Diabetes mellitus type 1 natural history, complications, and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Vishal Devarkonda, M.B.B.S[2]
Overview
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.
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.[1]
Complications
- Complications for type 1 diabetes include:[2][3][4][5]
Complications of Diabetes | |
---|---|
Acute Complications due to hyperglycemia | |
Microvascular complications | Eye disease
Neuropathy Sensory and motor (mono- and polyneuropathy) and Autonomic neuropathy Nephropathy (albuminuria and declining renal function) |
Macrovascular complications | Coronary heart disease |
Other | Gastrointestinal (gastroparesis, diarrhea)
Genitourinary (uropathy/sexual dysfunction) Cheiroarthropathy (thickened skin and reduced joint mobility) Fatty liver disease Low testosterone in men |
- 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.[6]
- 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. [7]
- Based on a systematic review, type 1 diabetic patients have worse executive function performance, working memory and task switching, compared to the control group.[8]
- 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.[9]
- The followings are some related dermatological consequences of type 1 diabetes:[10]
- 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%.
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.[12]
- When type 1 diabetes mellitus left untreated it can be fetal 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.[13]
- 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.[14]
- The following factors have been related to longer life expectancy in patients with type 1 diabetes:[15]
- 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
References
- ↑ Achenbach P, Bonifacio E, Koczwara K, Ziegler AG (2005). "Natural history of type 1 diabetes". Diabetes. 54 Suppl 2: S25–31. PMID 16306336.
- ↑ "ADA".
- ↑ Type 1 Diabetes mellitus "Dennis Kasper, Anthony Fauci, Stephen Hauser, Dan Longo, J. Larry Jameson, Joseph Loscalzo"Harrison's Principles of Internal Medicine, 19e Accessed on December 27th,2016
- ↑ Type 1 Diabetes mellitus "Dennis Kasper, Anthony Fauci, Stephen Hauser, Dan Longo, J. Larry Jameson, Joseph Loscalzo"Harrison's Principles of Internal Medicine, 19e Accessed on December 27th,2016
- ↑ Teng, Zhi-Pan; Tian, Rui; Xing, Fen-Li; Tang, Hui; Xu, Jin-Jing; Zhang, Bing-Wen; Qi, Jian-Wei (2017). "An association of type 1 diabetes mellitus with auditory dysfunction: A systematic review and meta-analysis". The Laryngoscope. 127 (7): 1689–1697. doi:10.1002/lary.26346. ISSN 0023-852X.
- ↑ Leão, Andreia Araújo Porchat; Fritz, Camilla Kapp; Dias, Marcia Regina Messaggi Gomes; Carvalho, Julienne Angela Ramires; Mascarenhas, Luis Paulo Gomes; Cat, Mônica Nunes Lima; Radominski, Rosana; Nesi-França, Suzana (2020). "Bone mass and dietary intake in children and adolescents with type 1 diabetes mellitus". Journal of Diabetes and its Complications. 34 (6): 107573. doi:10.1016/j.jdiacomp.2020.107573. ISSN 1056-8727.
- ↑ Jabbour, Georges; Henderson, Mélanie; Mathieu, Marie-Eve (2016). "Barriers to Active Lifestyles in Children with Type 1 Diabetes". Canadian Journal of Diabetes. 40 (2): 170–172. doi:10.1016/j.jcjd.2015.12.001. ISSN 1499-2671.
- ↑ Broadley, Melanie M.; White, Melanie J.; Andrew, Brooke (2017). "A Systematic Review and Meta-analysis of Executive Function Performance in Type 1 Diabetes Mellitus". Psychosomatic Medicine. 79 (6): 684–696. doi:10.1097/PSY.0000000000000460. ISSN 0033-3174.
- ↑ Ferguson, S. C.; Blane, A.; Wardlaw, J.; Frier, B. M.; Perros, P.; McCrimmon, R. J.; Deary, I. J. (2005). "Influence of an Early-Onset Age of Type 1 Diabetes on Cerebral Structure and Cognitive Function". Diabetes Care. 28 (6): 1431–1437. doi:10.2337/diacare.28.6.1431. ISSN 0149-5992.
- ↑ Feingold KR, Anawalt B, Boyce A, Chrousos G, de Herder WW, Dungan K; et al. (2000). "Endotext". PMID 29465926.
- ↑ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3987274/. Missing or empty
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(help) - ↑ "Diabetes in control".
- ↑ Zheng, Fanfan; Yan, Li; Yang, Zhenchun; Zhong, Baoliang; Xie, Wuxiang (2018). "HbA1c, diabetes and cognitive decline: the English Longitudinal Study of Ageing". Diabetologia. 61 (4): 839–848. doi:10.1007/s00125-017-4541-7. ISSN 0012-186X.
- ↑ Skrivarhaug, T.; Bangstad, H.-J.; Stene, L. C.; Sandvik, L.; Hanssen, K. F.; Joner, G. (2005). "Long-term mortality in a nationwide cohort of childhood-onset type 1 diabetic patients in Norway". Diabetologia. 49 (2): 298–305. doi:10.1007/s00125-005-0082-6. ISSN 0012-186X.
- ↑ Distiller LA (2014). "Why do some patients with type 1 diabetes live so long?". World J Diabetes. 5 (3): 282–7. doi:10.4239/wjd.v5.i3.282. PMC 4058732. PMID 24936249.