Diabetes Mellitus: Is it Type 1 or Type 2? It May Not Be So Easy
Pp. 102-113 (12)
Jason C. Baker
Type 1 diabetes arises from the autoimmune-mediated destruction of the
pancreatic beta cells leading to a state of insulin deficiency. Type 1 diabetes is
estimated to represent 5-10% of all the cases of diabetes, with an incidence that is rising
across the globe at a rate of 3-5% annually. The cause of type 1 diabetes is uncertain,
although it is believed that both a genetic predisposition and an environmental trigger(s)
are necessary for the development of the disease. Treatment of type 1 diabetes requires
insulin therapy, along with healthy diet and exercise habits. The amylin analogue
Symlin is also approved for use in conjunction with insulin, and metformin and incretin
mimetics are also being investigated. Insulin use requires close monitoring of blood
sugar levels, with studies indicating that the best control in type 1 diabetes is seen in
patients who monitor their blood sugar more frequently. Potential complications from
type 1 diabetes include microvascular, macrovascular and psychological complications.
Such complications are more severe in resource poor populations, often located in the
developing world, which have inadequate access to consistent insulin and testing
supplies. With adequate management of glucose levels, many such complications can
be prevented. There is currently no cure for type 1 diabetes, although immunotherapy
agents (including anti-CD3 mAb, CTLA-4 Ig, and anti-DC20) hold promise.
Transplantation, including that of the whole pancreas, islet cells or stem cells, holds
promise but issues exist with all modalities, which limits the cohort of patients for
whom they may be appropriate.
Behavior, blood glucose, diabetes, endocrinology, exercise, fatty
liver, fitness, global health, health status, insulin resistance, lifestyle,
macrovascular disease, microvascular disease, nephropathy, nutrition, obesity,
overweight, pancreas, retinopathy, risk, weight, wellness.
Weill Cornell Medical Associates. 211 E 80th St, New York, NY 10075, USA.