Emerging Trends — Type 1 Diabetes

1. Type 1 at 21? Emerging trends in diabetes Alex McConville Ithaca College The World Health Organization projects that deaths caused by diabetes and its complications will double between 2005 and 2030, while the Centers for Disease Control and Prevention estimates that 1 in 3 US adults could have diabetes by 2050. Currently, 1 in 10 adults are diabetic, according to World Health statistics 2012. In the US 25.6 million or 11.3% of 20 years or older have Diabetes. Type 1 Diabetes accounts for about 5-10% of Diabetes with Type 2 Diabetes being more prevalent due to weight, inactivity, poor nutrition, genetics, and environmental factors. Percentage of Health Expenditures Related to Diabetes Care Diabetes: The Epidemic Percentage of Adults with Diabetes Reporting Any Mobility Limitation by Age Latent Autoimmune Diabetes in Adults (LADA) Type 1 Diabetes can have a latent onset occurring between 15-50 years of age. Like those with type 2 diabetes, most people with LADA still produce their own insulin when first diagnosed. In the early stages of the disease, people with LADA may not require insulin injections. Often they can control their blood glucose levels with meal planning, physical activity, and oral diabetes medications. With time they must begin taking insulin to control their blood glucose. As it progresses, the beta cells of the pancreas will no longer make insulin because the body’s immune system has attacked and destroyed them, as in type 1 diabetes. It is estimated that as many as 10 percent of people diagnosed with type 2 diabetes have LADA. In 30-50 year olds type 1 diabetes accounts for 13% of all new Diabetes cases. The annual incidence is 15/100,000 in the 15-34 year age group, increasing by 2.8% annually and is 7/100,000 in the 30-50 year age group. Figure 7. US Department of Health and Human Services. Estimated % of Health Expenditures on State Government Employees that Relates to Diabetes Care. States are significant purchasers of health care Get Tested! Call your local Health Department to get tested quick, easy, and free Tests Fasting blood glucose level: Diabetes is diagnosed if it is higher than 126 mg/dL two times Random (non-fasting) blood glucose level: You may have diabetes if it is higher than 200 mg/dL, and you have symptoms (this must be confirmed with a fasting test) Oral glucose tolerance test: Diabetes is diagnosed if the glucose level is higher than 200 mg/dL after 2 hours Hemoglobin A1c test: Normal: Less than 5.7% Pre-diabetes: Between 5.7% and 6.4% Diabetes: 6.5% or higher Treatment Figure 4. (CDC) United States, 1997–2010. Recently researchers have discovered that many cases of Type 2 Diabetes are misdiagnosed and are Latent onsets of Type 1 Diabetes. Risk Factors of Type 1 Diabetes Family History: Genes indicate an increased risk of type 1 Diabetes Geography: Incidence of type 1 diabetes increases away from the equator. Finland and Sardinia have the highest incidence — about 2-3 times higher than rates in the United States and 400 times that of people living in Venezuela Viral Exposures: Can trigger the autoimmune destruction of the islet cells or the virus may infect the islet cells Vitamin D: May be protective against type 1 diabetes Omega-3 fatty acids: May offer some protection against type 1 diabetes Drinking Water: Water containing nitrates may increase the risk Figure 1. Illustration of number of and percentage of US population that has been diagnosed with Diabetes from 1958-2009. There has been an increase across all populations in diagnosed with Diabetes in the US. Figure 2. Demonstrates the process in which food is broken down into glucose and then enters the bloodstream to be broken down by Insulin produced by the Pancreas. Those with Type 1 and 2 Diabetes don’t produce any or enough Insulin. Figure 3. Shows the average age at onset of different types of diabetes. Black circle: significantly lower age of onset in type 1 diabetes compared to type 2 diabetes and undiagnosed patients Black square: significantly higher age of onset in type 2 diabetes compared to undiagnosed patients Black triangle: significantly lower age of onset in LADA compared to type 2 diabetes and higher than Type 1. Source: Characteristics and Prevalence of Latent Autoimmune Diabetes in Adults (LADA) 2011. Figure 5. Shows that the major contributing factors to Type 1 Diabetes are genetics Signs and Symptoms of LADA Emerging Trends —Type 1 Diabetes Type 1 Diabetes was previously called insulin-dependent diabetes mellitus (IDDM) or juvenile-onset diabetes. It is an autoimmune disease where the immune system attacks and destroys the insulin-producing beta cells in the pancreas. These pancreatic beta cells are the only cells in the body that make the hormone insulin that regulates blood glucose. The pancreas then produces little or no insulin. Resulting in the person needing to take insulin everyday. Scientists do not know exactly what causes the body’s immune system to attack the beta cells. Complications associated with LADA Type 1 Diabetes can affect many organs including the heart, blood vessels, nerves, eyes and kidneys. Long term complications develop gradually over time and can be disabling or life threatening. Symptoms usually develop over a short period, although beta cell destruction can begin years earlier, in LADA the process develops over a long period of time. If not diagnosed and treated one can lapse into a life-threatening diabetic coma, also known as diabetic ketoacidosis. Fruits, veggies, dieting, and exercise Insulin Pumps Insulin Syringe For further information Please contact amcconv1@ithaca.edufor more information on this and related projects can be obtained by contact. Literature cited American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. Jan 2007;30 Suppl 1:S2-7 Brahmkshatriya P, Mehta A, Saboo B, & Goyal R. Characteristics and Prevalence of Latent Autoimmune Diabetes in Adults (LADA). ISRN Pharmacology: Nov 2011. Farmer A, Fox R, Lasserson D. Easily Missed? Late onset type 1 diabetes. BJM. Apr 2012;344. Ludwig J, Sanbonmatsu L, Gennetian L, et al. Neighborhoods, obesity, and diabetes--a randomized social experiment. N Engl J Med. Oct 20 2011;365(16):1509-19. 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. Aug 2011;28(8):896-9. 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 Wang TJ, Larson MG, Vasan RS, Cheng S, Rhee EP, McCabe E, et al. Metabolite profiles and the risk of developing diabetes. Nat Med. Apr 2011;17(4):448-53.