n CME : Your SA Journal of CPD - Type 1 diabetes mellitus : main article
|Article Title||Type 1 diabetes mellitus : main article|
|© Publisher:||Health and Medical Publishing Group (HMPG)|
|Journal||CME : Your SA Journal of CPD|
|Publication Date||Oct 2006|
|Pages||578 - 585|
|Keyword(s)||Classification, Clinical features, Diagnostic criteria, Drug treatment, Evaluation, Monitoring, Non-drug treatment, Pathogenesis, Pathophysiology and Type 1 diabetes mellitus|
The term type 1 diabetes mellitus has replaced insulin-dependent diabetes (IDDM), juvenile-onset diabetes mellitus (JODM) and early-onset diabetes mellitus. The previous names were based on the fact that type 1 diabetics need insulin for life and usually present before the age of 30. <br>Type 1 diabetes mellitus is a disorder characterised by ß-cell destruction, usually leading to absolute insulin deficiency. <br>Type 1 diabetes mellitus is now divided into type 1A (autoimmune) and type 1B (idiopathic). <br>Type 1A diabetes results from cellmediated autoimmune destruction of the <SPAN lang lang=AF style="FONT-FAMILY: Symbol; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman'; mso-char-type: symbol; mso-symbol-font-family: Symbol"><SPAN style="mso-char-type: symbol; mso-symbol-font: Symbol">b</SPAN></SPAN>-cells of the pancreas. <br>Type 1B diabetes is less frequent than type 1A, has no known cause, and most patients are of Asian or African descent. <br>Type 1A diabetes mellitus results from a cell-mediated autoimmune attack on <SPAN lang lang=AF style="FONT-FAMILY: Symbol; mso-ascii-font-family: 'Times New Roman'; mso-hansi-font-family: 'Times New Roman'; mso-char-type: symbol; mso-symbol-font-family: Symbol"><SPAN style="mso-char-type: symbol; mso-symbol-font: Symbol">b</SPAN></SPAN>-cells. It is believed to arise as a result of a combination of genetic and environmental factors. <br>In South Africa about 4 million people are known to have DM. The crude prevalence in a study in Umtata, Eastern Cape, was 2.45%. Diabetes mellitus was responsible for 1.6% of deaths in South African females and 0.9% in males. The 'disability-adjusted life years' (DALY) rate for diabetes mellitus in South Africa ranks second in the world after the American region. <br>Diabetes is strongly associated with certain human leukocyte antigens (HLA). While certain HLA types may confer risk, others have been found to protect against diabetes. <br>The onset of type 1 diabetes is usually abrupt. Symptoms due to hyperglycaemia (polyuria, polydipsia, polyphagia, blurred vision) are common, as are fatigue and unusual weight loss. Impaired growth in children may also be seen. <br>The diagnosis of type 1 diabetes should not be difficult as most patients present with acute symptoms and markedly elevated blood glucose levels. <br>Monitoring of glycaemic status, by patients and health professionals, is a critical component of diabetes care. <br>Urine testing has largely been replaced by self-monitoring of blood glucose (SMBG), which has revolutionised the management of diabetes. Patients with type 1 diabetes should attempt to achieve and maintain blood glucose levels as close to normal as is safely possible. <br>Blood and urine glucose testing are useful for the day-to-day management of diabetes but do not provide any insight into the medium- to long-term control of hyperglycaemia. Here, measurement of glycated proteins such as haemoglobin has revolutionised the management of diabetes. <br>There is overwhelming evidence that good glycaemic control reduces microvascular and neuropathic complications of diabetes. <br>Education, diet and exercise are important in the non-drug treatment of type 1 diabetes mellitus. <br>Insulin therapy is the mainstay of drug treatment of type 1 diabetes mellitus. <br>In South Africa all varieties of insulin are biosynthetic. They are produced using a recombinant DNA technology and the human molecular structure. Only a single strength, 100 units/ml, is available. <br>Patients should keep a diary containing all sugar measurements, insulin doses and untoward symptoms. The data should be reviewed at each visit.
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