Type 1 diabetes mellitus (T1DM) is an autoimmune disease that causes the destruction of insulin-producing beta cells in the pancreas. As a result of this process, insulin levels in the body are significantly reduced, which leads to impaired glucose metabolism and increased glucose levels in the blood. T1DM most often develops in childhood or adolescence, but its signs can also appear in adults. The main symptoms include frequent urination, thirst, slight weight loss, and fatigue. Type 1 diabetes requires lifelong insulin therapy and careful monitoring of blood glucose levels to reduce the risk of complications that can arise from uncontrolled disease.
History of the disease and interesting historical facts
The history of diabetes mellitus goes back more than 2000 years. The first description of diabetes was made in the works of Hippocrates, who used the term "diabetes", which means "to pass". At that time, there was no clear understanding of the causes of the disease. The first more detailed descriptions of the symptoms were presented in the Middle Ages, but it was only in the 19th century that two main types of diabetes were identified - type 1 diabetes and type 2 diabetes. The discovery of insulin in 1921 by scientists Frederick Banting and Charles Best was a real breakthrough in the treatment of this disease and gave patients with type 1 diabetes the opportunity to lead a normal life. In recent decades, research in the field of genetics, immunology and therapy have led to significant progress in understanding the mechanisms of the disease.
Epidemiology
According to the International Diabetes Federation, there are more than 537 million cases of diabetes registered in the world in 2021. Type 1 diabetes is less common than type 2 diabetes and accounts for about 5-10% of all cases. Epidemiological studies show that the incidence of T1DM has geographic variations. For example, the lowest rates are registered in Asian and South American countries, while the highest number of cases is observed in Scandinavian countries, which is associated with genetic factors and environmental conditions. Every decade, there is an increase in the number of new cases among children and adolescents, which is of concern to specialists and requires the development of comprehensive preventive measures.
Genetic predisposition to this disease
Research shows that genetic predisposition plays a significant role in the development of type 1 diabetes. The main genes involved are located in the major histocompatibility complex (HLA) region on chromosome 6. The HLA-DR3 and HLA-DR4 genotypes are associated with an increased risk of developing type 1 diabetes. In addition, certain mutations in the INS (insulin) and PTPN22 genes may also contribute to the autoimmune process. However, the presence of predisposing genes does not guarantee the development of the disease, since additional factors such as viral infections or environmental exposures are necessary for its occurrence.
Risk factors for the development of this disease
There are several risk factors that may contribute to the development of type 1 diabetes. These include:
- Genetics - having a family history of type 1 diabetes increases the likelihood of developing the disease.
- Viral infections – Certain viruses, such as Epstein-Barr and swine flu, can be triggers for an autoimmune response.
- Environmental factors - exposure to certain toxins may increase the risk of developing T1D.
- Nutrition in early development - there were indications of a possible role for cow's milk proteins and gluten in the pathogenesis of the disease.
- Socioeconomic factors - differences in access to medical care can influence timely examination and diagnosis.
Diagnosis of this disease
Diagnosis of type 1 diabetes is based on clinical and laboratory evaluation. The main symptoms of the disease include:
- Frequent urination.
- Constant thirst.
- A sharp decrease in body weight.
- Fatigue and weakness.
Laboratory tests are central to diagnostics. Key methods include:
- Determination of fasting blood glucose level - a level ≥7.0 mmol/L is considered diagnostic.
- A glucose test 2 hours after a meal - a level ≥11.1 mmol/L also indicates diabetes.
- Determination of glycated hemoglobin (HbA1c) - level ≥6.5% confirms diabetes.
Radiological examinations and other diagnostics may include ultrasound of the pancreas to exclude other pathologies, but they are of limited value in the diagnosis of T1DM itself. Differential diagnosis is necessary to exclude other endocrine diseases such as Cushing's disease or acromegaly.
Treatment
Treatment of type 1 diabetes requires an individual approach and a comprehensive approach. The main method of managing the disease is insulin therapy, which may include:
- Injections of rapid-acting insulin before each meal.
- Use of prolonged (long-acting) insulin to maintain basal insulin levels in the blood.
- Insulin pumps are devices that provide continuous insulin delivery.
Pharmacological treatment may also include the use of adjuvant therapies such as metformin to improve metabolic control. Surgery, particularly pancreas or Langerhans cell transplants, is possible but is used in rare cases where serious complications arise. Other forms of treatment may include the use of newer techniques such as immunotherapy and cell therapies, which are being actively investigated and may change the approach to treatment in the future.
List of medications used to treat this disease
Among the main drugs for the treatment of type 1 diabetes are:
- Rapid-acting insulin (eg, aspart, lispro).
- Long-acting insulin (eg, glargine, detemir).
- Insulin analogues (eg, insulin degludec).
- Metformin - when combined with type 2 diabetes or to improve metabolic control.
- Immunosuppressive drugs - if beta cell transplantation is planned.
Disease monitoring
Monitoring of type 1 diabetes mellitus includes regular measurement of blood glucose levels, which should be done at least 4 times a day. Failure to maintain proper control can lead to short-term and long-term complications, such as diabetic ketosis coma, cardiovascular disease, retinopathy, and neuropathy. The prognosis depends on the level of glucose control, significantly reducing the likelihood of complications and improving the quality of life.
Age-related features of the disease
Type 1 diabetes can manifest itself at any age, but it is most often diagnosed in children and adolescents. In children, the disease may develop suddenly and with pronounced symptoms, while in adults, the symptoms may be less pronounced. In the age group over 30 years, there is a slight increase in the number of cases that require more careful monitoring and examination for concomitant diseases.
Questions and Answers
- What is the main cause of type 1 diabetes? The main cause is the autoimmune destruction of beta cells of the pancreas, which leads to a lack of insulin.
- Can Type 1 Diabetes Be Prevented? It is impossible to prevent T1D, but the risk of its occurrence can be reduced by controlling viral infections and environmental factors.
- How quickly should type 1 diabetes be treated after it is diagnosed? Treatment should begin immediately after diagnosis to prevent complications.
- What to do in case of hypoglycemia? In case of hypoglycemia, it is necessary to take a sweet drink or fast-acting glucose to raise the blood sugar level.
- What glucose level is considered normal for a person with T1D? Glucose levels should be within 4-7 mmol/l on an empty stomach and less than 10 mmol/l 2 hours after eating.
