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Endocrinology and Type 1 Diabetes

What is Type 1 diabetes?

Type 1 diabetes mellitus has been referred to as insulin-dependent diabetes mellitus or juvenile-onset diabetes, because most children with diabetes have Type 1 diabetes mellitus. However, many cases occur in adults as well.

Type 1 diabetes is an autoimmune disease, in which the body's white blood cells kill the islet cells that make insulin in the pancreas. This destruction leaves people with high blood sugar. Consequently, they must depend on insulin injections for their survival. Diabetes imposes great hardships on patients and their families and costs billions of dollars for the management of the disease and the treatment of complications.

Why is Type 1 diabetes an important concern?

Type 1 diabetes mellitus requires the injection of insulin throughout life, daily monitoring of blood sugar (glucose) levels, and adjustments in diet and other aspects of daily living. It also produces many complications, including blindness, vascular disease, kidney failure and peripheral vascular disease, which can decrease circulation and sometimes require the amputation of limbs. . In addition, a person with Type 1diabetes can experience life-threatening reactions to low blood sugar as well as extremely high glucose. As a result, insulin therapy must be rigorously managed.

Who is affected?

About half of patients with Type 1 diabetes develop the disease before age 18. At least one in every 300 children in the United States develops this disease. In addition, as many as 10 percent of the people diagnosed with Type 2 diabetes (adult-onset, non-insulin-dependent diabetes mellitus) actually have Type 1 diabetes.

What is the role of endocrinology?

Endocrinologists treat diabetes with diet and medications, which may include insulin. In addition, they work with patients on diabetes management to optimize glucose control and monitor for complications of diabetes.

Immunologic and endocrine research on Type 1 diabetes is entering an exciting phase due to several recent advances. The search for a cure for diabetes is linked to understanding the disease's cause and prevention.

A landmark clinical study, called the Diabetes Control and Complications Trial, showed that very careful control of blood sugars with insulin significantly reduced the complications of Type 1 diabetes. These unprecedented results offer new hope for individuals with diabetes. Type 1 diabetes is becoming the focus of efforts to define the genetic and triggering factors for the large group of autoimmune disorders. Two excellent animal models have been found.

Recently, it has become possible to predict who will develop diabetes. Clinical trials are beginning to determine possible ways of preventing the disease, including the use of low-dose insulin therapy or immunosuppressive drugs.

Researchers are currently defining the genes that make a person susceptible to Type 1 diabetes. They are also studying islet cells, which are the cells that secrete insulin, as well as some of the molecular targets by which these cells are damaged.

In small-scale trials, researchers are attempting to transplant islet cells, which will allow a person with diabetes to have normal insulin secretion. In addition, researchers are looking at genetic engineering, devices that continuously monitor blood sugar as well as other devices that deliver insulin to the body to mimic the function of a normal pancreas.

Patients with Type 1 diabetes and their relatives can experience other autoimmune illnesses such as celiac disease, low or overactive thyroid, and adrenal disease. Tests are now available to help diagnose these other illnesses, which often are readily treated. Doctors who suspect that a patient has diabetes are now able to perform tests to diagnose and subsequently treat these disorders.

Source: The Endocrine Society

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