Type 1 Diabetes

Excerpt

Type 1 diabetes (T1D) is a condition characterized by the immune-mediated destruction of insulin-producing pancreatic β-cells, leading to absolute insulin deficiency. The metabolic, genetic, and immunogenetic characteristics of T1D are heterogeneous, with age-related differences necessitating a personalized approach for each individual. Underlying genetic risk is present in many individuals with the disease. Hence, the American Diabetes Association (ADA) recommends that first- and second-degree relatives of individuals with T1D be screened and offered T1D autoantibody testing.

Individuals with multiple T1D-related autoantibodies eventually develop clinical disease. The loss of insulin secretion can occur gradually or rapidly. Classic symptoms at the onset include polyuria, polydipsia, and unintentional weight loss, but the clinical presentation varies individually. Adults with new-onset T1D usually present with symptoms similar to those seen in children but may have a more gradual progression.

Diabetic ketoacidosis is more prevalent among young patients with new-onset T1D. Disease-modifying therapy has now been approved in the early preclinical stages of T1D to delay the onset of clinical diabetes. Other immune-modifying therapies to delay disease onset in at-risk patients are also being studied.

Successful T1D management requires an interprofessional approach to patient care. Besides insulin replacement therapy, diabetes self-management education, nutrition support, and effectively recognizing and managing coexisting psychological issues are essential for optimizing T1D outcomes. A collaborative, interprofessional approach is recommended, involving many healthcare professionals, including nurses, dietitian educators, pharmacists, community resources, and specialists as needed, such as podiatrists, mental health professionals, social workers, ophthalmologists, and cardiologists.