Type 1 diabetes

Type 1 diabetes is a chronic autoimmune disease characterised by insulin deficiency and resultant hyperglycaemia. Knowledge of type 1 diabetes has rapidly increased over the past 25 years, resulting in a broad understanding about many aspects of the disease, including its genetics, epidemiology, immune and β-cell phenotypes, and disease burden. Interventions to preserve β cells have been tested, and several methods to improve clinical disease management have been assessed. However, wide gaps still exist in our understanding of type 1 diabetes and our ability to standardise clinical care and decrease disease-associated complications and burden. This Seminar gives an overview of the current understanding of the disease and potential future directions for research and care

Type 1 diabetes in children

Many children are not diagnosed early enough. Nicky Kime highlights the symptoms and importance of an accurate early diagnosis

Cell Therapy for Type 1 Diabetes

Acknowledgements The work described in this review was supported by a grant from the MRC. K.R.M. is supported by a fellowship from the Scottish Translational Medicines and Therapeutics Initiative through the Wellcome Trust.Peer reviewedPublisher PD

Type 1 diabetes and cardiovascular disease

The presence of cardiovascular disease (CVD) in Type 1 diabetes largely impairs life expectancy. Hyperglycemia leading to an increase in oxidative stress is considered to be the key pathophysiological factor of both micro- and macrovascular complications. In Type 1 diabetes, the presence of coronary calcifications is also related to coronary artery disease. Cardiac autonomic neuropathy, which significantly impairs myocardial function and blood flow, also enhances cardiac abnormalities. Also hypoglycemic episodes are considered to adversely influence cardiac performance. Intensive insulin therapy has been demonstrated to reduce the occurrence and progression of both micro- and macrovascular complications. This has been evidenced by the Diabetes Control and Complications Trial (DCCT) / Epidemiology of Diabetes Interventions and Complications (EDIC) study. The concept of a metabolic memory emerged based on the results of the study, which established that intensified insulin therapy is the standard of treatment of Type 1 diabetes. Future therapies may also include glucagon-like peptide (GLP)-based treatment therapies. Pilot studies with GLP-1-analogues have been shown to reduce insulin requirements

Incidence of type 1 diabetes in Australia 2000–2013

Presents the latest available national data on new cases of type 1 diabetes from Australia’s National (insulin-treated) Diabetes Register. In 2013, there were 2,323 new cases of type 1 diabetes in Australia, equating to 11 cases per 100,000 population. This rate has remained relatively stable between 2000 and 2013, fluctuating between 10 and 13 cases per 100,000 population each year. Summary Type 1 diabetes is a lifelong autoimmune  disease requiring management  with insulin to ensure blood glucose levels remain within a safe range. If left untreated, or improperly managed, type 1 diabetes can lead to many health complications. This report uses the latest available data from the National (insulin-treated) Diabetes Register to examine the incidence-that is, the number of new cases-of type 1 diabetes in Australia. From 2000 to 2013 there were 31,895 new cases of type 1 diabetes in Australia, with 2,323 of these in 2013. The rate of type 1 diabetes has remained stable for more than a decade, at around 10 to 13 cases per 100,000 population each year. The incidence of type 1 diabetes was higher for males than for females-12 per 100,000 compared with 9 per 100,000, respectively, in 2013. More than half of all new cases of type 1 diabetes were in people aged under 18 years. Rates were 3 times as high among 0-14 years olds (24 per 100,000 population) compared with those aged 15 and over (8 per 100,000 population). The rate of type 1 diabetes was lowest in the Northern Territory, at 6 per 100,000 population, compared with other states and territories, which ranged  from 11 to 13 per 100,000 population between 2000 and 2013. From 2001-2013, the rate of type 1 diabetes was lower in remote and very remote areas compared with other areas of Australia-7 cases per 100,000 population compared with 11-13 per 100,000, respectively. Aboriginal and Torres Strait Islander people had a lower incidence of type 1 diabetes than non-Indigenous  Australians: 7 per 1000,000 population and 10 per 100,000, respectively, in 2005-2013

Prevalence of type 1 diabetes among children aged 0–14 in Australia 2013

Prevalence of type 1 diabetes among children aged 0–14 in Australia 2013 presents the first national picture of children aged 0–14 living with type 1 diabetes in Australia. The report, based on data from the National (insulin-treated) Diabetes Register, highlights that in 2013, 6,091 children aged 0–14 had type 1 diabetes in Australia. This represented 139 cases per 100,000 population, or about 1 in 720 Australians aged 0–14. About 2 in 5 children with type 1 diabetes used an insulin pump to administer insulin. The prevalence of type 1 diabetes among children differed by age, state/territory, and residential remoteness areas

A new perspective on metformin therapy in type 1 diabetes

Metformin is quite frequently used off-label in type 1 diabetes to limit insulin dose requirement. Guidelines recommend that it can improve glucose control in those who are overweight and obese but evidence in support of this is limited. Recently-published findings from the REducing with MetfOrmin Vascular Adverse Lesions (REMOVAL) trial suggest that metformin therapy in type 1 diabetes can reduce atherosclerosis progression, weight and LDL-cholesterol levels. This provides a new perspective on metformin therapy in type 1 diabetes and suggests a potential role for reducing the long-term risk of cardiovascular disease

Insulin resistance in type 1 diabetes: what is ‘double diabetes’ and what are the risks?

In this review, we explore the concept of ‘double diabetes’, a combination of type 1 diabetes with features of insulin resistance and type 2 diabetes. After considering whether double diabetes is a useful concept, we discuss potential mechanisms of increased insulin resistance in type 1 diabetes before examining the extent to which double diabetes might increase the risk of cardiovascular disease (CVD). We then go on to consider the proposal that weight gain from intensive insulin regimens may be associated with increased CV risk factors in some patients with type 1 diabetes, and explore the complex relationships between weight gain, insulin resistance, glycaemic control and CV outcome. Important comparisons and contrasts between type 1 diabetes and type 2 diabetes are highlighted in terms of hepatic fat, fat partitioning and lipid profile, and how these may differ between type 1 diabetic patients with and without double diabetes. In so doing, we hope this work will stimulate much-needed research in this area and an improvement in clinical practice

Urinary C-peptide Creatinine Ratio in pregnant women with normal glucose tolerance and type 1 diabetes: evidence for insulin secretion

Hypothesis In pregnancy, urinary C peptide creatinine ratio (UCPCR) reflects endogenous insulin secretion in women with normal glucose tolerance and type 1 diabetes. Research design and methods UCPCR and serum C peptide were measured in 90 glucose-tolerant women at 0 and 120 min during a 75 g oral glucose tolerance test (OGTT) at 28 weeks of gestation. UCPCR was measured in 2 samples obtained over 10 weeks apart in 7 pregnant women with longstanding type 1 diabetes. Results UCPCROGTT and serum C peptideOGTT of glucose-tolerant women were significantly correlated at 0 and 120 min (rs0.675, 0.541 respectively, p<0.0001). All 7 pregnant women with type 1 diabetes had detectable first sample UCPCR (median (range) 49 (6–1038) pmol/mmol) that rose in 6 women by 477 (29–1491) pmol/mmol. Conclusions Detectable UCPCR in pregnant women with normal glucose tolerance and type 1 diabetes is likely to reflect endogenous insulin secretion and hence β-cell activity