powerpoint presentation on type 1 diabetes

This comprehensive slide deck of ADA's 2023 Standards of Care contains content created, reviewed, and approved by the American Diabetes Association. You are free to use the slides in presentations without further permission as long as the slide content is not altered in any way and appropriate attribution is made to the American Diabetes Association (the Association name and logo on the slides constitutes appropriate attribution).

Permission is required from the Association for any commercial use or for reproduction in any print materials (contact [email protected] ).

Using the links to the slide deck will download the deck. You may need to check the folder for downloaded documents on your device to see/open the file.

Ohio State nav bar

The Ohio State University

BuckeyeLink
Find People
Search Ohio State

Pathophysiology and Clinical Presentation

Pathophysiology:

Type 1 Diabetes Mellitus is a syndrome characterized by hyperglycemia and insulin deficiency resulting from the loss of beta cells in pancreatic islets (Mapes & Faulds, 2014). Nonimmune (type 1B diabetes), occurs secondary to other diseases and is much less common than autoimmune (type 1A). The destruction of beta cells in Type 1A diabetes results from the interaction of both genetic and environmental factors. Although the genetic susceptibility is not well understood, type 1 diabetes is most strongly associated with major histocompatibility complex (MHC), specifically histocompatibility leukocyte antigen (HLA) class II alleles (HLA-DQ and HLA-DR) (McCance & Heuther, 2014). Type 1 diabetes is less hereditary than type 2 but 7-13% of patients also have a first degree relative with type 1 diabetes (Mapes & Faulds, 2014). Environmental factors include viral infections (especially enteroviruses), exposure to infectious microorganisms (such as Helicobacter pylori ), exposure to cow’s milk proteins and a lack of vitamin D (McCance & Heuther, 2014).

The destruction of insulin-producing beta cells in the pancreas starts with the formation of autoantigens. These autoantigens are ingested by antigen-presenting cells which activate T helper 1 (Th1) and T helper 2 (Th2) lmphocytes. Activated Th1 lymphocytes secrete interluekin-2 (IL-2) and interferon. IL-2 activates autoantigen-specific T cytotoxic lymphocytes which destroy islet cells through the secretion of toxic perforins and granzymes. Interferon activates macrophages and stimulates the release of inflammatory cytokines (including IL-1 and tumor necrosis factor [TNF]) which further destroy beta cells (McCance & Heuther, 2014). Activated Th2 lymphocytes produce IL-4 which stimulates B lymphocytes to proliferate and produce islet cell autoantibodies (ICAs) and anti-glutamic acid decarboxylase (antiGAD65) antibodies. AntiGAD65 is an enzyme that helps control the release of insulin from beta cells and can be used to determine the cause of diabetes (McCance & Heuther, 2014). Insulin autoantibodies [IAAs]) and zinc transporter 8 (Znt8) protein are also associated with type 1 diabetes mellitus. Despite it’s complicated pathophysiology, it is important to understand the destruction of beta cells in type 1 diabetes because it leads to a lack of insulin and amylin. Without insulin or amylin the body cannot promote glucose disappearance or limit glucose appearance from the bloodstream, respectively, resulting in hyperglycemia (Mapes & Faulds, 2014).

Clinical Presentation:

Type 1 diabetes does not present clinically until 80-90% of the beta cells have been destroyed (McCance & Heuther, 2014). Because insulin stimulates glucose uptake into tissues, stores glycose as glycogen, inhibits glucagon secretion and inhibits glucose production from the liver, the destruction of insulin-producing beta cells causes hyperglycemia (Mapes & Faulds, 2014). Type 1 diabetics may present with abrupt onset of diabetic ketoacidosis, polyuria, polyphagia, polydipsia, or rapid weight loss with marked hyperglycemia (Mapes & Faulds, 2014). To diagnose diabetes, patients must have an A1C level greater than 6.5% percent on two separate tests; the presence of ketones in the urine and/or autoantibodies in the blood can distinguish type 1 from type 2 diabetes (Mayo Clinic, 2014).

2 thoughts on “ Pathophysiology and Clinical Presentation ”

none for now

Auth with social network:

Download presentation

We think you have liked this presentation. If you wish to download it, please recommend it to your friends in any social system. Share buttons are a little bit lower. Thank you!

Presentation is loading. Please wait.

Type 1 Diabetes Mellitus

Published by Kory Willis Modified over 6 years ago

Presentation on theme: "Type 1 Diabetes Mellitus"— Presentation transcript:

Understanding Diabetes. The Pancreas  No longer makes insulin with type 1 diabetes.

Diabetes.  A disease in which the body produces little or no insulin.  Insulin is the hormone that regulates the blood sugar (Glucose) levels in the.

Diabetes Mellitus.

Diabetes. How glucose gets into your body You eat. Glucose from the food gets into your bloodstream. Your pancreas produces a hormone called insulin.

The Disease: Type 1 diabetes is an auto-immune condition in which the immune system is activated to destroy the cells in the pancreas which produce insulin.

COMMON LIFESTYLE DISEASES

Anna Garcia’s Horrible Life

Pediatric Type 1 Diabetes Mellitus

Erica Frost, Katlyn Rhodes Samantha Mallik, Onalee Neff.

Fall  There are two types of diabetes ◦ Type 1 and 2  Blood sugar is involved  Insulin is involved  You might need to take your blood sugar.

Judith E. Brown Prof. Albia Dugger Miami-Dade College Diabetes Now Unit 13.

Mentoring in Medicine Virtual Camp Final project 22 nd August, 2013 By Poojitha Kolluri.

What is Diabetes? Diabetes is a disease that prevents the body from properly using the energy from the food you eat.

Diabetes and You Vidya Sundaram, MD. Diabetes in Asian Indians The prevalence of diabetes in rural India is 2 percent The prevalence of diabetes in rural.

Diabetes: The Modern Epidemic Roy Buchinsky, MD Director of Wellness.

By Nadia Steinbrecher, Sodexo Dietetic Intern 2013

Diabetes and Nutrition By Joshua Sandolo.  What is diabetes?  The different types of diabetes  Blood sugar levels  Nutrition and Diabetes interactions.

What is Sugar? Sugar or glucose, is our bodies main source of energy. Normally, after you eat, your sugar in your blood stream begins to rise. When your.

Diabetes Spring 2014.

DIABETIC TEACHING VERMALYNPAULETTEMICHELLEEDWARD.

About project

Type 1 Diabetes Mellitus Clinical Presentation

Author: Romesh Khardori, MD, PhD, FACP; Chief Editor: George T Griffing, MD more...
Sections Type 1 Diabetes Mellitus
Practice Essentials
Pathophysiology
Epidemiology
Patient Education
Physical Examination
Complications
Laboratory Studies
Tests to Differentiate Type 1 from Type 2 Diabetes
Approach Considerations
Self-Monitoring of Glucose Levels
Continuous Glucose Monitoring
Insulin Therapy
Management of Hypoglycemia
Management of Hyperglycemia
Management of Complications
Glycemic Control During Serious Medical Illness and Surgery
Glycemic Control During Pregnancy
Consultations
Medication Summary
Antidiabetics, Insulins
Antidiabetics, Amylinomimetics
Hypoglycemia Antidotes
Monoclonal Antibodies
Allogeneic Islet Cells
Questions & Answers

The most common symptoms of type 1 diabetes mellitus (DM) are polyuria, polydipsia, and polyphagia, along with lassitude, nausea, and blurred vision, all of which result from the hyperglycemia itself.

Polyuria is caused by osmotic diuresis secondary to hyperglycemia. Severe nocturnal enuresis secondary to polyuria can be an indication of onset of diabetes in young children. Thirst is a response to the hyperosmolar state and dehydration.

Fatigue and weakness may be caused by muscle wasting from the catabolic state of insulin deficiency, hypovolemia, and hypokalemia. Muscle cramps are caused by electrolyte imbalance. Blurred vision results from the effect of the hyperosmolar state on the lens and vitreous humor. Glucose and its metabolites cause osmotic swelling of the lens, altering its normal focal length.

Symptoms at the time of the first clinical presentation can usually be traced back several days to several weeks. However, beta-cell destruction may have started months, or even years, before the onset of clinical symptoms.

The onset of symptomatic disease may be sudden. It is not unusual for patients with type 1 DM to present with diabetic ketoacidosis (DKA), which may occur de novo or secondary to the stress of illness or surgery. An explosive onset of symptoms in a young lean patient with ketoacidosis always has been considered diagnostic of type 1 DM.

Over time, patients with new-onset type 1 DM will lose weight, despite normal or increased appetite, because of depletion of water and a catabolic state with reduced glycogen, proteins, and triglycerides. Weight loss may not occur if treatment is initiated promptly after the onset of the disease.

Gastrointestinal (GI) symptoms of type 1 DM are as follows:

Nausea, abdominal discomfort or pain, and change in bowel movements may accompany acute DKA

Acute fatty liver may lead to distention of the hepatic capsule, causing right upper quadrant pain

Persistent abdominal pain may indicate another serious abdominal cause of DKA (eg, pancreatitis

Chronic GI symptoms in the later stage of DM are caused by visceral autonomic neuropathy

Neuropathy affects up to 50% of patients with type 1 DM, but symptomatic neuropathy is typically a late development, developing after many years of chronic prolonged hyperglycemia. Peripheral neuropathy presents as numbness and tingling in both hands and feet, in a glove-and-stocking pattern; it is bilateral, symmetric, and ascending.

History in patients with established diabetes

It is important to inquire about the type and duration of the patient’s diabetes and about the care the patient is receiving for diabetes. Determination of the type of diabetes is based on history, therapy, and clinical judgment. The chronic complications of diabetes are related to the length of time the patient has had the disease.

Ask about the type of insulin being used, delivery system (pump vs injections), dose, and frequency. Also ask about oral antidiabetic agents, if any. Of course, a full review of all medications and over-the-counter supplements being taken is crucial in the assessment of patients with type 1 DM.

Patients using a pump or a multiple-injection regimen have a basal insulin (taken through the pump or with the injection of a long-acting insulin analogue) and a premeal rapid-acting insulin, the dose of which may be determined as a function of the carbohydrate count plus the correction (to adjust for how high the premeal glucose level is). In these patients, ask about the following:

Basal rates (eg, units per hour by pump, generally 0.4-1.5 U/h, potentially varying on the basis of time of day); the total daily dose as basal insulin is a helpful value to know

Carbohydrate ratio (ie, units of insulin per grams of carbohydrate, generally 1 unit of rapid-acting insulin per 10-15 g carbohydrate)

Correction dose (ie, how far the blood glucose level is expected to decrease per unit of rapid-acting insulin, often 1 U of insulin per 50-mg/dL decrease, though individuals with insulin resistance may need 1 U per 25-mg/dL decrease)

Some patients may be taking premeal pramlintide (an amylin analogue)

A focused diabetes history should also include the following questions:

Is the patient’s diabetes generally well controlled, with near-normal blood glucose levels? (Patients with poorly controlled blood glucose levels heal more slowly and are at increased risk for infection and other complications)

Does the patient have severe hypoglycemic reactions? (If the patient has episodes of severe hypoglycemia and therefore is at risk for losing consciousness, this possibility must be addressed, especially if the patient drives)

Does the patient have diabetic nephropathy that might alter the use of medications or intravenous (IV) radiographic contrast material?

Does the patient have macrovascular disease, such as coronary artery disease (CAD), which should be considered in the emergency department (ED)?

Does the patient self-monitor his or her blood glucose levels? (Note the frequency and range of values at each time of day; an increasing number of patients monitor with continuous sensors)

When was the patient’s hemoglobin A 1c (HbA 1c ) value (an indicator of long-term glucose control) last measured? What was it?

In assessing glycemic exposure of a patient with established type 1 DM, review of self-monitored blood glucose levels is necessary. Ideally, this done by uploading time- and date-stamped levels from the patient’s meter to assure full understanding of the frequency of testing and the actual levels.

Questions regarding hypoglycemia and hyperglycemia

Hypoglycemia and hyperglycemia should be considered. Ask the following questions as needed:

Has the patient experienced recent polyuria, polydipsia, nocturia, or weight loss?

Has the patient had episodes of unexplained hypoglycemia? If so, when, how often, and how does the patient treat these episodes?

Does the patient have hypoglycemia unawareness (ie, does the patient lack the adrenergic warning signs of hypoglycemia)? (Hypoglycemia unawareness indicates an increased risk of subsequent episodes of hypoglycemia)

Questions regarding microvascular complications

Microvascular complications, such as retinopathy and nephropathy, should be considered as well. Ask the following questions as appropriate:

When was the patient’s last dilated eye examination? What were the results?

Does the patient have known kidney disease?

What were the dates and results of the last measurements of urine protein and serum creatinine levels?

Questions regarding macrovascular complications

Macrovascular complications should be explored. Questions should include the following:

Does the patient have hypertension? What medications are taken?

Does the patient have symptoms of claudication or a history of vascular bypass?

Has the patient had a stroke or transient ischemic attack?

What are the patient’s most recent lipid levels?

Is the patient taking lipid-lowering medication?

Questions regarding neuropathy

Potential neuropathy should be taken into account. Ask whether the patient has a history of neuropathy or symptoms of peripheral neuropathy or whether autonomic neuropathy is present (including erectile dysfunction if the patient is a man).

Diabetes-focused examination

A diabetes-focused physical examination includes assessment of vital signs, funduscopic examination, limited vascular and neurologic examinations, and foot examination. Other organ systems should be assessed as indicated by the patient’s clinical situation. A comprehensive examination is not necessary at every visit.

Assessment of vital signs

Patients with established diabetes and autonomic neuropathy may have orthostatic hypotension. Orthostatic vital signs may be useful in assessing volume status and in suggesting the presence of an autonomic neuropathy. Measurement of the pulse is important, in that relative tachycardia is a typical finding in autonomic neuropathy, often preceding the development of orthostatic hypotension. If the respiratory rate and pattern suggest Kussmaul respiration, DKA must be considered immediately, and appropriate tests must be ordered.

Funduscopic examination

The funduscopic examination should include a careful view of the retina. Both the optic disc and the macula should be visualized. If hemorrhages or exudates are seen, the patient should be referred to an ophthalmologist as soon as possible. Examiners who are not ophthalmologists tend to underestimate the severity of retinopathy, which cannot be evaluated accurately unless the patients’ pupils are dilated.

Foot examination

The dorsalis pedis and posterior tibialis pulses should be palpated and their presence or absence noted. This is particularly important in patients who have foot infections: poor lower-extremity blood flow can delay healing and increase the risk of amputation.

Documenting lower-extremity sensory neuropathy is useful in patients who present with foot ulcers because decreased sensation limits the patient’s ability to protect the feet and ankles. If peripheral neuropathy is found, the patient should be made aware that foot care (including daily foot examination) is very important for the prevention of foot ulcers and lower-extremity amputation. (See Diabetic Foot and Diabetic Foot Infections .)

Infections cause considerable morbidity and mortality in patients with diabetes. Infection may precipitate metabolic derangements, and conversely, the metabolic derangements of diabetes may facilitate infection. (See Infections in Patients with Diabetes Mellitus .)

Patients with long-standing diabetes tend to have microvascular and macrovascular disease with resultant poor tissue perfusion and increased risk of infection. The ability of the skin to act as a barrier to infection may be compromised when the diminished sensation of diabetic neuropathy results in unnoticed injury.

Diabetes increases susceptibility to various types of infections. The most common sites are the skin and urinary tract. Dermatologic infections that occur with increased frequency in patients with diabetes include staphylococcal follicular skin infections, superficial fungal infections, cellulitis, erysipelas, and oral or genital candidal infections. Both lower urinary tract infections and acute pyelonephritis are seen with greater frequency.

A few infections, such as malignant otitis externa, rhinocerebral mucormycosis, and emphysematous pyelonephritis, occur almost exclusively in patients with diabetes, though they are fairly rare even in this population. Infections such as staphylococcal sepsis occur more frequently and are more often fatal in patients with diabetes than in others. Infections such as pneumococcal pneumonia affect patients with diabetes and other patients with the same frequency and severity. [ 84 ]

A study reported that out of 178 adult patients hospitalized with coronavirus disease 2019 (COVID-19), at least one underlying condition was found in 89.3%, the most common being hypertension (49.7%), obesity (48.3%), chronic lung disease (34.6%), diabetes mellitus (28.3%), and cardiovascular disease (27.8%). [ 85 ]

According to a report by Stokes et al, out of 287,320 US cases of COVID-19 in which the patient’s underlying health status was known, diabetes was the second most common underlying condition (30%), after cardiovascular disease (32%), which in this study included hypertension. [ 86 , 87 ]

The aforementioned study by Barrera et al found the overall prevalence of diabetes in patients with COVID-19 to be 12%, with the prevalence being 18% in severe COVID-19. [ 63 , 64 ]

In patients with type 1 DM who were diagnosed with COVID-19, a study by Ebekozien et al found that high blood glucose (48.5%), elevated temperature (45.5%), dry cough (39.4%), excess fatigue (33.3%), vomiting (33.3%), shortness of breath (30.3), nausea (30.2%), and body aches/headaches (21.2%) were the most prevalent presenting symptoms reported. Moreover, diabetic ketoacidosis was the most prevalent adverse outcome (45.5%) among these patients. [ 88 , 89 ]

The Centers for Disease Control and Prevention (CDC) includes type 2 DM in the list of conditions that increase the likelihood of severe illness in persons with COVID-19, and type 1 DM in the list of conditions that may increase this likelihood. [ 90 ]

Ophthalmologic complications

Diabetes can affect the lens, vitreous, and retina, causing visual symptoms that may prompt the patient to seek emergency care. Visual blurring may develop acutely as the lens changes shape with marked changes in blood glucose concentrations.

This effect, which is caused by osmotic fluxes of water into and out of the lens, usually occurs as hyperglycemia increases, but it also may be seen when high glucose levels are lowered rapidly. In either case, recovery to baseline visual acuity can take up to a month, and some patients are almost completely unable to read small print or do close work during this period.

Patients with diabetes tend to develop senile cataracts at a younger age than persons without diabetes. Rarely, patients with type 1 DM that is very poorly controlled (eg, those with frequent episodes of DKA) can acutely develop a “snowflake” (or “metabolic”) cataract. Named for their snowflake or flocculent appearance, these cataracts can progress rapidly and create total opacification of the lens within a few days.

Whether diabetes increases the risk of glaucoma remains controversial; epidemiologic studies have yielded conflicting results. [ 91 ] Glaucoma in diabetes relates to the neovascularization of the iris (ie, rubeosis iridis diabetica).

Diabetic retinopathy is the principal ophthalmologic complication of DM. (See Diabetic Retinopathy .) Diabetic retinopathy is the leading cause of blindness in the United States in people younger than 60 years and affects the eyes in the following different ways:

Background retinopathy involves retinal small vessel abnormality leading to hard exudates, hemorrhages, and microaneurysms; it does not affect acuity

Proliferative retinopathy involves extensive proliferation of new retinal small blood vessels; a sudden loss of vision can occur because of vitreous hemorrhage from proliferating new vessels or retinal detachment

Maculopathy involves edema and hard exudate or retinal ischemia; it causes a marked reduction of acuity

Whether patients develop diabetic retinopathy depends on the duration of their diabetes and on the level of glycemic control. [ 92 , 93 , 94 ] The following are the 5 stages in the progression of diabetic retinopathy:

Dilation of the retinal venules and formation of retinal capillary microaneurysms

Increased vascular permeability

Vascular occlusion and retinal ischemia

Proliferation of new blood vessels on the surface of the retina

Hemorrhage and contraction of the fibrovascular proliferation and the vitreous

The first 2 stages of diabetic retinopathy are jointly referred to as background or nonproliferative retinopathy. Initially, the retinal venules dilate, then microaneurysms (tiny red dots on the retina that cause no visual impairment) appear. The microaneurysms or retinal capillaries become more permeable, and hard exudates appear, reflecting leakage of plasma.

Rupture of intraretinal capillaries results in hemorrhage. If a superficial capillary ruptures, a flame-shaped hemorrhage appears. Hard exudates are often found in partial or complete rings (circinate pattern), which usually include multiple microaneurysms. These rings usually mark an area of edematous retina.

The patient may not notice a change in visual acuity unless the center of the macula is involved. Macular edema can cause visual loss; therefore, all patients with suspected macular edema must be referred to an ophthalmologist for evaluation and possible laser therapy. Laser therapy is effective in decreasing macular edema and preserving vision but is less effective in restoring lost vision. (See Macular Edema in Diabetes .)

Preproliferative (stage 3) and proliferative diabetic retinopathy (stages 4 and 5) are the next phases in the progression of the disease. Cotton-wool spots can be seen in preproliferative retinopathy. These represent retinal microinfarcts from capillary occlusion and appear as off-white to gray patches with poorly defined margins.

Proliferative retinopathy is characterized by neovascularization, or the development of networks of fragile new vessels that often are seen on the optic disc or along the main vascular arcades. The vessels undergo cycles of proliferation and regression. During proliferation, fibrous adhesions develop between the vessels and the vitreous. Subsequent contraction of the adhesions can result in traction on the retina and retinal detachment. Contraction also tears the new vessels, which hemorrhage into the vitreous.

Diabetic nephropathy

About 20–30% of patients with type 1 DM develop evidence of nephropathy, [ 95 ] and all patients with diabetes should be considered to have the potential for renal impairment unless proven otherwise. Chronically elevated blood pressure contributes to the decline in renal function. The use of contrast media can precipitate acute renal failure in patients with underlying diabetic nephropathy. Although most recover from contrast medium–induced renal failure within 10 days, some have irreversible renal failure. (See Diabetic Nephropathy .)

Diabetic neuropathy

In the peripheral nerves, diabetes causes peripheral neuropathy. (See Diabetic Lumbosacral Plexopathy and Diabetic Neuropathy .) The 4 types of diabetic neuropathy are as follows:

Peripheral distal symmetrical polyneuropathy, predominantly sensory

Autonomic neuropathy

Proximal painful motor neuropathy

Cranial mononeuropathy (ie, cranial nerve III, IV, or VI)

Of these 4 types, distal symmetric sensorimotor polyneuropathy (in a glove-and-stocking distribution) is the most common. [ 96 ] Besides causing pain in its early stages, this type of neuropathy eventually results in the loss of peripheral sensation. The combination of decreased sensation and peripheral arterial insufficiency often leads to foot ulceration and eventual amputation.

Acute-onset mononeuropathies in diabetes include acute cranial mononeuropathies, mononeuropathy multiplex, focal lesions of the brachial or lumbosacral plexus, and radiculopathies. Of the cranial neuropathies, the third cranial nerve (oculomotor) is most commonly affected, followed by the sixth nerve (abducens) and the fourth nerve (trochlear).

Patients can present with diplopia and eye pain. In diabetic third-nerve palsy, the pupil is usually spared, whereas in third-nerve palsy due to intracranial aneurysm or tumor, the pupil is affected in 80-90% of cases.

It is important to consider nondiabetic causes of cranial nerve palsies, including intracranial tumors, aneurysms, and brainstem stroke. [ 97 ] Therefore, evaluation should include nonenhanced and contrast-enhanced compute4d tomography (CT) or, preferably, magnetic resonance imaging (MRI). Neurologic consultation is recommended. Acute cranial-nerve mononeuropathies usually resolve in 2-9 months. Acute thrombosis or ischemia of the blood vessels supplying the structure involved is thought to cause these neuropathies.

Macrovascular complications

People with diabetes experience accelerated atherosclerosis, affecting the small arteries of the heart, brain, lower extremity, and kidney. Coronary atherosclerosis often occurs at a younger age and is more severe and extensive than in those without diabetes, increasing the risk of ischemic heart disease. Atherosclerosis of the internal carotid and vertebrobasilar arteries and their branches predisposes to cerebral ischemia.

Severe atherosclerosis of the iliofemoral and smaller arteries of the lower legs predisposes to gangrene. Ischemia of a single toe or ischemic areas on the heel are characteristic of diabetic peripheral vascular disease; these result from the involvement of much smaller and more peripheral arteries.

Atherosclerosis of the main renal arteries and their intrarenal branches causes chronic nephron ischemia, which is a significant component of multiple renal lesions in diabetes. However, not all people with type 1 DM are at risk for nephropathy, because there are some polymorphisms in the various factors involved in its pathogenesis, which can modulate the course of this disease from one person to the other.

Risk factors for macrovascular disease

Macrovascular disease is the leading cause of death in patients with diabetes, causing 65-75% of deaths in this group, compared with approximately 35% of deaths in people without diabetes. Diabetes by itself increases the risk of myocardial infarction (MI) 2-fold in men and 4-fold in women, and many patients have other risk factors for MI as well.

The HbA1c value per se, rather than self-reported diabetes status or other established risk factors, robustly predicts MI odds. Each 1% increment in HbA1c independently predicts 19% higher odds for MI. [ 98 ] The risk of stroke in people with diabetes is double that of nondiabetic people, and the risk of peripheral vascular disease is 4 times that of people without diabetes.

Patients with diabetes may have an increased incidence of silent ischemia. [ 99 ] Diastolic dysfunction is common in patients with diabetes and should be considered in patients who have symptoms of congestive heart failure and a normal ejection fraction.

Aathira R, Jain V. Advances in management of type 1 diabetes mellitus. World J Diabetes . 2014 Oct 15. 5 (5):689-96. [QxMD MEDLINE Link] . [Full Text] .

[Guideline] Diagnosis and classification of diabetes mellitus. Diabetes Care . 2010 Jan. 33 Suppl 1:S62-9. [QxMD MEDLINE Link] . [Full Text] .

International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care . 2009 Jul. 32(7):1327-34. [QxMD MEDLINE Link] . [Full Text] .

Vehik K, Beam CA, Mahon JL, et al. Development of Autoantibodies in the TrialNet Natural History Study. Diabetes Care . 2011 Sep. 34(9):1897-1901. [QxMD MEDLINE Link] . [Full Text] .

[Guideline] American Diabetes Association. Standards of medical care in diabetes--2011. Diabetes Care . 2011 Jan. 34 Suppl 1:S11-61. [QxMD MEDLINE Link] . [Full Text] .

Nainggolan L. Continuous Glucose Monitoring: Navigator Beats Rival Devices. Medscape Medical News. January 14, 2013. Available at http://www.medscape.com/viewarticle/777607 . Accessed: January 24, 2013.

Damiano ER, El-Khatib FH, Zheng H, Nathan DM, Russell SJ. A Comparative Effectiveness Analysis of Three Continuous Glucose Monitors. Diabetes Care . 2013 Jan 3. [QxMD MEDLINE Link] .

Tao B, Pietropaolo M, Atkinson M, Schatz D, Taylor D. Estimating the cost of type 1 diabetes in the U.S.: a propensity score matching method. PLoS One . 2010 Jul 9. 5(7):e11501. [QxMD MEDLINE Link] . [Full Text] .

Pilia S, Casini MR, Cambuli VM, et al. Prevalence of Type 1 diabetes autoantibodies (GAD and IA2) in Sardinian children and adolescents with autoimmune thyroiditis. Diabet Med . 2011 Aug. 28(8):896-9. [QxMD MEDLINE Link] .

Philippe MF, Benabadji S, Barbot-Trystram L, et al. Pancreatic volume and endocrine and exocrine functions in patients with diabetes. Pancreas . 2011 Apr. 40(3):359-63. [QxMD MEDLINE Link] .

Noble JA, Valdes AM. Genetics of the HLA region in the prediction of type 1 diabetes. Curr Diab Rep . 2011 Dec. 11(6):533-42. [QxMD MEDLINE Link] . [Full Text] .

Barchetta I, Riccieri V, Vasile M, et al. High prevalence of capillary abnormalities in patients with diabetes and association with retinopathy. Diabet Med . 2011 Sep. 28(9):1039-44. [QxMD MEDLINE Link] .

Young KA, Snell-Bergeon JK, Naik RG, Hokanson JE, Tarullo D, Gottlieb PA, et al. Vitamin D deficiency and coronary artery calcification in subjects with type 1 diabetes. Diabetes Care . 2011 Feb. 34(2):454-8. [QxMD MEDLINE Link] . [Full Text] .

Joergensen C, Hovind P, Schmedes A, Parving HH, Rossing P. Vitamin d levels, microvascular complications, and mortality in type 1 diabetes. Diabetes Care . 2011 May. 34(5):1081-5. [QxMD MEDLINE Link] .

Zhang D, Efendic S, Brismar K, Gu HF. Effects of MCF2L2, ADIPOQ and SOX2 genetic polymorphisms on the development of nephropathy in type 1 Diabetes Mellitus. BMC Med Genet . 2010 Jul 28. 11:116. [QxMD MEDLINE Link] . [Full Text] .

Busko M. Phenomenon of 'double diabetes' common among blacks. Medscape Medical News . April 25, 2013. [Full Text] .

Epstein EJ, Osman JL, Cohen HW, Rajpathak SN, Lewis O, Crandall JP. Use of the Estimated Glucose Disposal Rate (eGDR) as a Measure of Insulin Resistance in an Urban Multiethnic Population With Type 1 Diabetes. Diabetes Care . 2013 Apr 17. [QxMD MEDLINE Link] .

Davies JL, Kawaguchi Y, Bennett ST, Copeman JB, Cordell HJ, Pritchard LE, et al. A genome-wide search for human type 1 diabetes susceptibility genes. Nature . 1994 Sep 8. 371(6493):130-6. [QxMD MEDLINE Link] .

Steck AK, Barriga KJ, Emery LM, Fiallo-Scharer RV, Gottlieb PA, Rewers MJ. Secondary attack rate of type 1 diabetes in Colorado families. Diabetes Care . 2005 Feb. 28(2):296-300. [QxMD MEDLINE Link] .

Redondo MJ, Jeffrey J, Fain PR, Eisenbarth GS, Orban T. Concordance for islet autoimmunity among monozygotic twins. N Engl J Med . 2008 Dec 25. 359(26):2849-50. [QxMD MEDLINE Link] .

Borchers AT, Uibo R, Gershwin ME. The geoepidemiology of type 1 diabetes. Autoimmun Rev . 2010 Mar. 9(5):A355-65. [QxMD MEDLINE Link] .

Diabetes Epidemiology Research International Group. Geographic patterns of childhood insulin-dependent diabetes mellitus. Diabetes Epidemiology Research International Group. Diabetes . 1988 Aug. 37(8):1113-9. [QxMD MEDLINE Link] .

Erlich H, Valdes AM, Noble J, Carlson JA, Varney M, Concannon P, et al. HLA DR-DQ haplotypes and genotypes and type 1 diabetes risk: analysis of the type 1 diabetes genetics consortium families. Diabetes . 2008 Apr. 57(4):1084-92. [QxMD MEDLINE Link] .

Todd JA, Bell JI, McDevitt HO. HLA-DQ beta gene contributes to susceptibility and resistance to insulin-dependent diabetes mellitus. Nature . 1987 Oct 15-21. 329(6140):599-604. [QxMD MEDLINE Link] .

Corper AL, Stratmann T, Apostolopoulos V, Scott CA, Garcia KC, Kang AS, et al. A structural framework for deciphering the link between I-Ag7 and autoimmune diabetes. Science . 2000 Apr 21. 288(5465):505-11. [QxMD MEDLINE Link] .

Noble JA, Johnson J, Lane JA, Valdes AM. Race-specific type 1 diabetes risk of HLA-DR7 haplotypes. Tissue Antigens . 2011 Nov. 78(5):348-51. [QxMD MEDLINE Link] . [Full Text] .

Rotwein P, Yokoyama S, Didier DK, Chirgwin JM. Genetic analysis of the hypervariable region flanking the human insulin gene. Am J Hum Genet . 1986 Sep. 39(3):291-9. [QxMD MEDLINE Link] . [Full Text] .

Pugliese A, Zeller M, Fernandez A Jr, Zalcberg LJ, Bartlett RJ, Ricordi C, et al. The insulin gene is transcribed in the human thymus and transcription levels correlated with allelic variation at the INS VNTR-IDDM2 susceptibility locus for type 1 diabetes. Nat Genet . 1997 Mar. 15(3):293-7. [QxMD MEDLINE Link] .

Polychronakos C, Li Q. Understanding type 1 diabetes through genetics: advances and prospects. Nat Rev Genet . 2011 Oct 18. 12(11):781-92. [QxMD MEDLINE Link] .

Concannon P, Chen WM, Julier C, Morahan G, Akolkar B, Erlich HA, et al. Genome-wide scan for linkage to type 1 diabetes in 2,496 multiplex families from the Type 1 Diabetes Genetics Consortium. Diabetes . 2009 Apr. 58(4):1018-22. [QxMD MEDLINE Link] . [Full Text] .

Yeung WC, Rawlinson WD, Craig ME. Enterovirus infection and type 1 diabetes mellitus: systematic review and meta-analysis of observational molecular studies. BMJ . 2011 Feb 3. 342:d35. [QxMD MEDLINE Link] . [Full Text] .

Paronen J, Knip M, Savilahti E, Virtanen SM, Ilonen J, Akerblom HK, et al. Effect of cow's milk exposure and maternal type 1 diabetes on cellular and humoral immunization to dietary insulin in infants at genetic risk for type 1 diabetes. Finnish Trial to Reduce IDDM in the Genetically at Risk Study Group. Diabetes . 2000 Oct. 49(10):1657-65. [QxMD MEDLINE Link] .

Lempainen J, Tauriainen S, Vaarala O, Mäkelä M, Honkanen H, Marttila J, et al. Interaction of enterovirus infection and cow's milk-based formula nutrition in type 1 diabetes-associated autoimmunity. Diabetes Metab Res Rev . 2012 Feb. 28(2):177-85. [QxMD MEDLINE Link] .

Cardwell CR, Stene LC, Joner G, Bulsara MK, Cinek O, Rosenbauer J, et al. Maternal age at birth and childhood type 1 diabetes: a pooled analysis of 30 observational studies. Diabetes . 2010 Feb. 59(2):486-94. [QxMD MEDLINE Link] . [Full Text] .

Henry EB, Patterson CC, Cardwell CR. A meta-analysis of the association between pre-eclampsia and childhood-onset Type 1 diabetes mellitus. Diabet Med . 2011 Aug. 28(8):900-5. [QxMD MEDLINE Link] .

Simpson M, Brady H, Yin X, et al. No association of vitamin D intake or 25-hydroxyvitamin D levels in childhood with risk of islet autoimmunity and type 1 diabetes: the Diabetes Autoimmunity Study in the Young (DAISY). Diabetologia . 2011 Nov. 54(11):2779-88. [QxMD MEDLINE Link] .

Melville N. Early Upper-Respiratory Infections Linked to Type 1 Diabetes. Medscape Medical News. Available at http://www.medscape.com/viewarticle/807205 . Accessed: July 8, 2013.

Beyerlein A, Wehweck F, Ziegler AG, Pflueger M. Respiratory Infections in Early Life and the Development of Islet Autoimmunity in Children at Increased Type 1 Diabetes Risk: Evidence From the BABYDIET Study. JAMA Pediatr . 2013 Jul 1. [QxMD MEDLINE Link] .

Tucker ME. New Global Registry Investigates COVID-19 and New-Onset Diabetes. Medscape Medical News . 2020 Jun 13. [Full Text] .

Xie Y, Al-Aly Z. Risks and burdens of incident diabetes in long COVID: a cohort study. Lancet Diabetes Endocrinol . 2022 Mar 21. [Full Text] .

Tucker ME. 'Profound Implications': COVID Ups Diabetes Risk 40% a Year Later. Medscape Medical News . 2022 Mar 23. [Full Text] .

Tang X, Uhl S, Zhang T, et al. SARS-CoV-2 infection induces beta cell transdifferentiation. Cell Metab . 2021 May 19. [QxMD MEDLINE Link] . [Full Text] .

Wu CT, Lidsky PV, Xiao Y, et al. SARS-CoV-2 infects human pancreatic β cells and elicits β cell impairment. Cell Metab . 2021 May 18. [QxMD MEDLINE Link] . [Full Text] .

Barrett CE, Koyama AK, Alvarez P, et al. Risk for Newly Diagnosed Diabetes >30 Days After SARS-CoV-2 Infection Among Persons Aged MMWR Morb Mortal Wkly Rep</i>. 2022 Jan 7. 71: [Full Text] .

Tucker ME. COVID-19 Associated With Increased Diabetes Risk in Youth. Medscape Medical News . 2022 Jan 10. [Full Text] .

Kendall EK, Olaker VR, Kaelber DC, Xu R, Davis PB. Association of SARS-CoV-2 Infection With New-Onset Type 1 Diabetes Among Pediatric Patients From 2020 to 2021. JAMA Netw Open . 2022 Sep 1. 5 (9):e2233014. [QxMD MEDLINE Link] . [Full Text] .

Cromer SJ, Colling C, Schatoff D, et al. Newly diagnosed diabetes vs. pre-existing diabetes upon admission for COVID-19: Associated factors, short-term outcomes, and long-term glycemic phenotypes. J Diabetes Complications . 2022 Feb 4. 108145. [QxMD MEDLINE Link] . [Full Text] .

U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, 2011. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. Available at http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf . Accessed: January 28, 2011.

Mayer-Davis EJ, Lawrence JM, Dabelea D, et al. Incidence Trends of Type 1 and Type 2 Diabetes among Youths, 2002-2012. N Engl J Med . 2017 Apr 13. 376 (15):1419-29. [QxMD MEDLINE Link] .

Imkampe AK, Gulliford MC. Trends in Type 1 diabetes incidence in the UK in 0- to 14-year-olds and in 15- to 34-year-olds, 1991-2008. Diabet Med . 2011 Jul. 28(7):811-4. [QxMD MEDLINE Link] .

Tucker ME. IDF Atlas: 1 in 10 Adults Worldwide Now Has Diabetes. Medscape Medical News . 2021 Dec 7. [Full Text] .

Thomas NJ, Jones SE, Weedon MN, Shields BM, Oram RA, Hattersley AT. Frequency and phenotype of type 1 diabetes in the first six decades of life: a cross-sectional, genetically stratified survival analysis from UK Biobank. Lancet Diabetes Endocrinol . 2017 Nov 30. [QxMD MEDLINE Link] . [Full Text] .

Tucker ME. Needle in a Haystack: Type 1 Diabetes Arises Equally in Adulthood. Medscape . 2017 Dec 4. [Full Text] .

Harjutsalo V, Maric C, Forsblom C, et al. Sex-related differences in the long-term risk of microvascular complications by age at onset of type 1 diabetes. Diabetologia . 2011 Aug. 54(8):1992-1999. [QxMD MEDLINE Link] .

Murthy VL, Naya M, Foster CR, Gaber M, Hainer J, Klein J, et al. Association Between Coronary Vascular Dysfunction and Cardiac Mortality in Patients with and without Diabetes Mellitus. Circulation . 2012 Aug 23. [QxMD MEDLINE Link] .

Bode B, Garrett V, Messler J, et al. Glycemic Characteristics and Clinical Outcomes of COVID-19 Patients Hospitalized in the United States. J Diabetes Sci Technol . 2020. [Full Text] .

Tucker ME. Pay Attention to In-Hospital Glucose to Save Lives in COVID-19. Medscape Medical News . 2020 Apr 20. [Full Text] .

Barron E, Bakhai C, Kar P, et al. Associations of type 1 and type 2 diabetes with COVID-19-related mortality in England: a whole-population study. Lancet Diabetes Endocrinol . 2020 Aug 13. [QxMD MEDLINE Link] . [Full Text] .

Tucker ME. Newly Published Articles Inform on COVID-19 Risk by Diabetes Type. Medscape Medical News . 2020 Aug 17. [Full Text] .

Wargny M, Potier L, Gourdy P, et al. Predictors of hospital discharge and mortality in patients with diabetes and COVID-19: updated results from the nationwide CORONADO study. Diabetologia . 2021 Feb 17. [QxMD MEDLINE Link] . [Full Text] .

Davenport L. 1 in 5 Diabetes Patients Hospitalized With COVID-19 Die in 28 Days. Medscape Medical News . 2021 Feb 18. [Full Text] .

Zoler ML. Cleaner data confirm severe COVID-19 link to diabetes, hypertension. MDedge Cardiology News . 2020 Jul 27. [Full Text] .

Barrera FJ, Shekhar S, Wurth R, et al. Prevalence of Diabetes and Hypertension and their Associated Risks for Poor Outcomes in Covid-19 Patients. J Endocr Soc . 2020 Jul 21. [Full Text] .

Holman N, Knighton P, Kar P, et al. Risk factors for COVID-19-related mortality in people with type 1 and type 2 diabetes in England: a population-based cohort study. Lancet Diabetes Endocrinol . 2020 Aug 13. [QxMD MEDLINE Link] . [Full Text] .

Schlesinger S, Neuenschwander M, Lang A, et al. Risk phenotypes of diabetes and association with COVID-19 severity and death: a living systematic review and meta-analysis. Diabetologia . 2021 Apr 28. [QxMD MEDLINE Link] . [Full Text] .

Busko M. Older, Sicker Diabetes Patients Have Worse COVID-19 Prognosis. Medscape Medical News . 2021 Apr 28. [Full Text] .

Vangoitsenhoven R, Martens PJ, van Nes F, et al. No Evidence of Increased Hospitalization Rate for COVID-19 in Community-Dwelling Patients With Type 1 Diabetes. Diabetes Care . 2020 Oct. 43 (10):e118-9. [QxMD MEDLINE Link] . [Full Text] .

Tucker ME. Emerging Data on Type 1 Diabetes and COVID-19 Reassuring. Medscape Medical News . 2020 Oct 9. [Full Text] .

Carrasco-Sanchez FJ, Lopez-Carmona MD, Martinez-Marcos FJ, et al. Admission hyperglycaemia as a predictor of mortality in patients hospitalized with COVID-19 regardless of diabetes status: data from the Spanish SEMI-COVID-19 Registry. Ann Med . 2021 Dec. 53 (1):103-16. [QxMD MEDLINE Link] .

Tucker ME. Blood Glucose on Admission Predicts COVID-19 Severity in All. Medscape Medical News . 2020 Nov 30. [Full Text] .

Klonoff DC, Messler JC, Umpierrez GE, et al. Association Between Achieving Inpatient Glycemic Control and Clinical Outcomes in Hospitalized Patients With COVID-19: A Multicenter, Retrospective Hospital-Based Analysis. Diabetes Care . 2020 Dec 15. [QxMD MEDLINE Link] . [Full Text] .

Harding A. Glycemia in Early COVID-19 Hospitalization Linked to Mortality. Reuters Health Information . 2020 Dec 21. [Full Text] .

Tucker ME. Small-fiber neuropathy common at 40 years of type 1 diabetes. Medscape Medical News . September 18, 2013. [Full Text] .

Sveen KA, Karimé B, Jørum E, Mellgren SI, Fagerland MW, Monnier VM, et al. Small- and Large-Fiber Neuropathy After 40 Years of Type 1 Diabetes: Associations with glycemic control and advanced protein glycation: The Oslo Study. Diabetes Care . 2013 Sep 11. [QxMD MEDLINE Link] .

Finne P, Reunanen A, Stenman S, Groop PH, Grönhagen-Riska C. Incidence of end-stage renal disease in patients with type 1 diabetes. JAMA . 2005 Oct 12. 294(14):1782-7. [QxMD MEDLINE Link] .

Nathan DM, Cleary PA, Backlund JY, Genuth SM, Lachin JM, Orchard TJ, et al. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med . 2005 Dec 22. 353(25):2643-53. [QxMD MEDLINE Link] . [Full Text] .

DCCT/EDIC Research Group, de Boer IH, Sun W, Cleary PA, Lachin JM, Molitch ME, et al. Intensive diabetes therapy and glomerular filtration rate in type 1 diabetes. N Engl J Med . 2011 Dec 22. 365(25):2366-76. [QxMD MEDLINE Link] . [Full Text] .

Harjutsalo V, Forsblom C, Groop PH. Time trends in mortality in patients with type 1 diabetes: nationwide population based cohort study. BMJ . 2011 Sep 8. 343:d5364. [QxMD MEDLINE Link] . [Full Text] .

Purnell JQ, Hokanson JE, Cleary PA, Nathan DM, Lachin JM, Zinman B, et al. The Effect of Excess Weight Gain with Intensive Diabetes Treatment on Cardiovascular Disease Risk Factors and Atherosclerosis in Type 1 Diabetes: Results from the Diabetes Control and Complications Trial / Epidemiology of Diabetes Interventions and Complications Study (DCCT/EDIC) Study. Circulation . 2012 Dec 4. [QxMD MEDLINE Link] .

Zheng F, Yan L, Yang Z, Zhong B, Xie W. HbA 1c , diabetes and cognitive decline: the English Longitudinal Study of Ageing. Diabetologia . 2018 Jan 25. [QxMD MEDLINE Link] . [Full Text] .

Melville NA. HbA1c Levels in Diabetes Linked to Cognitive Decline. Medscape Medical News . 2018 Jan 30. [Full Text] .

Tucker ME. Type 1 Diabetes Raises COVID-19 Risk in Kids if A1c Is High. Medscape Medical News . 2021 Mar 22. [Full Text] .

Joshi N, Caputo GM, Weitekamp MR, Karchmer AW. Infections in patients with diabetes mellitus. N Engl J Med . 1999 Dec 16. 341(25):1906-12. [QxMD MEDLINE Link] .

Garg S, Kim L, Whitaker M, et al. Hospitalization Rates and Characteristics of Patients Hospitalized with Laboratory-Confirmed Coronavirus Disease 2019 — COVID-NET, 14 States, March 1–30, 2020. MMWR . 2020 Apr 8. [Full Text] .

Stokes EK, Zambrano LD, Anderson KN, et al. Coronavirus Disease 2019 Case Surveillance — United States, January 22–May 30, 2020. MMWR Morb Mortal Wkly Rep . 2020 Jun 15. [Full Text] .

Franki R. Comorbidities Increase COVID-19 Deaths by Factor of 12. Medscape Medical News . 2020 Jun 17. [Full Text] .

Ebekozien OA, Noor N, Gallagher MP, Alonso GT. Type 1 Diabetes and COVID-19: Preliminary Findings From a Multicenter Surveillance Study in the U.S. Diabetes Care . 2020 Jun 5. [QxMD MEDLINE Link] . [Full Text] .

Tucker ME. Half of Those With Type 1 Diabetes and COVID-19 Manage at Home. Medscape Medical News . 2020 Jun 11. [Full Text] .

Centers for Disease Control and Prevention. Coronavirus Disease 2019 (COVID-19): People of Any Age with Underlying Medical Conditions. CDC. Available at https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html . Updated June 25, 2020; Accessed: June 27, 2020.

Wong VH, Bui BV, Vingrys AJ. Clinical and experimental links between diabetes and glaucoma. Clin Exp Optom . 2011 Jan. 94(1):4-23. [QxMD MEDLINE Link] .

Gillespie KM. Type 1 diabetes: pathogenesis and prevention. CMAJ . 2006 Jul 18. 175(2):165-70. [QxMD MEDLINE Link] . [Full Text] .

Harris SS. Vitamin D in type 1 diabetes prevention. J Nutr . 2005 Feb. 135(2):323-5. [QxMD MEDLINE Link] .

Hammes HP, Kerner W, Hofer S, et al. Diabetic retinopathy in type 1 diabetes-a contemporary analysis of 8,784 patients. Diabetologia . 2011 Aug. 54(8):1977-1984. [QxMD MEDLINE Link] .

Julius MC, Schatz DA, Silverstein JH. The prevention of type I diabetes mellitus. Pediatr Ann . 1999 Sep. 28(9):585-8. [QxMD MEDLINE Link] .

Vinik AI, Mehrabyan A. Diabetic neuropathies. Med Clin North Am . 2004 Jul. 88(4):947-99, xi. [QxMD MEDLINE Link] .

Chou KL, Galetta SL, Liu GT, Volpe NJ, Bennett JL, Asbury AK, et al. Acute ocular motor mononeuropathies: prospective study of the roles of neuroimaging and clinical assessment. J Neurol Sci . 2004 Apr 15. 219(1-2):35-9. [QxMD MEDLINE Link] .

Gerstein HC, Islam S, Anand S, et al. Dysglycaemia and the risk of acute myocardial infarction in multiple ethnic groups: an analysis of 15,780 patients from the INTERHEART study. Diabetologia . 2010 Dec. 53(12):2509-17. [QxMD MEDLINE Link] .

Falcone C, Nespoli L, Geroldi D, Gazzaruso C, Buzzi MP, Auguadro C, et al. Silent myocardial ischemia in diabetic and nondiabetic patients with coronary artery disease. Int J Cardiol . 2003 Aug. 90(2-3):219-27. [QxMD MEDLINE Link] .

[Guideline] Handelsman Y, Mechanick JI, Blonde L, Grunberger G, Bloomgarden ZT, Bray GA, et al. American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for developing a diabetes mellitus comprehensive care plan. Endocr Pract . 2011 Mar-Apr. 17 Suppl 2:1-53. [QxMD MEDLINE Link] .

[Guideline] Hattersley A, Bruining J, Shield J, Njolstad P, Donaghue KC. The diagnosis and management of monogenic diabetes in children and adolescents. Pediatr Diabetes . 2009 Sep. 10 Suppl 12:33-42. [QxMD MEDLINE Link] .

Hemoglobin A1c and Mean Glucose in Patients With Type 1 Diabetes: Analysis of data from the Juvenile Diabetes Research Foundation continuous glucose monitoring randomized trial. Diabetes Care . 2011 Mar. 34(3):540-4. [QxMD MEDLINE Link] . [Full Text] .

Mianowska B, Fendler W, Szadkowska A, Baranowska A, Grzelak-Agaciak E, Sadon J, et al. HbA(1c) levels in schoolchildren with type 1 diabetes are seasonally variable and dependent on weather conditions. Diabetologia . 2011 Apr. 54(4):749-56. [QxMD MEDLINE Link] . [Full Text] .

Suzuki S, Koga M, Amamiya S, et al. Glycated albumin but not HbA(1c) reflects glycaemic control in patients with neonatal diabetes mellitus. Diabetologia . 2011 Sep. 54(9):2247-53. [QxMD MEDLINE Link] .

Brooks M. Hemoglobin A1c misses many cases of diabetes. Medscape . 2019 Mar 28. [Full Text] .

McDonald TJ, Colclough K, Brown R, et al. Islet autoantibodies can discriminate maturity-onset diabetes of the young (MODY) from Type 1 diabetes. Diabet Med . 2011 Sep. 28(9):1028-33. [QxMD MEDLINE Link] .

[Guideline] Holt RIG, DeVries JH, Hess-Fischl A, et al. The management of type 1 diabetes in adults. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). ADA. Available at https://professional.diabetes.org/sites/professional.diabetes.org/files/media/draft_easdada_t1dm_adults_consensusreport_0.pdf . 2021; Accessed: July 19, 2021.

[Guideline] Tucker ME. ADA/EASD draft guidance aims to bring adults with type 1 diabetes out of shadows. MDedge . 2021 Jul 14. [Full Text] .

[Guideline] Tucker ME. 'Push the Bar Higher': New Statement on Type 1 Diabetes in Adults. Medscape Medical News . 2021 Oct 4. [Full Text] .

[Guideline] Holt RIG, DeVries JH, Hess-Fischl A, et al. The management of type 1 diabetes in adults. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia . 2021 Sep 30. [QxMD MEDLINE Link] . [Full Text] .

[Guideline] Chiang JL, Kirkman MS, Laffel LM, Peters AL. Type 1 Diabetes Through the Life Span: A Position Statement of the American Diabetes Association. Diabetes Care . 2014 Jun 16. [QxMD MEDLINE Link] .

Tucker M. First-Ever ADA Guidance Specifically for Type 1 Diabetes. Medscape Medical news. Available at http://www.medscape.com/viewarticle/826854 . Accessed: June 20, 2014.

Kielgast U, Holst JJ, Madsbad S. Antidiabetic actions of endogenous and exogenous GLP-1 in type 1 diabetic patients with and without residual ß-cell function. Diabetes . 2011 May. 60(5):1599-607. [QxMD MEDLINE Link] .

Lantidra (donislecel) [package insert]. Chicago, IL: CellTrans Inc. June 2023. Available at [Full Text] .

US Food and Drug Administration. FDA Approves First Cellular Therapy to Treat Patients with Type 1 Diabetes. FDA. Available at https://www.fda.gov/news-events/press-announcements/fda-approves-first-cellular-therapy-treat-patients-type-1-diabetes . June 28, 2023; Accessed: July 3, 2023.

[Guideline] American Diabetes Association. Standards of Medical Care in Diabetes-2018 Abridged for Primary Care Providers. Clin Diabetes . 2018 Jan. 36 (1):14-37. [QxMD MEDLINE Link] . [Full Text] .

The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group. N Engl J Med . 1993 Sep 30. 329(14):977-86. [QxMD MEDLINE Link] .

Genuth S. Insights from the diabetes control and complications trial/epidemiology of diabetes interventions and complications study on the use of intensive glycemic treatment to reduce the risk of complications of type 1 diabetes. Endocr Pract . 2006 Jan-Feb. 12 Suppl 1:34-41. [QxMD MEDLINE Link] .

Lind M, Bounias I, Olsson M, et al. Glycaemic control and incidence of heart failure in 20,985 patients with type 1 diabetes: an observational study. Lancet . 2011 Jul 9. 378(9786):140-6. [QxMD MEDLINE Link] .

Tomlin A, Dovey S, Tilyard M. Health outcomes for diabetes patients returning for three annual general practice checks. N Z Med J . 2007 Apr 13. 120(1252):U2493. [QxMD MEDLINE Link] .

Jacobson AM, Ryan CM, Cleary PA, Waberski BH, Weinger K, Musen G, et al. Biomedical risk factors for decreased cognitive functioning in type 1 diabetes: an 18 year follow-up of the Diabetes Control and Complications Trial (DCCT) cohort. Diabetologia . 2011 Feb. 54(2):245-55. [QxMD MEDLINE Link] .

Asvold BO, Sand T, Hestad K, Bjørgaas MR. Cognitive function in type 1 diabetic adults with early exposure to severe hypoglycemia: a 16-year follow-up study. Diabetes Care . 2010 Sep. 33(9):1945-7. [QxMD MEDLINE Link] . [Full Text] .

Sherwood JS, Russell SJ, Putman MS. New and Emerging Technologies in Type 1 Diabetes. Endocrinol Metab Clin North Am . 2020 Dec. 49 (4):667-78. [QxMD MEDLINE Link] . [Full Text] .

Garg SK, Voelmle MK, Beatson CR, et al. Use of Continuous Glucose Monitoring in Subjects With Type 1 Diabetes on Multiple Daily Injections Versus Continuous Subcutaneous Insulin Infusion Therapy: A prospective 6-month study. Diabetes Care . 2011 Mar. 34(3):574-9. [QxMD MEDLINE Link] . [Full Text] .

Battelino T, Phillip M, Bratina N, Nimri R, Oskarsson P, Bolinder J. Effect of continuous glucose monitoring on hypoglycemia in type 1 diabetes. Diabetes Care . 2011 Apr. 34(4):795-800. [QxMD MEDLINE Link] . [Full Text] .

[Guideline] Klonoff DC, Buckingham B, Christiansen JS, et al. Continuous glucose monitoring: an endocrine society clinical practice guideline. J Clin Endocrinol Metab . 2011 Oct. 96(10):2968-79. [QxMD MEDLINE Link] .

[Guideline] Tucker ME. ADA 2018 Standards Address Diabetes Drugs With CV Benefit. Medscape . 2017 Dec 8. [Full Text] .

Medtronic, Inc. Medtronic gains approval of first artificial pancreas device system with threshold suspend automation [press release]. September 27, 2013. Available at http://newsroom.medtronic.com/phoenix.zhtml?c=251324&p=irol-newsArticle&ID=1859361&highlight . Accessed: October 7, 2013.

Tucker ME. FDA OKs insulin pump with low-glucose suspend feature. Medscape Medical News . September 27, 2013. [Full Text] .

Tucker ME. FDA Okays Use of Dexcom G5 CGM for Insulin Dosing. Medscape Medical News . 2016 Dec 20. [Full Text] .

Tucker ME. FDA Approves New 'Smart' Continuous Glucose Monitor for Diabetes. Medscape Medical News . 2018 Mar 13. [Full Text] .

Tucker ME. FDA Approves First Implantable Continuous Glucose Monitor. Medscape Medical News . 2018 Jun 21. [Full Text] .

FDA approves first continuous glucose monitoring system with a fully implantable glucose sensor and compatible mobile app for adults with diabetes. FDA. Available at https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm611454.htm . Jun 21, 2018; Accessed: Jun 25, 2018.

Nelson R, Tucker ME. FDA Approves FreeStyle Libre System for Patients. Medscape Medical News . 2017 Sep 27. [Full Text] .

What is the pancreas? What is an artificial pancreas device system?. US Food and Drug Administration. Available at http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/HomeHealthandConsumer/ConsumerProducts/ArtificialPancreas/ucm259548.htm . May 16, 2016; Accessed: July 6, 2016.

Tucker ME. Coming Soon: 'Artificial Pancreas' Options for Diabetes. Medscape Medical News . June 20, 2016. [Full Text] .

Boggs W. Round-the-Clock Closed-Loop Glucose Control Leads to Better Outcomes. Medscape . May 13, 2016. [Full Text] .

Renard E, Farret A, Kropff J, et al. Day-and-Night Closed-Loop Glucose Control in Patients With Type 1 Diabetes Under Free-Living Conditions: Results of a Single-Arm 1-Month Experience Compared With a Previously Reported Feasibility Study of Evening and Night at Home. Diabetes Care . 2016 Jul. 39 (7):1151-60. [QxMD MEDLINE Link] .

US Food and Drug Administration. FDA approves first automated insulin delivery device for type 1 diabetes. FDA. Available at http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm522974.htm . Sep 28, 2016; Accessed: Sep 30, 2016.

Busko M. FDA Approves Artificial Pancreas for Children With Type 1 Diabetes. Medscape Medical News . 2018 Jun 22. [Full Text] .

US Food and Drug Administration. FDA Approves First-of-its-Kind Automated Insulin Delivery and Monitoring System for Use in Young Pediatric Patients. Available at https://www.fda.gov/news-events/press-announcements/fda-approves-first-its-kind-automated-insulin-delivery-and-monitoring-system-use-young-pediatric . August 31, 2020; Accessed: December 1, 2020.

Tucker M. FDA Approves Inhaled Insulin Afrezza for Diabetes. Medscape Medical News. Available at http://www.medscape.com/viewarticle/827539. . Accessed: July 14, 2014.

Afrezza (insulin inhaled) prescribing information [package insert]. Valencia CA, United States: MannKind Corporation. June, 2014. Available at [Full Text] .

US Food and Drug Administration. Mixups between Insulin U-100 and U-500 (April 2008). FDA Patient Safety News. Available at http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/psn/transcript.cfm?show=79 . Accessed: January 28, 2012.

de la Pena A, Riddle M, Morrow LA, et al. Pharmacokinetics and pharmacodynamics of high-dose human regular u-500 insulin versus human regular u-100 insulin in healthy obese subjects. Diabetes Care . 2011 Dec. 34(12):2496-501. [QxMD MEDLINE Link] . [Full Text] .

Garg S, Ampudia-Blasco FJ, Pfohl M. Rapid-acting insulin analogues in Basal-bolus regimens in type 1 diabetes mellitus. Endocr Pract . 2010 May-Jun. 16(3):486-505. [QxMD MEDLINE Link] .

Fiasp Product Information [package insert]. 800 Scudders Mill Road, Plainsboro, NJ 08536: Novo Nordisk Inc. September 2017. Available at [Full Text] .

Nainggolan L. FDA Approves New Fast-Acting Insulin, Fiasp, for Diabetes in Adults. Medscape Medical News . 2017 Sep 29. [Full Text] .

Blair HA, Keating GM. Insulin Glargine 300 U/mL: A Review in Diabetes Mellitus. Drugs . 2016 Mar. 76 (3):363-74. [QxMD MEDLINE Link] .

Toujeo. US Food and Drug Administration. Available at https://www.accessdata.fda.gov/drugsatfda_docs/label/2018/206538s006lbl.pdf . Accessed: 2018 25 Apr.

Birkeland KI, Home PD, Wendisch U, Ratner RE, Johansen T, Endahl LA, et al. Insulin Degludec in Type 1 Diabetes: A randomized controlled trial of a new-generation ultra-long-acting insulin compared with insulin glargine. Diabetes Care . 2011 Mar. 34(3):661-5. [QxMD MEDLINE Link] . [Full Text] .

Davies MJ, Gross JL, Ono Y, Sasaki T, Bantwal G, Gall MA, et al. Efficacy and safety of insulin degludec given as part of basal-bolus treatment with mealtime insulin aspart in type 1 diabetes: a 26-week randomized, open-label, treat-to-target non-inferiority trial. Diabetes Obes Metab . 2014 Oct. 16 (10):922-30. [QxMD MEDLINE Link] . [Full Text] .

Zinman B, DeVries JH, Bode B, Russell-Jones D, Leiter LA, Moses A, et al. Efficacy and safety of insulin degludec three times a week versus insulin glargine once a day in insulin-naive patients with type 2 diabetes: results of two phase 3, 26 week, randomised, open-label, treat-to-target, non-inferiority trials. Lancet Diabetes Endocrinol . 2013 Oct. 1 (2):123-31. [QxMD MEDLINE Link] .

Nainggolan L. First Launch for Fiasp : 'Ultrafast' Mealtime Insulin Aspart. Medscape . 2017 29 Mar. [Full Text] .

Heise T, Pieber TR. Towards peakless, reproducible and long-acting insulins. An assessment of the basal analogues based on isoglycaemic clamp studies. Diabetes Obes Metab . 2007 Sep. 9(5):648-59. [QxMD MEDLINE Link] .

Suissa S, Azoulay L, Dell'aniello S, et al. Long-term effects of insulin glargine on the risk of breast cancer. Diabetologia . 2011 Sep. 54(9):2254-62. [QxMD MEDLINE Link] .

Johnson JA, Bowker SL, Richardson K, Marra CA. Time-varying incidence of cancer after the onset of type 2 diabetes: evidence of potential detection bias. Diabetologia . 2011 Sep. 54(9):2263-71. [QxMD MEDLINE Link] .

Bao J, Gilbertson HR, Gray R, et al. Improving the Estimation of Mealtime Insulin Dose in Adults With Type 1 Diabetes: The Normal Insulin Demand for Dose Adjustment (NIDDA) study. Diabetes Care . 2011 Oct. 34(10):2146-51. [QxMD MEDLINE Link] . [Full Text] .

Bergenstal RM, Tamborlane WV, Ahmann A, Buse JB, Dailey G, Davis SN, et al. Effectiveness of sensor-augmented insulin-pump therapy in type 1 diabetes. N Engl J Med . 2010 Jul 22. 363(4):311-20. [QxMD MEDLINE Link] .

Busko M. Insulin pump therapy bests injection therapy in large study. Medscape Medical News . August 19, 2013. [Full Text] .

Johnson SR, Cooper MN, Jones TW, Davis EA. Long-term outcome of insulin pump therapy in children with type 1 diabetes assessed in a large population-based case-control study. Diabetologia . 2013 Aug 21. [QxMD MEDLINE Link] . [Full Text] .

King BR, Goss PW, Paterson MA, Crock PA, Anderson DG. Changes in Altitude Cause Unintended Insulin Delivery From Insulin Pumps: Mechanisms and implications. Diabetes Care . 2011 Sep. 34(9):1932-3. [QxMD MEDLINE Link] . [Full Text] .

Grunberger G, Abelseth JM, Bailey TS, Bode BW, Handelsman Y, Hellman R. Consensus statement by the american association of clinical endocrinologists/american college of endocrinology insulin pump management task force. Endocr Pract . 2014 May 1. 20(5):463-89. [QxMD MEDLINE Link] .

Babiker A, Datta V. Lipoatrophy with insulin analogues in type I diabetes. Arch Dis Child . 2011 Jan. 96(1):101-2. [QxMD MEDLINE Link] .

Giménez M, Gilabert R, Monteagudo J, Alonso A, Casamitjana R, Paré C, et al. Repeated episodes of hypoglycemia as a potential aggravating factor for preclinical atherosclerosis in subjects with type 1 diabetes. Diabetes Care . 2011 Jan. 34(1):198-203. [QxMD MEDLINE Link] . [Full Text] .

Asvold BO, Sand T, Hestad KA, Bjorgaas MR. Quantitative EEG in type 1 diabetic adults with childhood exposure to severe hypoglycaemia: a 16 year follow-up study. Diabetologia . 2011 Sep. 54(9):2404-8. [QxMD MEDLINE Link] .

Kacerovsky M, Jones J, Schmid AI, et al. Postprandial and fasting hepatic glucose fluxes in long-standing type 1 diabetes. Diabetes . 2011 Jun. 60(6):1752-8. [QxMD MEDLINE Link] . [Full Text] .

Ahmedani MY, Haque MS, Basit A, Fawwad A, Alvi SF. Ramadan Prospective Diabetes Study: the role of drug dosage and timing alteration, active glucose monitoring and patient education. Diabet Med . 2012 Jun. 29(6):709-15. [QxMD MEDLINE Link] .

Pannu N, Wiebe N, Tonelli M. Prophylaxis strategies for contrast-induced nephropathy. JAMA . 2006 Jun 21. 295(23):2765-79. [QxMD MEDLINE Link] .

Salardi S, Balsamo C, Zucchini S, Maltoni G, Scipione M, Rollo A, et al. High rate of regression from micro-macroalbuminuria to normoalbuminuria in children and adolescents with type 1 diabetes treated or not with enalapril: the influence of HDL cholesterol. Diabetes Care . 2011 Feb. 34(2):424-9. [QxMD MEDLINE Link] . [Full Text] .

de Boer IH, Rue TC, Cleary PA, et al. Long-term Renal Outcomes of Patients With Type 1 Diabetes Mellitus and Microalbuminuria: An Analysis of the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Cohort. Arch Intern Med . 2011 Mar 14. 171(5):412-420. [QxMD MEDLINE Link] . [Full Text] .

Strippoli GF, Bonifati C, Craig M, Navaneethan SD, Craig JC. Angiotensin converting enzyme inhibitors and angiotensin II receptor antagonists for preventing the progression of diabetic kidney disease. Cochrane Database Syst Rev . 2006 Oct 18. CD006257. [QxMD MEDLINE Link] .

Vinik AI, Ziegler D. Diabetic cardiovascular autonomic neuropathy. Circulation . 2007 Jan 23. 115(3):387-97. [QxMD MEDLINE Link] .

Lipsky BA, Berendt AR, Deery HG, Embil JM, Joseph WS, Karchmer AW, et al. Diagnosis and treatment of diabetic foot infections. Clin Infect Dis . 2004 Oct 1. 39(7):885-910. [QxMD MEDLINE Link] .

Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA . 2005 Jan 12. 293(2):217-28. [QxMD MEDLINE Link] .

Buse JB, Ginsberg HN, Bakris GL, Clark NG, Costa F, Eckel R, et al. Primary prevention of cardiovascular diseases in people with diabetes mellitus: a scientific statement from the American Heart Association and the American Diabetes Association. Diabetes Care . 2007 Jan. 30(1):162-72. [QxMD MEDLINE Link] .

Margeirsdottir HD, Stensaeth KH, Larsen JR, Brunborg C, Dahl-Jørgensen K. Early signs of atherosclerosis in diabetic children on intensive insulin treatment: a population-based study. Diabetes Care . 2010 Sep. 33(9):2043-8. [QxMD MEDLINE Link] . [Full Text] .

van Dieren S, Nöthlings U, van der Schouw YT, Spijkerman AM, Rutten GE, van der A DL, et al. Non-fasting lipids and risk of cardiovascular disease in patients with diabetes mellitus. Diabetologia . 2011 Jan. 54(1):73-7. [QxMD MEDLINE Link] . [Full Text] .

Lee SH, Kim JH, Kang MJ, et al. Implications of nocturnal hypertension in children and adolescents with type 1 diabetes. Diabetes Care . 2011 Oct. 34(10):2180-5. [QxMD MEDLINE Link] . [Full Text] .

Leiter LA, Lundman P, da Silva PM, et al. Persistent lipid abnormalities in statin-treated patients with diabetes mellitus in Europe and Canada: results of the Dyslipidaemia International Study. Diabet Med . 2011 Nov. 28(11):1343-1351. [QxMD MEDLINE Link] .

Lund SS, Tarnow L, Astrup AS, Hovind P, Jacobsen PK, Alibegovic AC, et al. Effect of adjunct metformin treatment on levels of plasma lipids in patients with type 1 diabetes. Diabetes Obes Metab . 2009 Oct. 11(10):966-77. [QxMD MEDLINE Link] .

Tucker ME. ACC/AHA statin guidelines, with caveats. WebMD. Available at http://www.medscape.com/viewarticle/837138 . Accessed: Dec 24, 2014.

[Guideline] ElSayed NA, Aleppo G, Aroda VR, et al. Introduction and Methodology: Standards of Care in Diabetes-2023. Diabetes Care . 2023 Jan 1. 46 (Supplement_1):S1-S4. [QxMD MEDLINE Link] . [Full Text] .

Tucker ME. ADA Advises New BP, Lipid Targets for People With Diabetes. Medscape Medical News . 2022 Dec 13. [Full Text] .

Marks JB. Perioperative management of diabetes. Am Fam Physician . 2003 Jan 1. 67(1):93-100. [QxMD MEDLINE Link] .

[Guideline] Qaseem A, Humphrey LL, Chou R, Snow V, Shekelle P. Use of intensive insulin therapy for the management of glycemic control in hospitalized patients: a clinical practice guideline from the American College of Physicians. Ann Intern Med . 2011 Feb 15. 154(4):260-7. [QxMD MEDLINE Link] .

Kansagara D, Fu R, Freeman M, Wolf F, Helfand M. Intensive insulin therapy in hospitalized patients: a systematic review. Ann Intern Med . 2011 Feb 15. 154(4):268-82. [QxMD MEDLINE Link] .

[Guideline] Moghissi ES, Korytkowski MT, DiNardo M, Einhorn D, Hellman R, Hirsch IB, et al. American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Diabetes Care . 2009 Jun. 32(6):1119-31. [QxMD MEDLINE Link] . [Full Text] .

Vanhorebeek I, Langouche L, Van den Berghe G. Tight blood glucose control: what is the evidence?. Crit Care Med . 2007 Sep. 35(9 Suppl):S496-502. [QxMD MEDLINE Link] .

Murphy HR, Steel SA, Roland JM, et al. Obstetric and perinatal outcomes in pregnancies complicated by Type 1 and Type 2 diabetes: influences of glycaemic control, obesity and social disadvantage. Diabet Med . 2011 Sep. 28(9):1060-7. [QxMD MEDLINE Link] .

Diabetes Prevention Trial--Type 1 Diabetes Study Group. Effects of insulin in relatives of patients with type 1 diabetes mellitus. N Engl J Med . 2002 May 30. 346(22):1685-91.

Effects of insulin in relatives of patients with type 1 diabetes mellitus. N Engl J Med . 2002 May 30. 346(22):1685-91. [QxMD MEDLINE Link] .

Gale EA, Bingley PJ, Emmett CL, Collier T. European Nicotinamide Diabetes Intervention Trial (ENDIT): a randomised controlled trial of intervention before the onset of type 1 diabetes. Lancet . 2004 Mar 20. 363(9413):925-31. [QxMD MEDLINE Link] .

Herold KC, Bundy BN, Long SA, and the, Type 1 Diabetes TrialNet Study Group. An Anti-CD3 Antibody, Teplizumab, in Relatives at Risk for Type 1 Diabetes. N Engl J Med . 2019 Aug 15. 381 (7):603-13. [QxMD MEDLINE Link] . [Full Text] .

Sims EK, Bundy BN, Stier K, and the, Type 1 Diabetes TrialNet Study Group. Teplizumab improves and stabilizes beta cell function in antibody-positive high-risk individuals. Sci Transl Med . 2021 Mar 3. 13 (583): [QxMD MEDLINE Link] . [Full Text] .

Wherrett DK, Bundy B, Becker DJ, et al. Antigen-based therapy with glutamic acid decarboxylase (GAD) vaccine in patients with recent-onset type 1 diabetes: a randomised double-blind trial. Lancet . 2011 Jul 23. 378(9788):319-27. [QxMD MEDLINE Link] .

Orban T, Bundy B, Becker DJ, et al. Co-stimulation modulation with abatacept in patients with recent-onset type 1 diabetes: a randomised, double-blind, placebo-controlled trial. Lancet . 2011 Jul 30. 378(9789):412-9. [QxMD MEDLINE Link] .

[Guideline] Tucker ME. ADA Issues New Guidance on Type 1 Diabetes in Youth. Medscape Medical News . 2018 Aug 10. [Full Text] .

[Guideline] Chiang JL, Maahs DM, Garvey KC, et al. Type 1 Diabetes in Children and Adolescents: A Position Statement by the American Diabetes Association. Diabetes Care . 2018 Sep. 41 (9):2026-44. [QxMD MEDLINE Link] . [Full Text] .

[Guideline] American Diabetes Association. Introduction: Standards of Medical Care in Diabetes-2022. Diabetes Care . 2022 Jan 1. 45 (Supplement_1):S1-S2. [QxMD MEDLINE Link] . [Full Text] .

[Guideline] American Diabetes Association Professional Practice Committee. Summary of Revisions: Standards of Care in Diabetes-2024. Diabetes Care . 2024 Jan 1. 47 (Supplement_1):S5-S10. [QxMD MEDLINE Link] . [Full Text] .

[Guideline] Jenkins K. ADA Updates Recommendations for Managing Hypertension in Diabetes. Medscape . 2017 Sep 4. [Full Text] .

[Guideline] de Boer IH, Bangalore S, Benetos A, et al. Diabetes and Hypertension: A Position Statement by the American Diabetes Association. Diabetes Care . 2017 Sep. 40 (9):1273-1284. [QxMD MEDLINE Link] . [Full Text] .

[Guideline] Donaghue KC, Marcovecchio ML, Wadwa RP, et al. ISPAD Clinical Practice Consensus Guidelines 2018: microvascular and macrovascular complications in children and adolescents. Pediatr Diabetes . 2018 Oct. 19 Suppl 27:262-74. [QxMD MEDLINE Link] . [Full Text] .

[Guideline] DiMeglio LA, Acerini CL, Codner E, et al. ISPAD Clinical Practice Consensus Guidelines 2018: glycemic control targets and glucose monitoring for children, adolescents, and young adults with diabetes. Pediatr Diabetes . 2018 Oct. 19 Suppl 27:105-14. [QxMD MEDLINE Link] . [Full Text] .

[Guideline] LeRoith D, Biessels GJ, Braithwaite SS, et al. Treatment of Diabetes in Older Adults: An Endocrine Society* Clinical Practice Guideline. J Clin Endocrinol Metab . 2019 May 1. 104 (5):1520-74. [QxMD MEDLINE Link] . [Full Text] .

[Guideline] Tucker ME. New Endocrine Society Guidelines Address Diabetes in Older Adults. Medscape Medical News . 2019 Mar 23. [Full Text] .

[Guideline] Tucker ME. More Guidance on 'Vulnerable Subgroup' With Diabetes and COVID-19. Medscape Medical News . 2020 Apr 28. [Full Text] .

[Guideline] Bornstein SR, Rubino F, Khunti K, et al. Practical recommendations for the management of diabetes in patients with COVID-19. Lancet Diabetes Endocrinol . 2020 Apr 23. [QxMD MEDLINE Link] . [Full Text] .

[Guideline] Grunberger G, Sherr J, Allende M, et al. American Association of Clinical Endocrinology Clinical Practice Guideline: The Use of Advanced Technology in the Management of Persons With Diabetes Mellitus. Endocr Pract . 27 (2021):505-37. [Full Text] .

[Guideline] Tucker ME. 'A Better Picture': First AACE Guidelines on Diabetes Technology. Medscape Medical News . 2021 May 31. [Full Text] .

Lei J, Coronel MM, Yolcu ES, et al. FasL microgels induce immune acceptance of islet allografts in nonhuman primates. Sci Adv . 2022 May 13. 8 (19):eabm9881. [QxMD MEDLINE Link] . [Full Text] .

University of Missouri-Columbia. Harvard Scientists Have Developed a Revolutionary New Treatment for Diabetes. SciTechDaily. Available at https://scitechdaily.com/harvard-scientists-have-developed-a-revolutionary-new-treatment-for-diabetes/ . June 12, 2022; Accessed: June 13, 2022.

US Food and Drug Administration. FDA authorizes first interoperable, automated insulin dosing controller designed to allow more choices for patients looking to customize their individual diabetes management device system. Available at https://www.fda.gov/news-events/press-announcements/fda-authorizes-first-interoperable-automated-insulin-dosing-controller-designed-allow-more-choices?fbclid=IwAR3TSBssEd4n6b9hR5oe9Bzwmz3su1yQny8bcQeHVi0WFSsvURBh3nPjR-Y . December 13, 2019; Accessed: December 1, 2020.

[Guideline] American Diabetes Association. Standards of medical care in diabetes-2015 abridged for primary care providers. Clin Diabetes . 2015 Apr. 33 (2):97-111. [QxMD MEDLINE Link] . [Full Text] .

Brooks M. FDA Clears Blood Test to Help Diagnose Type 1 Diabetes. Medscape Medical News . Aug 21 2014. [Full Text] .

Hsiao-Chuan L, et al. Enterovirus infection is associated with an increased risk of childhood type 1 diabetes in Taiwan: A nationwide population-based cohort study. Diabetologia . 2014. [Full Text] .

Leegaard A, Riis A, Kornum JB, et al. Diabetes, Glycemic Control, and Risk of Tuberculosis: A population-based case-control study. Diabetes Care . 2011 Dec. 34(12):2530-5. [QxMD MEDLINE Link] . [Full Text] .

Ludwig J, Sanbonmatsu L, Gennetian L, et al. Neighborhoods, obesity, and diabetes--a randomized social experiment. N Engl J Med . 2011 Oct 20. 365(16):1509-19. [QxMD MEDLINE Link] .

[Guideline] Peters A, Laffel L. Diabetes Care for Emerging Adults: Recommendations for Transition From Pediatric to Adult Diabetes Care Systems: A position statement of the American Diabetes Association, with representation by the American College of Osteopathic Family Physicians, the American Academy of Pediatrics, the American Association of Clinical Endocrinologists, the American Osteopathic Association, the Centers for Disease Control and Prevention, Children with Diabetes, The Endocrine Society, the International Socie... Diabetes Care . 2011 Nov. 34(11):2477-85. [QxMD MEDLINE Link] . [Full Text] .

US Food and Drug Administration. Early Communication About Safety of Lantus (Insulin Glargine). Available at http://www.fda.gov/Drugs/DrugSafety/ucm239376.htm . Accessed: May 22, 2012.

Contributor Information and Disclosures

Romesh Khardori, MD, PhD, FACP (Retired) Professor, Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Eastern Virginia Medical School Romesh Khardori, MD, PhD, FACP is a member of the following medical societies: American Association of Clinical Endocrinology , American College of Physicians , American Diabetes Association , Endocrine Society Disclosure: Nothing to disclose.

George T Griffing, MD Professor Emeritus of Medicine, St Louis University School of Medicine George T Griffing, MD is a member of the following medical societies: American Association for Physician Leadership , American Association for the Advancement of Science , American College of Medical Practice Executives , American College of Physicians , American Diabetes Association , American Federation for Medical Research , American Heart Association , Central Society for Clinical and Translational Research , Endocrine Society , International Society for Clinical Densitometry , Southern Society for Clinical Investigation Disclosure: Nothing to disclose.

Howard A Bessen, MD Professor of Medicine, Department of Emergency Medicine, University of California, Los Angeles, David Geffen School of Medicine; Program Director, Harbor-UCLA Medical Center

Howard A Bessen, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

Barry E Brenner, MD, PhD, FACEP Professor of Emergency Medicine, Professor of Internal Medicine, Program Director, Emergency Medicine, Case Medical Center, University Hospitals, Case Western Reserve University School of Medicine

Barry E Brenner, MD, PhD, FACEP is a member of the following medical societies: Alpha Omega Alpha , American Academy of Emergency Medicine , American College of Chest Physicians , American College of Emergency Physicians , American College of Physicians , American Heart Association , American Thoracic Society , Arkansas Medical Society , New York Academy of Medicine , New York Academy ofSciences ,and Society for Academic Emergency Medicine

Aneela Naureen Hussain, MD, FAAFM Assistant Professor, Department of Family Medicine, State University of New York Downstate Medical Center; Consulting Staff, Department of Family Medicine, University Hospital of Brooklyn

Aneela Naureen Hussain, MD, FAAFM is a member of the following medical societies: American Academy of Family Physicians , American Medical Association , American Medical Women's Association , Medical Society of the State of New York , and Society of Teachers of Family Medicine

Anne L Peters, MD, CDE Director of Clinical Diabetes Programs, Professor, Department of Medicine, University of Southern California, Keck School of Medicine, Los Angeles, California, Los Angeles County/University of Southern California Medical Center

Anne L Peters, MD, CDE is a member of the following medical societies: American College of Physicians and American Diabetes Association

Disclosure: Amylin Honoraria Speaking and teaching; AstraZeneca Consulting fee Consulting; Lilly Consulting fee Consulting; Takeda Consulting fee Consulting; Bristol Myers Squibb Honoraria Speaking and teaching; NovoNordisk Consulting fee Consulting; Medtronic Minimed Consulting fee Consulting; Dexcom Honoraria Speaking and teaching; Roche Honoraria Speaking and teaching

Don S Schalch, MD Professor Emeritus, Department of Internal Medicine, Division of Endocrinology, University of Wisconsin Hospitals and Clinics

Don S Schalch, MD is a member of the following medical societies: American Diabetes Association , American Federation for Medical Research , Central Society for Clinical Research , and Endocrine Society

Erik D Schraga, MD Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Miriam T Vincent, MD, PhD Professor and Chair, Department of Family Practice, State University of New York Downstate Medical Center

Miriam T Vincent, MD, PhD is a member of the following medical societies: Alpha Omega Alpha , American Academy of Family Physicians , American Association for the Advancement of Science , Medical Society of the State of New York , North American Primary Care Research Group , Sigma Xi , and Society of Teachers of Family Medicine

Disclosure: Joslin Diabetes Group, Harvard Honoraria Speaking and teaching

Scott R Votey, MD Director of Emergency Medicine Residency, Ronald Reagan UCLA Medical Center; Professor of Medicine/Emergency Medicine, University of California, Los Angeles, David Geffen School of Medicine

Scott R Votey, MD is a member of the following medical societies: Society for Academic Emergency Medicine

Frederick H Ziel, MD Associate Professor of Medicine, University of California, Los Angeles, David Geffen School of Medicine; Physician-In-Charge, Endocrinology/Diabetes Center, Director of Medical Education, Kaiser Permanente Woodland Hills; Chair of Endocrinology, Co-Chair of Diabetes Complete Care Program, Southern California Permanente Medical Group

Frederick H Ziel, MD is a member of the following medical societies: American Association of Clinical Endocrinologists , American College of Endocrinology , American College of Physicians , American College of Physicians-American Society of Internal Medicine , American Diabetes Association , American Federation for Medical Research , American Medical Association , American Society for Bone and Mineral Research , California Medical Association , Endocrine Society , andInternational Society for Clinical Densitometry

What would you like to print?

Print this section
Print the entire contents of
Print the entire contents of article

Type 1 Diabetes Mellitus
Pediatric Type 1 Diabetes Mellitus
Type 2 Diabetes Mellitus
Pediatric Type 2 Diabetes Mellitus
Fast Five Quiz: How Much Do You Know About Diabetic Neuropathy?
Fast Five Quiz: Atrial Fibrillation and Diabetes
Perioperative Management of the Diabetic Patient
Diabetes Mellitus Type 1 News & Perspectives
Are Immune Therapies for Type 1 Diabetes Worthwhile?
Experts Offer CGM Tips for Type 1 Diabetes
Don't Overlook Cardiovascular Risk in Type 1 Diabetes
Preoperative HbA1c and Postoperative Outcomes in Spine Surgery

Extrahepatic Manifestations in Chronic Hepatitis C: The Impact of Diagnosis and Treatment

Drug Interaction Checker
Pill Identifier
Calculators

2003/viewarticle/994027Clinical Review Can Certain Medications Delay Treatment Response for Depression? 0.25 CME / CE / ABIM MOC Credits Clinical Review You are being redirected to Medscape Education Yes, take me there 0.25 CME / CE / ABIM MOC Can Certain Medications Delay Treatment Response for Depression?
2002117739-overviewDiseases & Conditions Diseases & Conditions Type 1 Diabetes Mellitus
2010trulicity-dulaglutide-999965Drugs Drugs dulaglutide

Edited by George S. Eisenbarth
Online Edition Version 3.0

This online edition is updated frequently. To receive email notifications of chapter and slideset revisions, please register .

Edited by George Eisenbarth TABLE OF CONTENTS ] if you have difficulty downloading PowerPoint files
-	-
-	- - -
-	-
-	-
-	-
	-
-	- Additional Slideset: Additional Slideset:
-	-
-	- Additional Slideset:
-	-
-	-
-	-
David V. Serreze and Derry C. Roopenian
-

The following presentations provide a multifaceted review of topics relating to diabetes. Overviews of Type 1 and Type 2 diabetes, metabolic syndrome, and gestational diabetes (diabetes developing during pregnancy) are discussed. In addition, complications associated with both forms of diabetes are discussed along with measures to lower the risk for these complications. The importance of monitoring maternal glucose in relation to infant growth and development is also discussed.

The presentation will download as a Powerpoint software file when you click on the title in the link.

Complications of Diabetes
Diabetes and Macrosomia
Gestational Diabetes
Metabolic Syndrome
Nutrient Sensing
Type 1 Diabetes
Type 2 Diabetes

Centers & Institutes

Metabolic Basis of Disease Center

Institute for Dementia Research & Prevention

Louisiana Clinical & Translational Science Center

Nutrition Obesity Research Center

Metamor Institute

Center for Military Performance & Resilience

Childhood Obesity and Diabetes Research

Human Research Protections Program

Research Kitchen + Recipes

Business Development

LAUNCHED Program

Pennington Biomedical Research Foundation

Our Partners

Obesity Society

American Diabetes Association

Sign Up For Updates

6400 Perkins Rd. Baton Rouge, LA 70808 ph: (225) 763-2500 fax: (225) 763-3022

Home PowerPoint Templates Template Backgrounds Diabetes PowerPoint Template

Diabetes PowerPoint Template

The Diabetes PowerPoint Template is a special presentation theme for medical professionals. The individuals who are directly and indirectly involve in treatment of diabetes can use this template. This PowerPoint can assist users in demonstrating symptoms, causes, medical issues, and trends for the disease. This template provides a wide range of shapes, clipart icons, and infographics relevant to diabetes topics. These include label diagrams, comparison tables, timeline scale, dashboard, and statistical analysis. Further, individual working in a medical field as doctors, research scientists, pharmacists etc. often present healthcare related topics in public. because the use of graphical content assists users to elaborate their discoveries about diabetes.

The Diabetes PowerPoint Template has 13 slides of high-quality vector graphics. This is a presentation tool to discuss diabetes and related topics in ways that are most appealing to the audience. Such as shapes and graphics demonstrating a body diagram, test device, and data charts. Furthermore, the diabetes PowerPoint presentation is a structured set of slides for medical details of a term or disease. The sequence is as follow:

10 early signs of diabetes – Human silhouette label diagram
Causes – 6 segment infographic bullet list format
Types of diabetes – 3 comparison tables
Risk and further complications – Label diagram
Diabetes prevention – Horizontal hierarchy structure
Smart food swap can help prevent type 2 diabetes – graphic comparison table
Diabetes blood test – Two content clipart and text segments slide
Text collage health and diabetes terms
TRACK – Bullet list design of diabetes control options
Diabetes infographics – dashboard style quick facts slide
lastly, Worldwide statistics of diabetes – data driven area chart and map

This is an editable PowerPoint medical design to effectively convey the useful information. The users can change color theme or image background of diabetes PowerPoint. Moreover, replace it with their company, hospital or business patterns.

Alternatively, you can download the Diabetes presentation template with additional diabetes slides, and compatible with PowerPoint & Google Slides presentations.

You must be logged in to download this file.

Favorite Add to Collection

Details (13 slides)

Supported Versions:

Subscribe today and get immediate access to download our PowerPoint templates.

Related PowerPoint Templates

Healthcare Market Analysis PowerPoint Template

5-Level Swiss Cheese Model PowerPoint Template

Incident Report PowerPoint Template

Neuroscience PowerPoint Template

Home Collections Medical Diabetes

Free Diabetes Presentation Templates

Struggling with boring diabetes presentations download free diabetes powerpoint templates and google slides themes that are easy to use and understand. bright colors, creative visuals, and helpful infographics - make your message clear spread awareness about diabetes mellitus, including causes, symptoms, diets, etc. the best choice for doctors.

Diverse themes: Explore slides dedicated to diabetic ketoacidosis, case studies, diet plans, and even captivating backgrounds for your chosen topic.
World Diabetes Day: Celebrate this special day with slides that everyone will understand! It will help you raise awareness and make people want to learn more about keeping their sugar in check.
Let creativity flow: Infographics, multicolor palettes, and a variety of layouts give your presentation a unique and impactful edge.
Customization: All slides are 100% editable, allowing you to tailor them to your specific needs and add your own touch.
Multiple formats: Choose from 4:3 or 16:9 aspect ratios, portrait or landscape orientations, and find slides that work seamlessly with any presentation platform.
Free options to explore: A collection of diabetes PPT presentation free downloads available to let you experience the quality before investing further.
Doctors, nurses, and teachers: Explain things clearly to patients, friends, and everyone else.
People who spread the word about diabetes: Teach people how to stay healthy and avoid problems with sugar.
People living with diabetes: Share your story and help others, or fight for better care with powerful pictures. It will help to share your experiences and make a difference!
Conferences and workshops: Deliver impactful presentations at medical gatherings, community events, and educational seminars.
Patient education sessions: Use clear visuals to explain complex topics to patients and families in an accessible and engaging way.
Awareness campaigns: Create presentations that raise awareness about diabetes , its impact, and steps for prevention and management.
Online presentations and webinars: Share your knowledge with a wider audience through online platforms using visually compelling slides.

We're here to help you!

What types of diabetes presentation templates are available.

We offer a variety of templates for different topics, including awareness campaigns, patient education, research presentations, and more.

Do I have to be good at design to use these templates?

Not at all! Our templates are made for everyone, even if you're just starting. Just put in your content and change the look with a few clicks – it's that easy!

Are the templates free to download?

Yes, we offer a collection of free slides to download and use.

Can I edit the templates after downloading them?

Yes, you can fully customize the templates with your own content, images, and colors. You can edit them from PowerPoint or Google Slides.

Can I use these templates for commercial purposes?

Yes, you can use our templates for personal and commercial use.

Can I share your templates with others?

Yes, you can share our templates with your friends, colleagues, and anyone else who needs to create a diabetes presentation.

How can I get help if I have trouble using the templates?

We're happy to help! Contact our 24/7 customer support team.

Do you offer any premium diabetes presentation templates?

Yes, we also offer a selection of premium templates.

JavaScript seems to be disabled in your browser. For the best experience on our site, be sure to turn on Javascript in your browser.

Exclusive access to over 200,000 completely editable slides.

Diagram Finder
Free Templates

Human Resources
Project Management
Timelines & Planning
Health & Wellness
Environment
Cause & Effect
Executive Summary
Customer Journey
30 60 90 Day Plan
Social Media
Escalation Matrix
Communication
Go to Market Plan/Strategy
Recruitment
Pros and Cons
Business Plan
Risk Management
Roles and Responsibilities
Mental Health
ISO Standards
Process Diagrams
Puzzle Diagrams
Organizational Charts
Arrow Diagrams
Infographics
Tree Diagrams
Matrix Charts
Stage Diagrams
Text Boxes & Tables
Data Driven Charts
Flow Charts
Square Puzzle
Circle Puzzle
Circular Arrows
Circle Segments
Matrix Table
Pillar Diagrams
Triangle Puzzle
Compare Diagrams
Ladder Diagrams
Google Slides
North America Maps
United States (US) Maps
Europe Maps
South America Maps
Apple Keynote
People & Objects
Trending Products
PowerPoint Templates

Type1 Diabetes

(8 Editable Slides)

Related Products

Chronic Kidney Disease

Cardiovascular Disease

Diabetes Mellitus

Diabetic Retinopathy

Diabetes Icons

Type-2 Diabetes

Diabetic Neuropathy PPT

Leverage our Type 1 Diabetes PPT template to describe the chronic autoimmune condition in which the pancreas stops making insulin in the body, resulting in very high blood sugar levels and life-threatening complications. Diabetologists can take advantage of this entirely editable deck to explain how carb counting, exercising, and eating a healthy, balanced diet can help manage type 1 diabetes. You can also use this set to discuss the age groups that are more likely to develop this type of diabetes and how they can lower their chance of developing it.

Our PowerPoint template features impressive illustrations that present data visually to keep the audience engaged and interested. So, download this PPT now and add to the awesomeness of your presentation!

What’s Inside the Deck?

A listicle explains type-1 diabetes in a comprehensible manner.
An infographic with eye-catching vectors explains what causes type 1 diabetes.
A beautifully crafted listicle with appealing icons depicts the symptoms.
An innovative infographic showcases the risk factors.
A comprehensively designed diagram explains how type 1 diabetes is diagnosed.
A gorgeously crafted infographic embedded with eye-pleasing vectors illustrates the path to type 1 diabetes.
An impressively designed pattern depicts how type 1 diabetes is treated.
A unique infographic presents the nine ways to prevent type 1 diabetes complications.

Exclusive Features

The set offers hassle-free customizations; you can add your text, alter the size of the vectors, and edit the background color without any extensive editing skills or seeking external assistance.
You can use the designs multiple times after downloading them once.
The deck is 100% unique and free from copyright issues.
The set incorporates high-definition graphics to keep the resolution intact.
We render ongoing customer support for quick resolution of your queries and issues.

So, craft convincing presentations quickly and easily with our slides. Download it now!

Create compelling presentations in less time

Type 1 Diabetes in Adults

Apr 05, 2019

330 likes | 485 Views

Type 1 Diabetes in Adults. Andrej Janež, MD PhD Dept. of Endocrinology Diabetes and Metabolic Diseases University Medical Center Ljubljana. Prevalence of Diabetes in the United States. US Population: 275 Million in 2000. Undiagnosed diabetes 5.2 million . Diagnosed type 2 diabetes

Share Presentation

cgms external closed
variable food consumption
hypoglycemiarisk factors
monthsafter transplant
insulin therapy

Presentation Transcript

Type 1 Diabetes in Adults Andrej Janež, MD PhD Dept. of Endocrinology Diabetes and Metabolic Diseases University Medical Center Ljubljana

Prevalence of Diabetesin the United States US Population: 275 Million in 2000 Undiagnosed diabetes 5.2 million Diagnosed type 2 diabetes 12 million Diagnosed type 1 diabetes ~1.0 million Type 1 diabetes misdiagnosed as type 2 diabetes ~1.0 million Centers for Disease Control. Available at: http://www.cdc.gov/diabetes/pubs/estimates.htm;EURODIAB ACE Study Group. Lancet. 2000;355:873-876; Harris MI. In: NationalDiabetes Data Group. Diabetes in America. 2nd ed. Bethesda, Md: NIDDK;1995:15-36; U.S. Census Bureau Statistical Abstract of the U.S.; 2001

Incidence of Type 1 Diabetes • Incidence increasing by 3.4% per year • 50% of patients diagnosed before age 20 years • 50% of patients diagnosed after age 20 years • Often mistaken for type 2 diabetes—may make up 10% to 30% of individuals diagnosed with type 2 diabetes • Oral agents ineffective; insulin therapy required • Autoimmune process slower and possibly different • Can usually be confirmed by beta cell antibodies • Loss of c-peptide EURODIAB ACE Study Group. Lancet. 2000;355:873-876; Naik RG, Palmer JP. Curr Opin Endocrinol Diabetes. 1997;4:308-315

Making the Diagnosis of Type 1 Diabetes Symptoms of diabetes Polyuria, polydipsia, polyphagia, diabetic plus ketoacidosis (DKA) Random plasma glucose200 mg/dL* Fasting plasma glucose (FPG)126 mg/dL* Oral glucose tolerance test (OGTT) with 2-hour value200 mg/dL* Loss of c-peptidec-peptide<0.8 ng/dL Presence of islet autoantibodiesGADA, ICA, IA-2A, IAA *Requires confirmation by repeat testing American Diabetes Association. Diabetes Care. 2004;27(suppl 1):S5-S10

Natural History of “Pre”–Type 1 Diabetes Putative trigger -Cell mass 100% Cellular autoimmunity Circulating autoantibodies (ICA, GAD65, ICA512A, IAA) Loss of first-phase insulin response (IVGTT) Abnormal glucosetolerance (OGTT) Clinical onset Genetic predisposition Insulitis-Cell injury -Cell insufficiency Diabetes Time Eisenbarth GS. N Engl J Med. 1986;314:1360-1368

Rationale for Intensive Therapyof Type 1 DiabetesGlucose Control Is Critical

Risk of Progression ofMicrovascular Complications vs A1C DCCT Relative risk 20 Retinopathy Neuropathy 15 Microalbuminuria 10 5 0 1 5 6 7 8 9 10 11 12 A1C (%) A1C=hemoglobin A1c Skyler JS. Endocrinol Metab Clin North Am. 1996;25:243-254

Intensive Therapy for Diabetes:Reduction in Incidence of Complications T1DM = type 1 diabetes mellitus; T2DM = type 2 diabetes mellitus. *Not statistically significant due to small number of events. †Showed statistical significance in subsequent epidemiologic analysis. DCCT Research Group. N Engl J Med. 1993;329:977-986; Ohkubo Y, et al. Diabetes Res Clin Pract. 1995;28:103-117; UKPDS 33: Lancet. 1998;352: 837-853; Stratton IM, et al. Brit Med J. 2000;321:405-412.

Long-term Microvascular Risk Reduction in Type 1 DiabetesCombined DCCT-EDIC Intensive Conventional Retinopathy progression (incidence) 12% A1C 10% 8% 6% P<0.001 P<0.001 P=0.61 DCCTEnd of randomized treatment EDICYear 1 EDICYear 7 No. Evaluated Conventional 169 203 220 581 158 192 200 Intensive 191 222 197 596 170 218 180 DCCT/EDIC Research Group. JAMA. 2002;287:2563-2569

Cost-Effectiveness of IntensiveTherapy in Type 1 Diabetes DCCT Modeling Study DCCT Research Group. JAMA. 1996;276:1409-1415

Principles of Intensive Therapy ofType 1 DiabetesTargets

Current Targets for Glycemic Control *Peak American Diabetes Association. Diabetes Care. 2004,27:S15-S35. The American Association of Clinical Endocrinologists. Endocr Pract. 2002; 8(suppl. 1):40-82. Chacra AR, et al. Diabetes Obes Metab. 2005;7:148-160. IDF (Europe) European Diabetes Policy Group. Diabet Med. 1999;16:716-730.

Principles of Intensive Therapy ofType 1 DiabetesInsulin Options

Action Profiles of Insulins 2 3 4 5 6 7 8 9 12 13 14 15 16 17 18 19 20 21 22 23 24 0 1 10 11 Aspart, glulisine, lispro 4–5 hours Regular 6–8 hours Plasma insulin levels NPH 12–16 hours Detemir ~14 hours Ultralente 18–20 hours Glargine ~24 hours Hours Burge MR, Schade DS. Endocrinol Metab Clin North Am. 1997;26:575-598; Barlocco D. Curr Opin Invest Drugs. 2003;4:1240-1244; Danne T et al. Diabetes Care. 2003;26:3087-3092

Normal Daily Plasma Insulin ProfileNondiabetic Obese Individuals U/mL 100 B L D 80 60 40 20 1200 2400 1800 0800 0600 0600 Time of day B=breakfast; L=lunch; D=dinner Polonsky KS et al. N Engl J Med. 1988;318:1231-1239

Basal/Bolus Treatment Program with Rapid-acting and Basal Analogs Breakfast Lunch Dinner Rapid Rapid Rapid Plasma insulin Basal 4:00 8:00 12:00 16:00 20:00 24:00 4:00 8:00 Time

Physiologic Multiple Injection RegimensThe Basal-Bolus Insulin Concept • Basal insulin • Controls glucose production between meals and overnight • Near-constant levels • Usually ~50% of daily needs • Bolus insulin (mealtime or prandial) • Limits hyperglycemia after meals • Immediate rise and sharp peak at 1 hour postmeal • 10% to 20% of total daily insulin requirement at each meal • For ideal insulin replacement therapy, each component should come from a different insulin with a specific profile or via an insulin pump (with one insulin)

Basal-bolus Therapy: • More frequent decision making, testing, and insulin dosing • Allows for variable food consumption based on hunger level • Ability to skip meal or snack if desired (bedtime) • Reduced variability of insulin absorption • Easy to adapt to acute changes in schedule (exercise, sleeping in on weekends)

Insulin pens Faster and easier than syringes Improve patient attitude and adherence Have accurate dosing mechanisms, but inadequate resuspension of NPH may be a problem Insulin Injection Devices

Mealtime Insulin and Severe HypoglycemiaAspart vs Regular Insulin Favors RegularInsulin Favors Aspart P Values NS 0.076 <0.050 <0.005 All severe hypoglycemia Nocturnal event Nocturnal, glucagon required 4–6 hours postmeal 0.1 1 10 Relative risk Home PD et al. Diabet Med. 2000;17:762-770

Variable Basal Rate Continuous Subcutaneous Insulin Infusion (CSII) 75 Breakfast Lunch Dinner 50 Bolus Plasma Insulin µU/ml) Bolus Bolus 25 Basal Infusion 4:00 8:00 12:00 16:00 20:00 24:00 4:00 8:00 Time

Insulin PumpsContinuous Subcutaneous Insulin Infusion (CSII) • For motivated patients • Expensive • External, programmable pump connected to an indwelling subcutaneous catheter • Only rapid-acting insulin • Programmable basal rates • Bolus dose without extra injection • New pumps with dose calculator function • Bolus history • Requires support system of qualified providers

CSII vs Multiple Injections of InsulinMeta-analyses Pickup et al. 12 RCTs Weissberg-Benchell et al. 11 RCTs InjectionTherapyBetter PumpTherapyBetter Blood glucose concentration Glycated hemoglobin A1C Insulin dose -2 -1 0 1 2 Mean difference RCT=randomized controlled trial Pickup J et al. BMJ. 2002;324:1-6; Weissberg-Benchell J et al. Diabetes Care. 2003;26:1079-1087

Balancing Risk of Severe Hypoglycemia Against the Risk of ComplicationsDCCT Retinopathy Progression Severe Hypoglycemia 100 patient-years 120 100 patient-years 16 14 100 12 80 10 60 8 6 40 4 20 2 0 0 8.0 10.5 5.0 5.5 6.0 6.5 7.0 7.5 8.5 9.0 9.5 10.0 5.5 6.0 6.5 7.0 7.5 8.0 8.5 9.0 9.5 10.0 10.5 5.0 A1C (%) A1C (%) DCCT Research Group. N Engl J Med. 1993;329:977-986

HypoglycemiaRisk Factors • Behavioral Factors • Dietary inconsistency • Prolonged fasting • Missed meal or snack • Strenuous exercise • Patient Factors • Hypoglycemia unawareness • History of previous hypoglycemia • Defective glucose counterregulation • Long duration of diabetes • Erratic insulin absorption • Age less than 5 to 7 years • Medical Factors • Drug side effects (-blockers) • Dosing errors • Unpredictable insulin kinetics • Inappropriate insulin distribution

Weight Gain • Insulin therapy reverses catabolic effects of diabetes • Glycosuria reduced • Normal fuel-storage mechanisms restored • Risk of hypoglycemia often causes patients to increase caloric intake and avoid exercise • Risk of weight gain decreases with more physiologic insulin administration • Flexible insulin dosing to meet dietary and exercise needs

Future Glucose Monitors Guardian™ CGMS External Closed-Loop • Minimally invasive continuous glucose monitors • Implanted glucose sensors • Implanted insulin pumps • “Closed-loop” systems Freestyle Navigator™ Implanted Closed-Loop

Can Type 1 Diabetes Be “Cured?”Islet Cell Transplantation 7 Type 1 Patients, Aged 29 to 54 Years, With History of Severe Hypoglycemia and Metabolic Instability MeanC-peptide(ng/mL) Mean A1C (%) * 5.7 8.4% * * 2.5 5.7% 0.48 Baseline 6 monthsafter transplant Baseline 90 min postmeal Fasting 6 monthsafter transplant *P<0.001 vs baseline Shapiro AMJ et al. N Engl J Med. 2000;343:230-238

Opportunities for Intervention inType 1 Diabetes TrialNet Multiple antibody positive Genetically at risk Loss of first-phase insulin response -Cell mass Newly diagnosed diabetes Genetic predisposition Insulitis-Cell injury -Cell insufficiency Diabetes Time

More by User

barriers in young adults with type 1 diabetes

barriers in young adults with type 1 diabetes. Dr. Turki AlBatti,MD. barriers in young adults with type 1 diabetes. Glycemic control and adherence behaviors remain low for patients with type 1 diabetes

511 views • 27 slides

Type 1 Diabetes

Type 1 Diabetes. Pennington Biomedical Research Center Division of Education. Types of Diabetes. Type 1 Diabetes mellitus (DM) Type 2 Diabetes mellitus (DM) Gestational Diabetes. Type 1: Overview. Usually diagnosed in children and young adults. Previously known as “juvenile diabetes”.

915 views • 38 slides

Type 1 Diabetes. Karen S. Penko, MD Fellow, Pediatric Endocrinology September 2005. PREP Content Specifications. Recognize signs/symptoms Know how to treat type 1 diabetes Know the value of hemoglobin A1c Know the natural history Counsel patients on self-management

1.23k views • 78 slides

Background . Married in 1997. Three Children, Jack (9); Adam (7) and Kate (18 months)My eldest son was diagnosed with Type 1 Diabetes on the 22nd April 1999, aged 1 year. Diagnosed with Coeliac Disease in April 2007 during a routine diabetes annual check up. . Initial Feelings. Anger Frustration

339 views • 18 slides

Diabetes Mellitus Type 1

Objectives. Recognize the difference between Type 1 and Type 2 DMIdentify the etoiology, epidemiology, pathophysiology, and common clinical manifestations of DM1.Know the pathophysiology, common presentation, labs, complications and proper treatment of DKABe familiar with different types of insul

777 views • 38 slides

TYPE 1 DIABETES MELLITUS

increasing incidence [ + 3-4%/year ] up to 50/10 5 /year, earlier age at onset multifactorial, polygenic disease islet of Langerhans. 1 autoantibody. 2 autoantibodies. b cell. 3 autoantibodies. islet cell autoantibodies. prediabetes.

529 views • 18 slides

Type 1 Diabetes . Shannon, Matthew, Dionne, Aaron. Definition . Type 1 diabetes is a lifelong (chronic) disease in which there are high levels of sugar (glucose) in the blood. About Diabetes .

357 views • 15 slides

Diabetes mellitus type 1 (Type 1 diabetes, T1D, T1DM , IDDM, juvenile diabetes):

Diabetes mellitus type 1 (Type 1 diabetes, T1D, T1DM , IDDM, juvenile diabetes):. is a form of diabetes mellitus . Type 1 diabetes is an autoimmune disease [1] that results in destruction of insulin -producing beta cells of the pancreas .

1.33k views • 54 slides

Type 1 Diabetes. Kayla Izzard Nov. 17 2009. What is Type 1 Diabetes?.

163 views • 9 slides

Type 1 Diabetes in Children

Type 1 Diabetes in Children. By: Briana Wexler EEC2732 : Summer 2013. What is type 1 diabetes?. It is a disease that affects how the body uses it’s glucose, which is the main type of sugar in the blood. It results when the pancreas loses it’s ability to create the hormone, Insulin.

379 views • 9 slides

Type 1 Diabetes. By: Neera Shukla EEC-4731. Type 1 Diabetes . Known as Juvenile diabetes

204 views • 10 slides

Type 1 Diabetes. No cure. No cause. What is type 1 diabetes?. Type 1 diabetes can occur at any age. However, it is most often diagnosed in children, adolescents, or young adults .

796 views • 7 slides

Type 1 diabetes

Type 1 diabetes. Anti-insulin: health. No cure; therapy is insulin for life; physiologic glycaemic control never achieved. Anti-insulin: disease. Excess morbidity and mortality. Incidence increasing by ~5% every 5 years; costs ~ £1 billion of UK NHS budget. Peakman. Islet autoantigen.

783 views • 39 slides

Type 1 Diabetes. By Rachel Lepre and Lisa Cunningham. What is it. Cannot make insulin Insulin Without insulin What it can cause Gestational diabetes 1. Cause. Immune system destroys the beta cells Pancreas Beta cells Inherit the disease 2. Effects.

336 views • 13 slides

Type 1 Diabetes. Elliott Duax. What is diabetes? Symptoms Managing T1D. Preview. Type 1Diabetes (T1D) is an Autoimmune D isease I nsulin producing cells are attacked Causes Not Understood No Prevention D ependence on I nsulin Complications From T1D. What is Type 1 Diabetes?.

353 views • 11 slides

Type 1 Diabetes. Jennifer McVean, MD September 23, 2010. Outline. Type 1 diabetes: increasing incidence and prevalence Exciting research and developments in type 1 diabetes Juvenile Diabetes Research Foundation and The Walk to Cure Diabetes. Type 1 Diabetes. Autoimmune Disease

881 views • 20 slides

Type 1 diabetes in children

Type 1 diabetes in children is a condition in which your child's pancreas no longer produces the insulin your child needs to survive, and you'll need to replace the missing insulin. Type 1 diabetes in children used to be known as juvenile diabetes.

538 views • 7 slides

484 views • 39 slides

Diagnosing Diabetes In Adults– Type 1, LADA, or Type 2?

Diagnosing Diabetes In Adults– Type 1, LADA, or Type 2?. Part 3. Stanley Schwartz MD, FACE, FACP Affiliate Main Line Health Emeritus, Clinical Assoc. Prof. of Medicine Perlman School of Medicine, University of Pennsylvania Struan F.A. Grant, Ph.D Vanessa Guy

137 views • 13 slides

457 views • 38 slides

Diagnosing Diabetes In Adults– Type 1, LADA, or Type 2?. Part 2 2. Stanley Schwartz MD, FACE, FACP Affiliate Main Line Health Emeritus, Clinical Assoc. Prof. of Medicine Perlman School of Medicine, University of Pennsylvania Struan F.A. Grant, Ph.D Vanessa Guy

202 views • 13 slides

Diagnosing Diabetes In Adults– Type 1, LADA, or Type 2?. Part 1 of 4. Stanley Schwartz MD, FACE, FACP Affiliate Main Line Health Emeritus, Clinical Assoc. Prof. of Medicine Perlman School of Medicine, University of Pennsylvania Struan F.A. Grant, Ph.D Vanessa Guy

144 views • 12 slides

COMMENTS

Type 1 diabetes mellitus
Introduction Type1 diabetes Insulin Dependent diabetes mellitus, or Juvenile onset DM. Average onset is in childhood or early adulthood (usually before 30 years of age) Due to pancreatic islet destruction predominantly by an autoimmune process. Cell mediated response: - Type 1 diabetes is caused by a T cell mediated autoimmune destruction of ...
Type 1 diabetes powerpoint
Type 1 Diabetes is an autoimmune disease where the body's immune system attacks and destroys the insulin-producing beta cells in the pancreas. Common symptoms include frequent urination, excessive thirst, hunger, weight loss, fatigue, and blurred vision. It is diagnosed through blood tests showing high blood glucose levels.
PDF Diabetes 101
Type 2 Diabetes Warning Signs. Warning Signs and Symptoms - Can occur slowly over time. Blurred vision. Tingling or numbness in legs, feet or fingers. Recurring skin, gum or urinary tract infections. Drowsiness. Slow healing of cuts and bruises. Any symptoms that occur with Type 1 diabetes.
Diebetes mellitus type 1
Diebetes mellitus type 1. Type 1 diabetes is characterized by low or absent insulin production. It is an autoimmune disease where the body's immune system attacks the beta cells in the pancreas that produce insulin. The main treatment is lifelong insulin therapy via injections or insulin pump to control blood glucose levels.
Slide Deck
This comprehensive slide deck of ADA's 2023 Standards of Care contains content created, reviewed, and approved by the American Diabetes Association. You are free to use the slides in presentations without further permission as long as the slide content is not altered in any way and appropriate attribution is made to the American Diabetes Association (the Association name and logo on the slides ...
Pathophysiology and Clinical Presentation
Pathophysiology and Clinical Presentation. Pathophysiology: Type 1 Diabetes Mellitus is a syndrome characterized by hyperglycemia and insulin deficiency resulting from the loss of beta cells in pancreatic islets (Mapes & Faulds, 2014). Nonimmune (type 1B diabetes), occurs secondary to other diseases and is much less common than autoimmune (type ...
PPT
TYPE 1 DIABETES MELLITUS. Jan 23, 2013. 250 likes | 527 Views. increasing incidence [ + 3-4%/year ] up to 50/10 5 /year, earlier age at onset multifactorial, polygenic disease islet of Langerhans. 1 autoantibody. 2 autoantibodies. b cell. 3 autoantibodies. islet cell autoantibodies. prediabetes. Download Presentation. lancet kulmala et al.
Type 1 Diabetes Mellitus
8 Assessment 12 year-old female with newly diagnosed Type I Diabetes Mellitus upon hospital admission with a blood-glucose level of 724 mg/dL Height of 5' (60in) Weight of 82 lbs (37.3kg) Patient is at 50th percentile for height/age 25th percentile for weight/age Prior weight of 90 lbs (normal) Patient is at 91% of UBW BMI of 16 Estimated ...
Type 1 Diabetes Mellitus Clinical Presentation
Next: Physical Examination. Type 1 diabetes is a chronic illness characterized by the body's inability to produce insulin due to the autoimmune destruction of the beta cells in the pancreas. Onset most often occurs in childhood, but the disease can also develop in adults in their late 30s and early 40s.
PPT PowerPoint Presentation
Standards of medical care in diabetes—2014. Diabetes Care 2014;37(suppl 1):S25-S26; Table 9 American Diabetes Association. ... PowerPoint Presentation Author: ssetter Last modified by ... Times New Roman Arial Calibri Light Calibri MS Pゴシック Futura Book Office Theme Type 1 Diabetes Mellitus Pathophysiology of T1DM Model for ...
Type 1 Diabetes: Cellular, Molecular & Clinical Immunology
Type 1 Diabetes: Cellular, Molecular & Clinical Immunology Edited by George S. Eisenbarth Online Edition Version 3.0. ... ADA Update June 2008.ppt Powerpoint slide set (added 7/08) 13. Theoretical Essays Kevin J. Lafferty and George S. Eisenbarth, Editors A. The Development of Autoimmune Diabetes
Diabetes Presentations
Diabetes. The following presentations provide a multifaceted review of topics relating to diabetes. Overviews of Type 1 and Type 2 diabetes, metabolic syndrome, and gestational diabetes (diabetes developing during pregnancy) are discussed. In addition, complications associated with both forms of diabetes are discussed along with measures to ...
PPT
Presentation Transcript. Type 1: Overview • Usually diagnosed in children and young adults. • Previously known as "juvenile diabetes". • In this type of diabetes, the body does not produce insulin. • Insulin is required in order for the body to properly use sugar, in the form of glucose.
PPT
Presentation Transcript. Type 1 Diabetes Mellitus Treatment. Goals of T1DM Management Utilize intensive therapy aimed at near-normal BG and A1C levels Prevent diabetic ketoacidosis and severe hypoglycemia Achieve the highest quality of life compatible with the daily demands of diabetes management In children, achieve normal growth and physical ...
Diabetes PowerPoint Template & Slide Presentations
The Diabetes PowerPoint Template has 13 slides of high-quality vector graphics. This is a presentation tool to discuss diabetes and related topics in ways that are most appealing to the audience. Such as shapes and graphics demonstrating a body diagram, test device, and data charts. Furthermore, the diabetes PowerPoint presentation is a ...
Type 1 Diabetes
Type 1 Diabetes. Oct 18, 2012 • Download as PPT, PDF •. 15 likes • 14,432 views. AI-enhanced description. Parthasarathy Ravichandran. India has a high burden of diabetes, with over 61 million diabetic patients. Type 1 diabetes incidence is increasing, with around 78,000 children developing it annually.
Free Diabetes PowerPoint Templates And Google Slides
Download FREE Diabetes PowerPoint templates and Google Slides themes that are easy to use and understand. Bright colors, creative visuals, and helpful infographics - make your message clear! Spread awareness about diabetes mellitus, including causes, symptoms, diets, etc. The best choice for doctors! Diabetes PPT Presentation Template and ...
PPTX PowerPoint Presentation
Type I diabetes is characterized by absolute insulin deficiency. Usually occurs in children and young adults. It is characterized as an autoimmune disorder resulting from the combination of genetic and unknown environmental factors. More common in the athletic population than type II. Athletes with diabetes can compete at the highest level with ...
Type1 Diabetes PowerPoint Template
Disease. Leverage our Type 1 Diabetes PPT template to describe the chronic autoimmune condition in which the pancreas stops making insulin in the body, resulting in very high blood sugar levels and life-threatening complications. Diabetologists can take advantage of this entirely editable deck to explain how carb counting, exercising, and ...
Diabetes Mellitus Powerpoint
Diabetes Mellitus Powerpoint - Free download as Powerpoint Presentation (.ppt / .pptx), PDF File (.pdf), Text File (.txt) or view presentation slides online. This document provides information about diabetes mellitus, including the different types and their symptoms and treatment. There are three main types of diabetes: type 1 caused by the immune system attacking the pancreas and requiring ...
Diabetes powerpoint
M. There are four main types of diabetes: type 1, type 2, gestational diabetes, and pre-diabetes. Type 1 is usually diagnosed in childhood and requires daily insulin injections. Type 2 is the most common type and is often linked to obesity. Gestational diabetes occurs during pregnancy, and pre-diabetes means blood sugar levels are higher than ...
PPT
Type 1 Diabetes mellitus (DM) Type 2 Diabetes mellitus (DM) Gestational Diabetes. Type 1: Overview. Usually diagnosed in children and young adults. Previously known as "juvenile diabetes". 907 views • 38 slides. Type 1 Diabetes. Type 1 Diabetes. Karen S. Penko, MD Fellow, Pediatric Endocrinology September 2005. PREP Content Specifications.
PDF American Diabetes Association Showcases Innovations and Guidance for
benefits of early detection of type 1 diabetes, including reduced risk of diabetic ketoacidosis at diagnosis, increased planning and preparation time, and the opportunity to consider research aimed at delaying and preventing type 1 diabetes. "We are experiencing a paradigm shift in type 1 diabetes care, and we can now identify
PDF Sit with your Game Show Network Family!
Family Fuse Question #1 1. Alumni Band 11. 2. Young Alumni 9. 3. Lyman T. Johnson 7. 4. Pride Cats 6 ... • Diabetes and obesity • Energy • Equity • Materials science • Neuroscience ... PowerPoint Presentation Author: Stamper, Whitney L. Created Date:
Early pregnancy HbA1c as the first screening test for gestational
After excluding early pregnancy type 2 diabetes and gestational diabetes at booking, 407 (19·2%) women in India and 65 (3·0%) women in Kenya had gestational diabetes based on OGTTs . Baseline characteristics of participants with and without gestational diabetes are shown in Table 1 , Table 2 .
PPT
Type 1 Diabetes in Adults. Andrej Janež, MD PhD Dept. of Endocrinology Diabetes and Metabolic Diseases University Medical Center Ljubljana. Prevalence of Diabetes in the United States. US Population: 275 Million in 2000. Undiagnosed diabetes 5.2 million . Diagnosed type 2 diabetes. Download Presentation.
PDF Centers for Disease Control and Prevention
6 RSV was associated with1 90,000 - 140,000 annual hospitalizations in U.S. adults aged 65 years and older and 10,000 - 20,000 annual hospitalizations in U.S. adults aged 60-64 years Influenza* was associated with2 170,000 - 470,000 annual hospitalizations in U.S. adults aged 65 years and older During 2016-2020, CDC estimates: 1.