Children attending day care may have a 32% lower risk of developing type 1 diabetes compared to those who do not, according to a new meta-analysis, which suggests an association that may reflect the effects of early microbial exposure on immune development.
The meta-analysis suggests an inverse association between day care attendance and the risk of type 1 diabetes (T1D). This systematic review included 22 observational studies with a total of 100,575 participants, among whom 3,693 were diagnosed with T1D and 96,882 served as controls. Findings indicated that children attending day care had 32% lower odds of developing T1D compared to those who did not attend (odds ratio [OR], 0.68; 95% confidence interval [CI], 0.58-0.79; P < .001), even when adjusted for confounders such as maternal education and family history of diabetes.
The findings, published in JAMA Pediatrics, align with the 'hygiene hypothesis,' which suggests that early microbial exposure may influence immune system development and could be associated with a reduced risk of autoimmune conditions like T1D. Researchers propose that increased microbial contact in day care settings may be associated with immune tolerance, which could correlate with a reduced likelihood of autoimmunity. Subgroup analysis revealed that children entering day care before the age of 2 years were associated with a 33% lower risk of T1D compared with non-attendees (OR, 0.67; 95% CI, 0.51-0.90; P = .01), though differences by age at day care initiation were not statistically significant across all studies.
In a separate analysis of the three cohort studies included, no statistically significant association was observed, with day care attendance conferring a 15% reduced risk (OR, 0.85; 95% CI, 0.59-1.12; P = .37). The retrospective design of most included studies may contribute to potential recall bias, suggesting that further prospective cohort studies could help clarify the association. These findings suggest an association between early social exposures and a reduced risk of T1D, though additional research is recommended to confirm this association and investigate potential mechanisms.
Full disclosures can be found in the published study.
