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March 1, 2002

Research: Causes and Prevention

Question from Bristol, England:

What are the causes of diabetes other than the metabolic ones (i.e., obesity)? Can where I live affect the likelihood of getting diabetes?


There are a great many causes of diabetes and you can get an idea of the complexity by looking at Diagnosis and Classification of Diabetes Mellitus: New Criteria. However, in the end, all forms are due either to a direct insufficiency of insulin or to some factor which interferes with the ability of insulin to act normally. There is also a genetic component and an environmental one that is needed for the full clinical picture to develop.

In England, the most common form in young people is type�1 which is nearly always due to a disorder of the immune system which destroys the insulin producing cells in the pancreas. In middle-aged and older people, there is a less well understood genetic component, but a clear environmental one related to lack of physical activity and being overweight. Both genetic and environmental factors are involved in whether your chances of getting diabetes are related to where you live. In Europe, for example, the incidence of type 1 diabetes is twice as high in Finland and Sardinia as it is in England and significantly higher in Scotland than in England. All of these places have a much higher incidence than China.

In the case of type 2 diabetes, lifestyle seems to play a larger part then genetics. Pacific Cook Islanders have a low incidence of type 2 diabetes at home in Rara Tonga, but when they emigrate to New Zealand, as many do, they are far more likely to get diabetes. Likewise, circumpolar peoples have very little type 2 diabetes in their usual habitat, but it rises steeply when they move to an urban setting. Local changes in where you live (e.g., from Bristol to London) do not seem to affect the likelihood of getting any form of diabetes.