Diabetes mellitus type 1 overview

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Diabetes mellitus type 1 Microchapters

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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

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History and Symptoms

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Laboratory Findings

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Case #1

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Diabetes mellitus type 1
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Differential Diagnosis

Complications

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Priyamvada Singh, M.B.B.S. [2]; Cafer Zorkun, M.D., Ph.D. [3]Vishal Devarkonda, M.B.B.S[4]

Overview

Diabetes mellitus type 1 is a metabolic disorder that is primarily characterized by deficiency in insulin. Type 1 DM has 2 forms of presentations 1) Classic new onset, which commonly present with persistent thirst, frequent urination, and dehydration 2) Diabetic ketoacidosis, which commonly presents with abdominal pain, vomiting and flu-like symptoms. Patients with classic onset presentation of type 1 DM are usually well appearing. Whereas type 1 DM patients presenting with diabetic ketoacidosis is usually remarkable for tachycardia, tachypnea (kussumal breathing) and dehydration. Type 1 diabetes is characterized by an absolute insulin deficiency. For these patients, a basal-bolus regimen with a long-acting analog and a short- or rapid-acting insulin analog is the most physiologic insulin regimen and the best option for optimal glycemic control.

Historical Perspective

Term "diabetes" was first described in the literature by a Egyptian scientist Eberes papyrus in 1500 BC. Discovery of insulin by Friedrick Banting in 1921-22, was considered as an important landmark in understanding the nature of disease.

Classification

American Diabetic Association(ADA), classifies type 1 DM based on etiology into 1) Immune mediated and 2) Idiopathic

Pathophysiology

Type 1 diabetes is a disorder characterized by abnormally high blood sugar levels.Type 1 DM is the result of interactions of geneticenvironmental, and immunologic factors that ultimately lead to the destruction of the pancreatic beta cells and insulin deficiency.

Causes

There are no established causes for type 1 DM. Studies have found that cause of Type 1 DM is the result of interactions of geneticenvironmental, and immunologic factors.

Differentiating Diabetes Mellitus Type 1 from other Diseases

Type 1 DM must be differentiated from type 2 DM, MODY-DM, psychogenic polydipsia, diabetes insipidus, transient hyperglycemia, steroid therapy, renal tubular acidosis type-1, glucagonoma, cushing's syndrome, and hypothyroidism.

Epidemiology and Demographics

Epidemiology and demographics of type 1 DM varies with geography, agerace and genetic susceptibility.

Risk Factors

Risk factors for type 1 DM include family history, genetics, geography, congenital rubella infection, maternal entero-viral infection, cesarean infection, higher birth weight, older maternal age, low maternal intake of vegetables, enteroviral infection, frequent respiratory or enteric infections, early exposure to cereals, root vegetables, eggs and cow's milk, infant weight gain, persistent or recurrent entero-viral infections, overweight or increased height velocity, high glycemic load, fructose intake, dietary nitrates or nitrosamines, puberty, psychological stress and low vitamin D levels.

Screening

According to the American Diabetic Association, screening for type 1 DM is not recommended.[1]

Natural History, Complications and Prognosis

If left untreated, patients with [type 1 DM] may progress to develop complications of the hyperglycemia state, which commonly include diabetes ketoacidosis and hyperglycemia hyperosmolar state. Prognosis is generally good with compliance with medications.

Diagnosis

The diagnosis of type 1 DM is based on the ADA criteria, which include FPG ≥126 mg/dL (7.0 mmol/L), or 2-h PG ≥200 mg/dL (11.1 mmol/L) during an OGTT, or A1C ≥6.5% (48 mmol/mol), or classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose ≥200 mg/dL (11.1 mmol/L).

History and Symptoms

Type 1 DM has 2 forms of presentations 1) Classic new onset, which commonly present with persistent thirst, frequent urination, and dehydration 2) Diabetic ketoacidosis, which commonly presents with abdominal pain, vomiting and flu-like symptoms.

Physical Examination

Patients with classic onset presentation of type 1 DM are usually well appearing. Whereas patients with diabetic ketoacidosis present with tachycardia, tachypnea (kussumal breathing) and dehydration.

Laboratory Findings

Laboratory findings consistent with the diagnosis of type 1 DM include FPG ≥126 mg/dL (7.0 mmol/L), or 2-h PG ≥200 mg/dL (11.1 mmol/L) during an OGTT, or A1C ≥6.5% (48 mmol/mol), or classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose ≥200 mg/dL (11.1 mmol/L).

Treatment

Medical Therapy

Type 1 diabetes is characterized by an absolute insulin deficiency. For these patients, a basal-bolus regimen with a long-acting analog and a short- or rapid-acting insulin analog is the most physiologic insulin regimen and the best option for optimal glycemic control.

Surgery

Surgery is not the first-line treatment option for patients with type 1 DM. β-Cell replacement therapy is usually reserved for patients with either who have an indication for kidney transplantation and are poorly controlled with large glycemic excursions or in patients who already received a kidney transplant.

Primary Prevention

Currently there are no primary preventive measures available for type 1 DM. However, there are clinical trials ongoing that aim to find methods of preventing or slowing its development.

Secondary Prevention

Secondary prevention strategies following type 1 diabetes mellitus include: maintain optimal glycemic control, life style modifications, and monitoring for micro and macrovascular complications.

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Future research mainly focuses of artificial pancreas, beta cell replacement, smart insulin, and gene therapy.

Case Studies

Case #1

References



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