Chapter 6

Diabetes Mellitus: Is it Type 1 or Type 2? It May Not Be So Easy

Jason C. Baker

Abstract

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.

Total Pages: 102-113 (12)

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