0.79; p<0.001). The effect was consistent across studies, supporting the hygiene hypothesis that increased microbial exposure may reduce autoimmune triggers. Findings suggest early social interactions may have protective immunological effects against T1D. Conclusions are limited by inclusion of studies that didn’t report important confounders, such as socioeconomic status and family history (among others) that are well known to contribute to risk of type 1 diabetes.
How will this change my practice?
I’m not sure how much this will change my practice directly, as I don’t typically “prescribe” daycare. Further, while there is certainly an association between daycare and decreased risk of type 1 diabetes, variation in daycare exposure and other potential confounders, such as family hx of T1D, are hard to overlook. That said, discussing risks and benefits of daycare is somewhat common. With daycare used as a proxy for microbe exposure in these studies, other types of social interactions could be discussed with parents as well. This could be encouraging for parents feeling the reality of the back to back illness for daycare kids.
Source
Day Care Attendance and Risk of Type 1 Diabetes: A Meta-Analysis and Systematic Review. JAMA Pediatr. 2024 Dec 1;178(12):1290-1297. doi: 10.1001/jamapediatrics.2024.4361. PMID: 39495535
