Enterovirus infection Linked to Increased Risk of Childhood Diabetes

MedicalResearch.com Interview with:
Dr Tsai Chung-Li
Graduate Institute of Biostatistics, College of Management, China
Medical University,Taichung, Taiwan and
Dr. Hsiao-Chuan Lin
Department of Public Health, College of Public Health, and
Department of Pediatrics,
China Medical University, Taichung, Taiwan

Medical Research: What are the main findings of the study?

Response: We conducted a nationwide population-based cohort study that included two groups. Children with enterovirus infection (aged < 18 years) during 2000-2007 were identified and followed up until December 31, 2008 or until first occurrence of type 1 diabetes. The group without enterovirus infection comprised half of all insured children of the same age and without a diagnosis of enterovirus infection. By use of frequency-matching with sex and birth year, children in the group with enterovirus were selected from those eligible. This nationwide retrospective cohort study found:

  • type 1 diabetes is positively correlated with enterovirus infection in patients younger than 18 years.
  • the incidence rate of type 1 diabetes was lower in the non-enterovirus than the¬†enterovirus group (4 vs 6 per 100,000 person-years; incidence rate ratio 1.48 [95% CI 1.19, 1.83]).
  • children that have been infected with enterovirus are 48% more likely to have developed type 1 diabetes.
  • the risk of developing type 1 diabetes is 2.18 times greater among children aged 10 years and older than among those aged younger than 1 year.

Medical Research: What was most surprising about the results?

Response: As this is first epidemiological cohort study examined the association between enterovirus infection and type 1 diabetes, we were unsure as to whether this association remains similar among children with atopic diseases. Specifically we postulated that in atopic groups, deviation of the immune system toward the T helper 2 pathway may confer protective effects that prevent these patients from developing type 1 diabetes (which is a T helper 1 pathway autoactivity disease). Because in our study the sample size for children in atopic groups is much smaller compared with that in non-atopic group and the incidence rate of type 1 diabetes is low, our data did not have enough power to answer this question.

Medical Research:  What should clinicians and patients take away from your report?

Response: The prevention strategy for enterovirus infection should be taken in children who are likely to be exposed to enterovirus agents.

Medical Research: What recommendations do you have for future research as a result of this study?

Response: To provide experimental evidence, a well-run vaccine trial demonstrating whether a reduction in EV infection will lead to lower type 1 diabetes is warranted. In addition, our study have had limited power to detect the association between enterovirus infection and type 1 diabetes in children with atopic diseases. Future studies need to be well-powered to determine this association in children with atopic diseases.


Tsai-Chung Li et al. Enterovirus infection is associated with an increased risk of childhood type 1 diabetes in Taiwan: a nationwide population-based cohort study. Diabetologia, October 2014 DOI: 10.1007/s00125-014-3400-z