Diabetes mellitus type 1 natural history, complications, and prognosis

Diabetes mellitus main page
Diabetes mellitus type 1 Microchapters
Home
Patient Information
Overview
Historical Perspective
Pathophysiology
Classification
Causes
Differentiating Diabetes mellitus type 1 from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural history, Complications, and Prognosis
Diagnosis
Diagnostic study of choice
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X-ray
Echocardiography and Ultrasound
CT scan
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Dietary Management
Medical Therapy
Surgery
Strategies for Improving Care
Foundations of Care and Comprehensive Medical Evaluation Diabetes Self-Management, Education, and Support Nutritional Therapy
Glycemic Targets
Approaches to Glycemic Treatment
Cardiovascular Disease and Risk Management Hypertension and Blood Pressure Control Lipid Management Antiplatelet Agents Coronary Heart Disease
Microvascular Complications and Foot Care Diabetic Kidney Disease Diabetic Retinopathy Diabetic Neuropathy Diabetic Footcare
Older Adults with Diabetes
Children and Adolescents with Diabetes Management of Cardiovascular Risk Factors in Children and Adolescents with Diabetes Microvascular Complications in Children and Adolescents with Diabetes
Management of Diabetes in Pregnancy
Diabetes Care in the Hospital Setting
Primary Prevention
Future or Investigational Therapies
Case Studies
Case #1

Diabetes mellitus Main page
Patient Information Type 1 Type 2
Overview
Classification Diabetes mellitus type 1 Diabetes mellitus type 2 Gestational diabetes
Differential Diagnosis
Complications
Screening
Diagnosis
Prevention

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Vishal Devarkonda, M.B.B.S[2]Anahita Deylamsalehi, M.D.[3]

Overview

The symptoms of type 1 diabetes usually develop in the first decade of life, and start with non-specific symptoms of classic new onset type 1 diabetes or acute symptoms with diabetic ketoacidosis. If left untreated, patients with type 1 DM may develop acute complications of the hyperglycemia state, such as diabetes ketoacidosis and hyperglycemia hyperosmolar state. In addition other complications related to microvascular or macrovascular changes, such as retinopathy, autonomic neuropathy, dermatology diseases, coronary heart disease, peripheral arterial disease and macular edema. Prognosis is generally good with compliance with medications.

Natural History, Complications, and Prognosis

Natural History

• The symptoms of type 1 diabetes usually develop in the first decade of life, and start with non-specific symptoms of classic new onset type 1 diabetes or acute symptoms with diabetic ketoacidosis. Without treatment, the patient will develop complications of type 1 diabetes.

Complications

• Complications of type 1 diabetes include:

Complications of Diabetes
Acute Complications due to hyperglycemia	Diabetes ketoacidosis Hyperglycemic hyperosmolar state
Microvascular complications	Eye disease   Retinopathy (nonproliferative/proliferative) Macular edema Neuropathy  Sensory and motor (mono- and polyneuropathy)   and Autonomic neuropathy Nephropathy (albuminuria and declining renal function)
Macrovascular complications	Coronary heart disease Peripheral arterial disease Cerebrovascular disease
Other	Gastrointestinal (gastroparesis, diarrhea) Genitourinary (uropathy/sexual dysfunction) Dermatological complications Infectious complications Cataracts Glaucoma Cheiroarthropathy (thickened skin and reduced joint mobility) Periodontal disease Hearing loss Depression Obstructive sleep apnea Fatty liver disease Hip fracture Osteoporosis Cognitive impairment Dementia Low testosterone in men Dead-in-bed syndrome

• In a control study patients with type 1 diabetes had significantly lower total body bone mineral density (BMD) z-score values. Lower levels of osteocalcin, C-terminal telopeptide, calcium, phosphorus, and magnesium have been found in patients with type 1 diabetes, compared to control group.
• A study demonstrated that children with type 1 diabetes mentioned barriers for physical activity (eg, fear of hypoglycemia, loss of control of diabetes and low fitness). This study report significant improvement with parental support.
• Based on a systematic review, type 1 diabetic patients have worse executive function performance, working memory and task switching, compared to the control group.
• There have been a reported association between early childhood onset of type 1 diabetes mellitus and mild cerebral atrophy and reduced intellectual performance in adulthood.
• The followings are some related dermatological consequences of type 1 diabetes:
  • Scleroderma-like skin changes: Pathogenesis is not fully understood, nevertheless advanced glycosylation end products and sugar alcohols buildup in the upper dermis is believed to effect the strengthening of collagen.
  • Cheiroarthropathy (thickened skin and reduced joint mobility)
  • Scleredema diabeticorum
  • Necrobiosis lipoidica
  • Bullosis diabeticorum
  • Xerosis
  • Eruptive xanthomas: Although xanthomas are routinely related to hypertriglyceridemia, type 1 diabetic patients may develop eruptive xanthomas with normal levels of triglyceride. Prevelance of Eruptive xanthomas in type 1 diabetes is approximately 1%.

Necrobiosis Lipoidica in type 1 diabetes, Case courtesy by Nandini Chatterjee

Prognosis

• Diabetes is a lifelong disease and there is no cure. Tight control of blood glucose can prevent or delay diabetes complications. But these problems can occur, even in people with good diabetes control.
• When type 1 diabetes mellitus left untreated it can be fatal due to complications like diabetic ketoacidosis.
• Prognosis of type 1 diabetes mellitus is effected by factors such as blood glucose concentration, hemoglobin A1c ([[Glycosylated hemoglobin|HbA1c), lipids, blood pressure, and weight.
• There is a direct relationship between hemoglobin A1c level and long-term cognitive decline.
• The most common cause of death among type 1 diabetes mellitus patients under 30 years old is acute metabolic complications, based on a study done on Norwegian patients who were diagnosed between 1973 and 1982.
• The following factors have been related to longer life expectancy in patients with type 1 diabetes:
  • Proper (not necessarily optimal) glycaemic control
  • High HDL-cholesterol levels
  • Low insulin requirements (insulin sensitive)
  • Normal body mass index (BMI)
  • Proper blood pressure control
  • Patients who do not smoke
  • Absence of microalbuminuria after 15-20 years of type 1 diabetes onset
  • Familial history of long life