Prevention of Type 1 Diabetes: Past Experiences and Future Opportunities

Type 1 diabetes (T1D) results from autoimmune destruction of insulin-producing beta-cells in the pancreas, caused by the interplay of genetic and environmental factors. Despite the introduction of advanced technologies for diabetes management, most patients fail to achieve target glycemic control, and T1D still has a high burden of long-term end-organ complications. Over several decades, multiple clinical trials have attempted to find prevention for T1D in at-risk individuals or to stabilize, ultimately reverse, the disease in those with T1D. To date, T1D remains yet incurable condition; however, recently improved understanding of the natural history of the disease may lead to new strategies to preserve or improve beta-cell function in those at increased risk and T1D patients. This publication aims to provide an overview of past experiences and recent findings in the prevention of T1D.

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Pregnancy and delivery in a patient with a 40-year history of type 1 diabetes mellitus and antiphospholipid syndrome

Journal of obstetrics and women s diseases ◽

10.17816/jowd67693-99 ◽

2018 ◽

Vol 67 (6) ◽

pp. 93-99

Author(s):

Roman V. Kapustin ◽

Natalia V. Borovik ◽

Ekaterina V. Musina ◽

Olga N. Arzhanova ◽

Maria I. Yarmolinskaya ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Type 1 Diabetes Mellitus ◽

Antiphospholipid Syndrome ◽

Perinatal Outcomes ◽

Increased Risk ◽

Pregnancy And Delivery ◽

Perinatal Center ◽

History Of

Type 1 diabetes mellitus is a condition associated with an increased risk of adverse perinatal outcomes such as spontaneous abortions, preterm birth, placental insufficiency, congenital malformations, and perinatal mortality. Diabetes mellitus combined with cardiovascular diseases in women during pregnancy often leads to hypertensive disorders and pre-eclampsia. The severity of the microvascular diabetic complications and frequency of hypoglycemic episodes, particularly in early pregnancy, are related to the risk of pre-eclampsia. We report the case of pregnancy and delivery of a live newborn in a 42-year-old woman with type 1 diabetes mellitus, pre-existing hypertension, heritable thrombophilia, and antiphospholipid syndrome. She had a 40-year history of type 1 diabetes mellitus with well-controlled diabetic nephropathy and retinopathy. The woman had been receiving continuous subcutaneous insulin therapy for the last five years, which allowed maintaining an appropriate glycemic control during pregnancy. Multidisciplinary supervision of course of pregnancy was carried out from the pre-gravidity stage until delivery and postpartum. In spite of the severe pre-eclampsia and preterm delivery by cesarean section at 36 weeks, she and newborn could avoid the intensive unit care and discharge from perinatal center without any complications.

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The impact of parental risk factors on the risk of stroke in type 1 diabetes

Acta Diabetologica ◽

10.1007/s00592-021-01694-x ◽

2021 ◽

Author(s):

Anni Ylinen ◽

◽

Stefanie Hägg-Holmberg ◽

Marika I. Eriksson ◽

Carol Forsblom ◽

...

Keyword(s):

Risk Factors ◽

Type 1 Diabetes ◽

Hemorrhagic Stroke ◽

Cox Regression Analysis ◽

Parental Risk Factors ◽

Increased Risk ◽

History Of ◽

The Impact

Abstract Background Individuals with type 1 diabetes have a markedly increased risk of stroke. In the general population, genetic predisposition has been linked to increased risk of stroke, but this has not been assessed in type 1 diabetes. Our aim was, therefore, to study how parental risk factors affect the risk of stroke in individuals with type 1 diabetes. Methods This study represents an observational follow-up of 4011 individuals from the Finnish Diabetic Nephropathy Study, mean age at baseline 37.6 ± 11.9 years. All strokes during follow-up were verified from medical records or death certificates. The strokes were classified as either ischemic or hemorrhagic. All individuals filled out questionnaires concerning their parents’ medical history of hypertension, diabetes, stroke, and/or myocardial infarction. Results During a median follow-up of 12.4 (10.9–14.2) years, 188 individuals (4.6%) were diagnosed with their first ever stroke; 134 were ischemic and 54 hemorrhagic. In Cox regression analysis, a history of maternal stroke increased the risk of hemorrhagic stroke, hazard ratio 2.86 (95% confidence interval 1.27–6.44, p = 0.011) after adjustment for sex, age, BMI, retinal photocoagulation, and diabetic kidney disease. There was, however, no association between maternal stroke and ischemic stroke. No other associations between parental risk factors and ischemic or hemorrhagic stroke were observed. Conclusion A history of maternal stroke increases the risk of hemorrhagic stroke in individuals with type 1 diabetes. Other parental risk factors seem to have limited impact on the risk of stroke.

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Stress, Self-Efficacy, Worries, and Challenges for Caregivers of Children with Type 1 Diabetes During the COVID-19 Pandemic

Proceedings of IMPRS ◽

10.18060/24619 ◽

2020 ◽

Vol 3 ◽

Author(s):

Breanne Hand ◽

Priya Soni ◽

Rebecca Oyetoro ◽

Anastasia Albanese-O’Neill ◽

Heba Ismail ◽

...

Keyword(s):

Mental Health ◽

Type 1 Diabetes ◽

Self Efficacy ◽

Diabetes Management ◽

Short Form ◽

Severe Disease ◽

Measurement Information ◽

Increased Risk ◽

Patient Reported

Background: Approximately 200,000 American youth live with Type 1 Diabetes (T1D). Intensive daily management is critical to optimize disease outcomes. Little is known about COVID-19 pandemic effects on persons with T1D and their caregivers. We hypothesized caregivers would report increased stress, lower self-efficacy (SE), and more difficult diabetes management associated with the pandemic. Methods: A 49-item survey using Likert scales and open-ended response questions was distributed via email and T1D-related social media platforms from May 4-June 2,2020 to caregivers of children with T1D <18 years of age. The Patient-Reported Outcomes Measurement Information System (PROMIS) SE short form was used to measure general SE. Results: 260 caregivers completed surveys: 94.2% female, mean age 42.4±7.7 years, 80.3% college degree or higher, 53.8% annual income >$99,000, 77.3% privately insured. Mean child age 11.0±4.1 years, mean T1D duration 4.2±3.4 years. 24.2% reported having COVID-19 or knowing someone diagnosed with COVID-19. 71.9% reported greater stress than before the pandemic. 9.6% reported job loss, 25.8% financial difficulty related to COVID-19. General SE levels were high, significantly correlated with overall COVID-19-related SE (r=0.394, p<0.001), and T1D care-SE during COVID-19 (r=0.421, p<0.001). 210 respondents provided open-ended response qualitative information on worries: 87.6% reported a worry, remainder not worried. Common worries were COVID-19-related diabetes complications including uncontrolled blood sugars, diabetic ketoacidosis, and worry about child’s increased risk for severe disease, including death. 209 reported about challenges; 90.9% stated they had at least one challenge. Family isolation and mental health were the most-stated challenges. Conclusion: Despite reporting high overall SE, caregivers of T1D children during the pandemic reported greater overall stress, worries, and challenges. Given that data do not suggest that children with T1D are at increased risk of COVID-19 complications, healthcare providers should work to address this knowledge gap while providing families with social and mental health supports.

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Natural History of -Cell Function in Type 1 Diabetes

Diabetes ◽

10.2337/diabetes.54.suppl_2.s32 ◽

2005 ◽

Vol 54 (Supplement 2) ◽

pp. S32-S39 ◽

Cited By ~ 99

Author(s):

N. A. Sherry ◽

E. B. Tsai ◽

K. C. Herold

Keyword(s):

Type 1 Diabetes ◽

Natural History ◽

Cell Function ◽

History Of

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Iowa Gambling Task Performance Prospectively Predicts Changes in Glycemic Control among Adolescents with Type 1 Diabetes

Journal of the International Neuropsychological Society ◽

10.1017/s135561771600103x ◽

2017 ◽

Vol 23 (3) ◽

pp. 204-213 ◽

Cited By ~ 3

Author(s):

Yana Suchy ◽

Tara L. Queen ◽

Bryce Huntbach ◽

Deborah J. Wiebe ◽

Sara L. Turner ◽

...

Keyword(s):

At Risk ◽

Type 1 Diabetes ◽

Glycemic Control ◽

Iowa Gambling Task ◽

Diabetes Management ◽

Moderate Increase ◽

Late Adolescents ◽

Gambling Task ◽

Increased Risk

AbstractObjectives: Good glycemic control is an important goal of diabetes management. Late adolescents with type 1 diabetes (T1D) are at risk for poor glycemic control as they move into young adulthood. For a subset of these patients, this dysregulation is extreme, placing them at risk for life-threatening health complications and permanent cognitive declines. The present study examined whether deficiency in emotional decision making (as measured by the Iowa Gambling Task; IGT) among teens with T1D may represent a neurocognitive risk factor for subsequent glycemic dysregulation. Methods: As part of a larger longitudinal study, a total of 241 high-school seniors (147 females, 94 males) diagnosed with T1D underwent baseline assessment that included the IGT. Glycated hemoglobin (HbA1c), which reflects glycemic control over the course of the past 2 to 3 months, was also assessed at baseline. Of the 241,189 (127 females, 62 males, mean age=17.76, mean HbA1c=8.11) completed HbA1c measurement 1 year later. Results: Baseline IGT performance in the impaired range (per norms) was associated with greater dysregulation in glycemic control 1 year later, as evidenced by an average increase in HbA1c of 2%. Those with normal IGT scores (per norms) exhibited a more moderate increase in glycemic control, with an HbA1c increase of 0.7%. Several IGT scoring approaches were compared, showing that the total scores collapsed across all trials was most sensitive to change in glycemic control. Conclusions: IGT assessment offers promise as a tool for identifying late adolescents at increased risk for glycemic dysregulation. (JINS, 2017, 23, 204–213)

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