Diabetes Mellitus, Type 1

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DESCRIPTION

  • Type 1 diabetes mellitus (T1DM) is a chronic disease caused by insulin deficiency following autoimmune β-cell destruction.
  • Three stages have been described:
    • 1: positive autoantibodies with normoglycemia
    • 2: positive autoantibodies with glucose intolerance
    • 3: positive autoantibodies with overt diabetes (autoantibodies may disappear over time) (1)[C]
  • The velocity of presentation depends on the rate of β-cell destruction.
  • System(s) affected: endocrine, cardiovascular, nervous, renal, ocular

EPIDEMIOLOGY

  • T1DM accounts for 5–10% of all cases of diabetes.
  • T1DM can occur at any age (incidence peaks in puberty and early adulthood).

Incidence

  • In the United States, incidence is 23.6/100,000 in non-Hispanic white children and adolescents.

Prevalence

  • Global prevalence is 5.9 per 10,000 people (2)[C].

ETIOLOGY AND PATHOPHYSIOLOGY

There are two main categories of T1DM (3)[C].

  • Immune-mediated diabetes (90–95% of cases)
  • Idiopathic diabetes: classic T1DM presentation with no evidence of autoimmunity

Genetics

  • T1DM has strong HLA associations, with linkage to the DQB1 and DRB1 haplotypes (3)[C].

RISK FACTORS

  • Increased susceptibility to T1DM is inheritable

GENERAL PREVENTION

  • Teplizumab is approved in individuals aged ≥8 years with stage 2 T1DM, to delay the progression to stage 3 (3)[C].

COMMONLY ASSOCIATED CONDITIONS

  • Other autoimmune diseases (thyroid, celiac disease, primary adrenal insufficiency, atrophic gastritis)

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