Type 1 Diabetes

Type 1 Diabetes

Currently, there is no way to prevent type 1 diabetes. There is no effective screening test for type 1 diabetes in people with no symptoms.

To prevent complications of diabetes, visit your healthcare provider or diabetes educator at least four times a year. Talk about any problems you are having.

Stay up-to-date with all of your vaccinations and get flu shot every year in the fall

 

Yesterday, Today and Tomorrow

 

Yesterday

In the 1950’s about one in five people died within twenty years after a diagnosis of type 1 in diabetes. One in three people died within twenty-five years of diagnosis.

About one in four people developed kidney failure within twenty-five years of a type 1 diabetes diagnosis. Doctors could not detect early kidney disease and had no tools for slowing its progression to kidney failure. Survival after kidney failure was poor, with one of ten patients dying each year.

About 90% of people with type 1 diabetes developed diabetic retinopathy within twenty-five years of diagnosis. Blindness from diabetic retinopathy was responsible for about 12 percent of new cases of blindness between ages of forty-five and seventy-four.

Studies had not proven the value of laser surgery in reducing blindness.

Major birth defects in the offspring of mothers with type 1 diabetes were three times higher than in the general population.

Patients relied on injections of animal-derived insulin. The insulin pump would soon be introduced but would not become widely used for years.

Studies had not yet shown the need for intensive glucose control to delay or prevent the debilitating eye, nerve, kidney, heart, and blood vessel complications of diabetes. Also, the importance of blood pressure control in preventing complications had not been developed yet.

Researchers had just discovered autoimmunity as the underlying cause of type 1 diabetes.

 

Today

The long-term survival of those with type 1 diabetes has dramatically improved in the last thirty years. For people born between 1975 and 1980, about 3.5 percent die within twenty years of diagnosis, and 7 percent die within twenty-five years of diagnosis. These death rates are much lower than those of patients born in the 1950s, but are still significantly increased compared to the general population.

After twenty years of annual increases from 5 to 10 percent, rates for new kidney failure cases have leveled off. The most encouraging trend is in diabetes, where rates for new cases in whites under age forty are the lowest in twenty years. Improved control of glucose and blood pressure and the use of specific antihypertensive drugs called angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) prevent or delay the progression of kidney disease to kidney failure. With good care, people with good advanced diabetic retinopathy can reduce their risk of blindness by 90percent.

For expectant mothers with type 1 diabetes, tight control of glucose that begins before conception lowers the risk of birth defects, miscarriage, and newborn death to a range that is close to that of the general population.

Patients use genetically engineered human insulin in a variety of formulations, e.g., rapid-acting, intermediate-acting, and long-acting insulin, to control their blood glucose. Insulin pumps are widely used, and inhaled insulin is available. Components of an artificial pancreas are being in clinical studies.

A major clinical trial, the Diabetes Control and Complication Trial (DCCT), showed that intensive glucose control dramatically delays or prevent the eye, nerve, and kidney complications of type 1 diabetes. A paradigm shift in the way type 1 diabetes is controlled was based on this finding. As researchers continued to follow study participants, they found that tight glucose control also prevent or delays the cardiovascular complications of type 1 diabetes, such as heart attack and stroke.

The DCCT and its follow-up study also showed that recurrent episodes of low blood sugar (hypoglycemia) do not affect patients’ long term cognitive function and do not result in long-term damage to patients’ brains.

Patients can regularly monitor their blood glucose with precise, less painful methods, including a continuous glucose monitor. The widely used hemoglobin A1c test (HbA1c) shows average blood glucose over the past three months. The HbA1c Standardization Program  has enabled the translation of tight blood glucose control into common practice.

In addition to identifying a key gene region that contributes nearly half the increased risk of developing type 1 diabetes, scientist have identified other genes associated with  susceptibility to developing the disease. With new technologies and biosample collections, we are poised to discover additional genes and gene regions associated with type 1 diabetes.

Researchers have learned a great deal about the underlying biology of autoimmune diabetes and can now predict who is at high, moderate, and low risk for developing type 1 diabetes. This knowledge and recent advances immunology have enabled researchers to design studies that seek to prevent type 1 diabetes and to preserve insulin production in newly diagnosed patients. This new understanding has prevented life-threatening complications in clinical trial participants at risk for developing diabetes.

The Search for Diabetes in Youth Study has provided the first national data on prevalence of diabetes in youth: 1 of every 523 youth had physician-diagnosed diabetes in 2001 (both type 1 and type 2 diabetes). Search has also provided the first data on the rate of development of new  cases of childhood diabetes and will continue to monitor trend in the future.

 

 

Tomorrow.

The National Institute of Health (NIH) are poised to make major discoveries in the  prediction of who will develop type 1 diabetes and its complications, to personalize individual treatments , and to use this information to preempt disease onset and development of complications. This knowledge will have a major impact on reducing the human and economic toll of type 1 diabetes.

By finding all the genes and environmental factors (e.g. viruses, toxins, dietary factors) that contribute to type 1 diabetes, researchers will develop ways to safely prevent or reverse the autoimmune destruction of insulin-production cells.

New therapies will preempt the vascular changes in the eye that are currently treated with laser therapy.

Methods for safely imaging the insulin-production beta cells will help scientists better understand the disease process and assess the benefits of treatments and preventions that are under study.

Knowledge about biological pathways regulation development and growth if insulin-production beta cells will help scientist generate beta cells in the lab. This progress may relieve the shortage of beta cells for transplantation and lead to ways to promote beta cell regeneration in people  with type 1 diabetes.

Toxic suppression of the immune system to prevent rejection of transplanted organs and tissues  will be replaced with safer, more targeted methods of immune modulation.

New technologies, such as closed loop system that automatically senses blood glucose and adjust insulin dosage precisely, will become available – allowing patients to more easily control their blood glucose levels and develop fewer complications.

As the molecular pathways by which blood glucose causes cell injury are better understood, scientist will develop medicines that prevent and repair the damage.

Some of the most important progress in type 1 diabetes has been gained from clinical studies in patients with diabetes and those at risk for the disease. To maintain the rapid pace of discovery, it is critical, for individuals to take part in well-designed clinical studies . As one leading researcher put it ,” The patient is the most important member of the search team.”

 

 

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