Review of evidence that epidemics of type 1 diabetes and type 2 diabetes/metabolic syndrome are polar opposite responses to iatrogenic inflammation

Curr Diabetes Rev. 2012 Nov;8(6):413-8. doi: 10.2174/157339912803529869.


There is an epidemic in children of metabolic syndrome, obesity, type 2 diabetes and other individual diseases that form the components of metabolic syndrome. Poor diet and low exercise can not explain many facets of the epidemic including the onset in children 6 month of age, the protective effect of obesity on the incidence of type 1 diabetes and the epidemic of type 2 diabetes/metabolic syndrome in grass fed horses. Poor diet and exercise also do not explain the epidemic of type 1 diabetes in children that resembles the epidemic of type 2 diabetes/metabolic syndrome. Several papers have been published to indicate that the epidemics of type 1 and type 2 diabetes/metabolic syndrome in children are linked and are polar opposite responses to iatrogenic inflammation. Several lines of research support this. Data from different races indicates that there is an inverse relationship between developing type 1 diabetes and type 2 diabetes. Races with high risk of developing type 2 diabetes have a decreased risk of developing type 1 diabetes. Data from Italy confirmed an inverse association between obesity and type 1 diabetes. Further studies indicate the inverse relationship between type 1 diabetes and type 2 diabetes/obesity is due to cortisol production. Data indicates those with low cortisol responses have a predilection for type 1 diabetes and other autoimmune disorders following inflammation, while those with high cortisol/ immune suppressive responses develop type 2 diabetes/metabolic syndrome/obesity which resembles a Cushingoid state but are spared in the autoimmune disorders. Japanese children produce much more cortisol following immunization than Caucasian children. The later explains why discontinuation of BCG vaccination was associated with a decrease in type 1 diabetes in European children and a decrease in type 2 diabetes in Japanese children. Both the epidemics of type 1 diabetes and metabolic syndrome correlate with an increase in immunization. Finally, there is a strong mechanism data that macrophage produced interleukin 1, tumor necrosis factor and interleukin 6, which are released following inflammation, causing destruction of insulin secreting islet cells and increase cortisol release, and thus have the ability to cause both type 1 and type 2 diabetes/metabolic syndrome (which resembles a Cushingoid state). The propensity to develop type 1 diabetes or type 2 diabetes/metabolic syndrome depends on the propensity to release of cortisol which correlates with race.

Publication types

  • Review

MeSH terms

  • Adolescent
  • Adult
  • BCG Vaccine / adverse effects*
  • Child
  • Child, Preschool
  • Diabetes Mellitus, Type 1 / epidemiology
  • Diabetes Mellitus, Type 1 / immunology
  • Diabetes Mellitus, Type 1 / metabolism*
  • Diabetes Mellitus, Type 2 / epidemiology
  • Diabetes Mellitus, Type 2 / immunology
  • Diabetes Mellitus, Type 2 / metabolism*
  • Epidemics
  • Female
  • Humans
  • Hydrocortisone / metabolism*
  • Infant
  • Infant, Newborn
  • Inflammation / epidemiology
  • Inflammation / metabolism*
  • Inflammation Mediators / blood
  • Interleukin-1 / metabolism
  • Interleukin-6 / metabolism
  • Italy / epidemiology
  • Japan / epidemiology
  • Male
  • Metabolic Syndrome / epidemiology
  • Metabolic Syndrome / immunology
  • Metabolic Syndrome / metabolism*
  • Obesity / epidemiology
  • Obesity / metabolism*
  • Tumor Necrosis Factor-alpha / metabolism


  • BCG Vaccine
  • Inflammation Mediators
  • Interleukin-1
  • Interleukin-6
  • Tumor Necrosis Factor-alpha
  • Hydrocortisone