Diabetes is a chronic disease that is posing a great challenge to the health services. It is expected that the number of people who have diabetes will increase to approximately 430 million by 2030 worldwide [1] [2] . Kuwait is ranked among the top 10 countries for the high prevalence of diabetes in the world [3] . In 2017, 441.000 cases of diabetes were reported in Kuwait (International Diabetes Federation).

Though genetic susceptibility is undoubtedly important in the development of type 1 diabetes, the majority of the genetically predisposed do not develop the disease, suggesting the presence of some environmental triggers [4] . Role of a strong environmental component in the causation of type 1 diabetes is also suggested by the considerable increase in the incidence of diabetes in recent decades. For instance, the incidence of childhood type 1 diabetes in Australia has been doubled in the last 20 years, with the greatest increase in younger children with lower risk genes [5] . Evidence for most of the putative environmental risk factors proposed, including infections, dietary factors, air pollution, vaccines, the location of residence, family environment, and stress, is inconclusive [6] . However, the literature does support a possible role of environmental chemicals as triggers or accelerators of type 1 diabetes development [7] . It is presently undecided whether environmental factors trigger islet autoimmunity in genetically susceptible subjects, and accelerate the disease progression in islet autoantibody subjects, or both [8] .

Type 2 diabetes is also increasing rapidly globally and is occurring at a younger age, including childhood [9] . There appears to be a complex interplay of genetic and environmental factors in type 2 diabetes. People with a family history of diabetes are likely to have diabetes two to six times more than those without a family history of diabetes [10] - [15] .

Another study suggested a complementary role for behavioral and environmental factors that modulate the genetic susceptibility and diabetes risk [16] . It is, however, usually considered that lifestyle factors, especially nutrition and exercise are of primary importance in the development of type 2 diabetes. Also, some environmental factors, including chemicals, vaccines, and electromagnetic radiation have been studied for a possible role in causation.

The present study was conducted to examine the factors associated with the causation of types 1 and 2 diabetes and its influence on the prevalence of diabetes in Kuwaiti children.

Diabetes is a major public health problem in Kuwait. The incidence of type 1 diabetes in Kuwaiti children of age 0 - 14 years has doubled in the last 2 decades. Further investigation to find out the reasons for this increase is suggested [17] .

In this survey, several factors were measured that might be associated with diabetes. The results of the survey support that along with the hereditary factors; there are some environmental factors that may play a major role in causing diabetes. Factors such as family history, the age of mother, diet were found to be highly associated with both types of diabetes in children.

The major paradigms: genetic risk variants and behavioral/environmental/ lifestyle factors jointly underlie diabetes development [16] . Altobelli et al., investigated the role of genetic and environmental factors that affect the onset of diabetes type 1 in patients < 15 years of age. In all age groups, a significant rising trend was observed for the overall population (3.40%, p < 0.01) and for 5 - 9 yr. olds (5.48%, p < 0.01). Mixed feeding and a family history of diabetes were associated with early onset of diabetes, while multiple bacterial infections contracted before diabetes was associated with a significant delay [18] .

Family history, BMI, and sex are the established risk factors of diabetes. In a study by Channanath, et al., 32% of diabetes patients have a family history of diabetes and/or hypertension [19] . A child with a family history of diabetes is more likely to have type 1 or 2 diabetes. In the present study, type 1 or type 2 diabetes mother had exactly the same chance of having a child with type 1 diabetes, however, if she was type 1 diabetes, there was a greater chance of having a child with type 2 diabetes.

In the current survey, diabetes was also found to be associated with the mother’s age. The research to find the role of maternal age in onset type 1 diabetes in childhood began during 1960s with the analysis of case studies [20] . Recently, this association was studied in cohort studies and has received much attention [20] [21] [22] . However, conflicting results were obtained, and the results are difficult to interpret due to the different sizes and power of the studies and the different ways of reporting the association [22] [23] [24] [25] . According to the analysis of current data, older mothers are significantly more likely to have a child with type 1 diabetes. Cardwell et al. conducted a pooled analysis of 30 observational studies to investigate whether children born to older mothers have an increased risk of type 1 diabetes. Overall, there was a 5% increase in childhood type 1 diabetes odds per 5-year increase in maternal age, but there was heterogeneity among studies. There is nearly 20% difference in the risk of type 1 diabetes, across the maternal age range. Though the evidence was weak but significant linear increase in the risk of childhood type 1 diabetes with maternal age was observed. However, in recent years a very small increase in the incidence of childhood diabetes type 1 could be explained by increases in maternal age [25] . If this were borne out, it could partly explain the rise in type 1 diabetes in some countries given a steady increase in mother’s age when giving birth.

Low physical activity levels, poor diet, and excess body weight are the major contributory factors for type 2 diabetes mellitus in Middle Eastern countries including Kuwait [26] . Eating large portions and frequent eating out is the cause of diabetes in Kuwait. The results of this study indicate that heavy consumption of sweets by the pregnant mother or by the child as a risk factor for type 2 diabetes in the child, and consumption of fried foods or fast foods by the child are risk factors for both type 1 and type 2 diabetes. These risks do not appear to have been previously reported earlier. However, the consensus view appears that sugar and fats act through increasing obesity. The large effect observed of the increase in the prevalence of type 2 diabetes in children with high consumption of nuts is anomalous, since nuts are usually regarded as beneficial in diabetes

A cross-sectional study conducted on all hospital admissions in the Department of Medicine at Al-Sabah Hospital in Kuwait reported diabetes as the principal or secondary diagnosis in 40.6% of hospitalizations [27] . A marked increase in the incidence of diabetes during recent decades also suggest the involvement of environmental factors and, as the peak incidence of diabetes occurs in late childhood; it is thought that the exposures in early life could play an important role [25] [28] . Similarly, the findings from another study showed that environmental factors play an important role in the etiology of type 1 diabetes [29] . In the current study, residence and exposure to certain chemicals were found to be associated with diabetes.

The course metabolic control of diabetes is affected by many factors related to lifestyles such as physical activity and the availability and quality of medical care. The residing place of the patient also matters as it determines the healthcare and specialist availability, therapy, education, and also the degree of patient adherence to medical recommendations [2] . Hospital outpatient preventive and treatment strategies and effective primary care may reduce the burden of diabetes in Kuwait [27] .

The numbers are too small for firm conclusions, but the results suggest the possibility of complex interactions in the causation of both types.

The survey had certain limitations. Firstly, the relatively small sample size that may not be truly representative of the whole population of children with diabetes. Secondly, the presence of unaccounted-for confounding factors. In future, the assessment of a sample that would be a true representative for the population, i.e., examination large group of people with a random selection of subjects suffering from type 1 and type 2 diabetes is advisable.

In Kuwait diabetes is imposing a great burden on health care utilization. Both genetic and environmental factors are associated with diabetes in Kuwait. Type 1 and type 2 diabetes may be more closely connected than generally acknowledged. Among all the factors examined in the survey, family history, mother’s age and diet of mother and a child were the most significant factors associated with the causation of either type 1 or 2 diabetes.

Based on the results of the current survey some considerations may be suggested to reduce the incidence of diabetes in children which include:

- The importance of nutrition for both the pregnant mother and the child in terms of reducing sweets, fried and fast food as much as possible and not over-eating nuts.

- The importance of the mother’s health: if a mother has a chronic illness such as diabetes, heart disease, thyroid disorder, or liver disorder, or if she is overweight, she should consider her health before and during pregnancy, considering the medical and nutritional requirements, besides maintaining healthy body weight.

- A special consideration for the health of the child, especially if he had asthma or acute infection required hospitalization during his first year of life.

- Keep the child participating regularly in some sport activities.

- It is advised to reduce using insecticides in a house and to avoid housing near communication towers or electricity towers.

It is hoped that these results will help to guide health promotion and education on the topic in Kuwait and would promote future research. In order to attain greater success, a more extensive initiative is required, may be in the form of programs, and resources to address the health needs that have been identified in this study.

The research was supported by Kuwait University (Grant Number TT03/16).

The author declares that there is no conflict of interest.

Al-Khamees, N.A. (2018) Factors Associated with Type 1 and Type 2 Diabetes in Infants in Kuwait. Health, 10, 1474-1486. https://doi.org/10.4236/health.2018.1011113