When 7-year-old Gus Ramsey of Weston, Massachusetts, was found to have type 1 (juvenile) diabetes in September 2007, it seemed mere coincidence that Grayson Welo, age 6 and living around the corner, had been diagnosed with the same disease a few months before. After all, type 1 was considered rare—only about 15,000 new cases were diagnosed annually in the United States at the beginning of the decade, according to the Centers for Disease Control and Prevention (CDC). At least Gus’s parents could be reassured that they lived in a healthy community: Weston, population 11,134, is the wealthiest town in the state, with three golf courses, 13 soccer fields, 19 baseball diamonds, and not a single fast-food restaurant.
Yet two months after Gus’s diagnosis, another child, Natalia Gormley, was found to have the disease on her tenth birthday. She lived on the other side of town. In January 2008 12-year-old Sean Richard was diagnosed. He lived less than a mile away. Then 8-year-old Finn Sullivan became the fifth case of type 1 diabetes diagnosed in Weston in less than a year. He lived on Gus’s block, just six doors down. And the cases kept on coming. Six-year-old Mya Smith, from nearby Wellesley, received the diagnosis in April. On June 15 came the jaw-dropper, when Walker Allen was diagnosed. His father, basketball star Ray Allen, scored 26 points two nights later in game six of the NBA Finals to give the Celtics their first championship in 22 years. Far more notable was Walker’s age: just 17 months.
Weston’s school nurses had never seen anything like it. There were now eight children attending Weston public schools who had type 1 diabetes, including those who had been diagnosed in previous years. That number did not even include the local kids who were too young for school, who went to private school, or who lived just over the town line. By comparison, between 1978 and 1996, the nurses could not recall there ever being more than one or two diabetic children in the 2,300-student public school system. Some years there had been none. Type 1 diabetes, after all, was supposed to be really rare.
The next month, Ann Marie Kreft (Gus’s mother), her husband, and another parent published a letter in The Boston Globe to share their concerns about the seeming cluster of type 1 diabetes in their community. “Something’s not right here,” they wrote. “The lack of a national or even statewide diabetes registry complicates monitoring efforts, and we know little about what causes type 1 diabetes. But we do know that this many diagnoses, in this tight proximity in this short period, are way out of the norm.”
Apparently the norm no longer holds. Over the next year and a half, the number of cases in the Weston-Wellesley cluster would more than double, hitting at least 18 in December 2009. Even more troubling was the discovery that the situation was not only a local phenomenon. The rising rate of adult, or type 2, diabetes is familiar and well documented, but just recently scientists have begun to realize that type 1 diabetes rates are soaring as well—around the country and around the world. Millions of children may now be at risk. And nobody knows why.
Whether type 1 or type 2, diabetes occurs when levels of glucose in the blood climb too high. The basic building block of carbohydrates, glucose is our body’s primary fuel; it is what gives muscles the energy to move. But before glucose can be tapped, it must be ushered into cells with the help of insulin, a hormone produced in the pancreas. When insulin concentrations are too low or when our cells resist its action, excess glucose is left floating around in the blood. The result is diabetes, a dangerous, lifelong, and costly disease.
Diabetes triples the risk of heart disease, doubles the risk of depression, causes kidney disease in one-third of patients, and results in advanced retinopathy—bleeding in the retina that damages vision—in up to 30 percent of cases.
Although they share a name, the two types of diabetes occur and progress in distinct ways. People with type 2 diabetes can usually control it initially with diet, exercise, and glucose-lowering medication, but those with type 1 need to begin insulin injections immediately—a particularly tough blow when the patient is a child. Because insulin injections are a blunt instrument for controlling blood-glucose levels, people treated with insulin face an ever-present risk of severe hypoglycemia, a drop in their glucose level so severe it can cause coma or death. Even when diabetes is kept in check, sufferers must grapple with near-daily fluctuations of glucose levels in the blood. Mild dips make them feel temporarily anxious and confused. Slight bumps leave them fatigued. For parents of young children, the constant risks and inevitable highs and lows are an endless source of worry and guilt.
Another difference is that type 2 typically begins later in life, usually in people who are overweight, when the body begins requiring higher and higher levels of insulin to maintain normal blood-glucose levels. For them, the loss of insulin-producing beta cells in their pancreas tends to be gradual, a result of overworking the cells. Type 1 develops in childhood, adolescence, or early adulthood, when the body’s own immune system attacks the insulin-producing cells in the pancreas, wiping them out in a relatively quick time.
Type 2 nips, hyena-like, at the heels of the poor more often than the rich, the old more often than the young, the obese more often than the fit. Type 1 diabetes is more audacious, striking out at the young and those seemingly in the pink of health. Given the epidemic of obesity, it is no surprise that type 2 diabetes should be exploding. The surge of type 1 is more unsettling, and seemingly inexplicable.
Nonetheless, a large and growing body of scientific literature documents that the dramatic rise in type 1 diabetes is real and global. Back in 1890, the U.S. annual death rate due to diabetes for children under age 15 was 1.3 per 100,000. (Because juvenile diabetes in those days was invariably fatal, the death rate is considered more or less equal to the rate of all new cases.) In Denmark, the annual rate was fairly similar (about 2 per 100,000) at the beginning of the 20th century. From that baseline, things took off. As a 2002 paper in Diabetes states: “The best evidence available suggests that childhood diabetes showed a stable and relatively low incidence over the first half of the 20th century, followed by a clear increase that began at some time around or soon after the middle of the century.”
By the mid-1980s, the yearly incidence had jumped to 14.8 per 100,000 children through age 17 in Colorado, one of the few states then collecting good data. In 2007 the CDC estimated that the yearly incidence of type 1 in the United States had hit 19 per 100,000. Just two years later, the estimate was revised upward, to 23.6 per 100,000 among non-Hispanic white children. “The incidence of type 1 diabetes in non-Hispanic white youth in the U.S. is one of the highest in the world,” researchers concluded in a 2009 study. The reported national rates were 68 percent higher than those recorded in Colorado in the 1980s and more than twice as high as reported in Philadelphia in the late 1990s, the study notes.
The same trend has been seen on every continent, including Europe, where a paper published last year in The Lancet concluded that the number of new cases of type 1 diabetes, as measured in 17 countries there, was growing at a rate of 0.6 percent to 9.3 percent per year between 1989 and 2003. The same study, known as Eurodiab, projected that by the year 2020 the annual incidence of type 1 would double overall among European children under age 5.
“It seems the trend we’re seeing in the United States today is similar to what has been reported in Europe and worldwide, about a 3 percent increase annually in the incidence of type 1,” says Pina Imperatore, the epidemiology team leader in the diabetes division at the CDC.