Children with Type 1 Diabetes Face Increased Risk of Acute Leukemia, Study Finds

Finland: Children diagnosed with type 1 diabetes mellitus (T1DM) may face an elevated risk of developing acute leukemia, particularly acute lymphoblastic leukemia (ALL), according to a large population-based study from Finland. The findings, published in the International Journal of Cancer by Julia Ventelä and colleagues from Tampere University, shed light on a potential connection between two serious childhood conditions that share immune and environmental risk factors. Researchers examined nationwide registry data from 1990 to 2019, identifying 1,626 children under the age of 18 with leukemia. Each case was matched with three controls of the same age and sex from the general population. Children with Down syndrome or pancreatitis were excluded to minimize potential confounding factors. Data analysis relied on conditional logistic regression, adjusting for variables such as maternal smoking and birth weight relative to gestational age. Key Findings of the Study Children with type 1 diabetes had a 70% higher likelihood of developing acute leukemia compared to those without diabetes (aOR 1.7). The link was strongest for acute lymphoblastic leukemia (ALL), with an odds ratio of 1.9. Among children aged 10–17 years, the risk of ALL was markedly elevated, showing a five-fold increase (OR 5.4). The sequence of disease onset—whether type 1 diabetes or leukemia occurred first—did not significantly influence the association. While an imprecise link of similar magnitude was noted for acute myeloid leukemia (AML), the clearest evidence pointed to ALL, particularly in adolescents. The researchers emphasized that treatment-related pancreatitis did not account for the co-occurrence, thereby strengthening the case for a common underlying mechanism. The team noted that the etiology of childhood leukemia is still poorly understood. Both leukemia and T1DM have been associated with childhood infection patterns and abnormal immune responses. The current findings support the theory that exposure to common pathogens or dysregulated immunity may contribute to the development of both diseases. However, the authors cautioned about certain limitations. The retrospective design, based on registry data, meant that detailed clinical, genetic, and environmental information was not available. Moreover, data from the Finnish Medical Birth Register were incomplete for children born before 1987, which affected the precision of adjustments for factors such as delivery method and maternal smoking. Additionally, the small number of cases prevented subtype-specific analyses within ALL, such as B-cell or T-cell leukemia. Despite these challenges, the study provides compelling evidence of an association between T1DM and childhood leukemia. The age-related risk patterns suggest that cumulative environmental exposures or immune system maturation could play a role in shaping vulnerability. The authors concluded that further research is needed to unravel the biological pathways linking autoimmune diseases like type 1 diabetes to hematological malignancies. Such insights may eventually improve strategies for prevention and early detection in at-risk children. Reference: Ventelä, J., Pellikka, I., Auvinen, A., Lohi, O., & Nikkilä, A. Childhood acute leukemia and type 1 diabetes in children: A nationwide case–control study. International Journal of Cancer. https://doi.org/10.1002/ijc.70122