Diabetes mellitus type 1 overview

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Case #1

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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

Term Diabetes was first decribed in the literature by an Egyptian scientist Eberes papyrus in 1500BC. Discovery of insuliniby Friedrick Banting, in 1921-22, was considered as an important landmark in understanding the nature of disease.Type 1 diabetes is a disorder characterized by abnormally high blood sugar levels.Type 1 DM is the result of interactions of genetic, environmental, and immunologic factors that ultimately lead to the destruction of the pancreatic beta cells and insulin deficiency. American Diabetic Association(ADA), classifies type 1 DM based on etiology into 1) Immune mediated and 2) Idiopathic. The exact cause of type 1 DM remains unknown. Studies have found that cause of Type 1 DM is the result of interactions of genetic, environmental, and immunologic factors.The exact cause of type 1 DM remains unknown. Epidemiology and demographics of type 1 DM varies with geography, age, race and genetic susceptibility. Risk factors for type 1 DM include family history, genetics, geography, congential 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. According to the American Diabetic Association, screening for type 1 DM is not recommended. 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. 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). 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. The international guidelines recommend for patient's based approach (individualization) of insulin therapy and dietary regimen in type 1 diabetes. 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 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. There is currently no preventive measure that can be taken against type 1 diabetes.

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

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Electrocardiogram

Chest X Ray

CT

MRI

Echocardiography or Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

References

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