A consensus report of a particular topic contains a comprehensive examination and is authored by an expert panel (i.e., consensus panel) and represents the panel’s collective analysis, evaluation, and opinion. In some cases, investigation for pancreatic or other types of diabetes may be appropriate. Based on type 2 diabetes guidelines, moderate-intensity statins should be considered for people aged over 40 years, and in those aged between 20–39 years with additional atherosclerotic cardiovascular disease risk factors or when the 10-year cardiovascular risk estimated by one of the risk calculators suitable for people with type 1 diabetes exceeds 10% (49–51). An assessment of islet autoantibodies at diagnosis is recommended as the primary investigation of an adult with suspected type 1 diabetes. Basic and advanced carbohydrate counting vs. intuitive dosing. In asymptomatic people with type 1 diabetes, routine screening for coronary artery disease is not recommended as it does not improve outcomes as long as atherosclerotic cardiovascular disease risk factors are treated. serves on the advisory board for Abbott Diabetes Care, Eli Lilly, Novo Nordisk, Medscape, and Zealand Pharmaceuticals. Technology and its impact on the ability to have more frequent communication between the person with type 1 diabetes and their health care professional. On the other hand, sleep disturbances including poor sleep quality and shorter sleep duration are associated with worsening glycemic levels in type 1 diabetes (154,155). Specific DSMES should not be confined to one particular moment but offered on a continuous basis and tailored to the ever-evolving individual’s educational needs. Level 3 DSMES refers to structured education that meets nationally agreed criteria, including an evidence-based curriculum, quality assurance of teaching standards, and regular audit. Urine testing, the traditional method, detects acetoacetate, but not β-hydroxybutyrate, which is measured in blood testing. Support for social needs can be provided by a social worker and/or community organization. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Standardized glucose reports with visual cues, such as the ambulatory glucose profile (AGP) and daily tracings, should be available for all CGM devices (Text box: Standardized CGM metrics for Clinical Care) (Fig. Pregnant women with type 1 diabetes are at risk for DKA at lower blood glucose levels than in the nonpregnant state and should receive education on DKA prevention and detection (268). Diabetes hat zwar keinen Einfluss auf die Zeugungsfähigkeit, kann aber durchaus Folgen für die männliche Sexualität haben. The use of longer needles increases the risk of intramuscular injection. Am höchsten ist die Neuerkrankungsrate bei Kindern zwischen 11 und 13 Jahren. Many interventions have been tested in clinical trials but, to date, the most promising results have been from the anti-CD3 monoclonal antibody teplizumab, low-dose antithymocyte globulin (ATG), and the anti-TNF drug, golimumab. DKA is a life-threatening but preventable acute complication of type 1 diabetes, characterized by hyperglycemia, metabolic acidosis, and ketosis. Although first-generation basal analogs and NPH insulin are frequently administered once a day, greater flexibility and better coverage of basal insulin needs may be obtained if they are administered twice daily. Monogenic diabetes is found in approximately 4% of those diagnosed with diabetes before the age of 30 years; the likelihood of monogenic diabetes rises to 20% where islet antibodies are negative and C-peptide secretion is maintained (18). With type 2 diabetes, the more common type, your body does not make or use insulin well. Monogenic diabetes should be considered in those with one or more of the following features: age at diagnosis of less than 35 years, HbA1c <58 mmol/mol (7.5%) at diagnosis, one parent with diabetes, and features of specific monogenic cause (e.g., renal cysts, partial lipodystrophy, maternally inherited deafness, severe insulin resistance in the absence of obesity) (34). Patient information: See related handout on type 1 diabetes, written by the authors of this article. At the first level, people living with type 1 diabetes do not require professional mental health care. This seminal study has been the basis for glycemic target recommendations for type 1 diabetes worldwide. The major risks are from the acute effects of exercise on glucose concentrations, which depend on several factors, including: the baseline fitness of the individual and type, intensity, and the duration of activity; the amount of insulin in the circulation; the blood glucose concentration before exercise; and the composition of the last meal or snack. Particular attention should be made to prevent level 2 and 3 hypoglycemia. He received research support from Tolerion. DSMES is an essential component of type 1 diabetes care that allows all other diabetes interventions to work optimally. were the writing group members for the ADA. received research funding from Afon, Eli Lilly, and Novo Nordisk. Die technische Speicherung oder der Zugriff, der ausschließlich zu statistischen Zwecken erfolgt. Eating disorders, including anorexia nervosa, bulimia nervosa, and binge eating, are overrepresented in type 1 diabetes populations, particularly in young women (193,194) but may also occur in men. Diabeloop, DBLG1, Rock Your Diabetes und YourLoops sind entweder eingetragene Marken oder Marken von Diabeloop SA in Europa und/oder in anderen Ländern. Diabetes self-management education is an effective tool in reducing DKA risk. Health A to Z Type 1 diabetes About type 1 diabetes What is type 1 diabetes? However, these approaches have not been compared with the newer systems of hybrid closed-loop technology, which might render immunosuppression requiring therapies less necessary, in large long-term studies (243). Neben der Behandlung mit Medikamenten gibt es noch weitere, weniger bekannte Methoden, die auch Menschen mit Diabetes mellitus 1 offenstehen. Weight loss and maintenance interventions involving nutritional advice and physical activity should be offered to individuals with type 1 diabetes who have overweight or obesity, in conjunction with other DSMES topics. At the second level, which concerns approximately one-quarter of individuals with type 1 diabetes, some degree of professional psychosocial support is warranted. When glucose can't enter the cells, it builds up in the blood. Persistent C-peptide >600 pmol/L (non fasting) is strongly suggestive of type 2 diabetes, and people with C-peptide in this range are often able to replace insulin with other agents (27–30). Independent effects on β-cell function and HbA1c have not been established beyond doubt but appear beneficial. Insulin analogs are, therefore, considered the insulins of choice. Level 2 refers to ongoing learning that may be informal, perhaps through a peer group. After the acute symptoms have resolved, a further 20 g of long-acting carbohydrate as part of a snack or meal should be given and the cause of the hypoglycemic episode sought to prevent further episodes. 9C-peptide values 200–600 pmol/L are usually consistent with type 1 diabetes or maturity-onset diabetes of the young (MODY) but may occur in insulin-treated type 2 diabetes, particularly in people with normal or low BMI or after long duration. CGM is the standard for glucose monitoring for most adults with type 1 diabetes. A study from the Type 1 Diabetes Exchange clinic registry noted the prevalence of autoimmune disease was 27% in a population of over 25 000 people with type 1 diabetes with a mean age of 23 years. Die technische Speicherung oder der Zugang ist unbedingt erforderlich für den rechtmäßigen Zweck, die Nutzung eines bestimmten Dienstes zu ermöglichen, der vom Teilnehmer oder Nutzer ausdrücklich gewünscht wird, oder für den alleinigen Zweck, die Übertragung einer Nachricht über ein elektronisches Kommunikationsnetz durchzuführen. Misclassification of type 1 diabetes in adults is common, and over 40% of those developing type 1 diabetes after age 30 years are initially treated as having type 2 diabetes (6–8). People with type 1 diabetes should be taught about the effects of exercise on glucose levels and how to balance exogenous insulin delivery and carbohydrate intake for the different forms and intensities of exercise. In people with type 2 diabetes, improved cardiovascular outcomes, mainly due to a reduction in congestive heart failure, and improved renal outcomes have been established, but there are only limited data on the applicability of these findings to people with type 1 diabetes (262,263). In older adults, pancreatic cancer may present with diabetes and weight loss. RCTs of the original is-CGM devices are more mixed, but observational data are supportive of their use. Adults with new-onset type 1 diabetes can present with a short duration of illness of 1–4 weeks or a more slowly evolving process that can be mistaken for type 2 diabetes. With the onset of the coronavirus disease 2019 (COVID-19) pandemic, the use of telemedicine became a necessity and there was an abrupt widespread adoption of remote visits (videoconference/telephone call) to deliver diabetes care. Bei einfachen Störungen ist es nicht notwendig, einen Sexualmediziner aufzusuchen. aIndividuals with type 1 diabetes are also at increased risk for the development of other autoimmune diseases, including autoimmune thyroid disorders, pernicious anemia, celiac disease, collagen vascular diseases, and Addison disease (291,292). This report has covered many areas of the management of type 1 diabetes; however, the writing group recognizes that huge gaps exist in our knowledge in the prevention, diagnosis, and treatment of the disease. GAD should be the primary antibody measured and, if negative, should be followed by islet tyrosine phosphatase 2 (IA2) and/or zinc transporter 8 (ZNT8) where these tests are available. Hypoglycemia is classified into three levels: Level 1 corresponds to a glucose value below 3.9 mmol/L (70 mg/dL) and greater than or equal to 3.0 mmol/L (54 mg/dL) and is named as an alert value. What may not be as well recognized is that level 3 hypoglycemia is also associated with major microvascular events, noncardiovascular disease, and death from any cause, although much of this evidence is obtained from people with type 2 diabetes (108). As there may be a 5–15 min lag between changes in capillary blood glucose and interstitial glucose, the restoration of normoglycemia may not be detected by CGM straight away. Sie kann sich über viele Jahre hinweg entwickeln, wobei Gefäße und Nerven geschädigt sein können, deren Funktion unerlässlich ist, um „einen hoch zu kriegen“. In some individuals, an increased production of anti-insulin antibodies has been observed while using this route of insulin delivery. The choice of the device should be based on individual preferences and circumstances. Most of the available data discussed below are derived from White European populations and may not be representative of other ethnic groups. A framework for the follow-up treatment of an individual with type 1 diabetes. LADA („latent autoimmune diabetes in adults"), ein sich meist langsam entwickelnder Diabetes im höheren Alter, wird dem Typ-1-Diabetes zugeordnet. It appears that older adults with type 1 diabetes are more prone to mild cognitive impairment associated with hypoglycemia (110,111), while hypoglycemia occurs more frequently in those with cognitive impairment. In times of illness and decreased oral intake, advise the patient as follows: Increase blood glucose testing to every two to four hours and contact physician. The ideal regimen of insulin replacement maintains blood glucose in the normal physiological range, as far as possible, while allowing flexibility in terms of mealtimes and activity levels. Mortality from hypoglycemia in type 1 diabetes is not trivial. Where there is a reduced level of consciousness, oral glucose intake is contraindicated because of risk for aspiration. A larger amount of glucose may be needed if glucose levels are below 3.0 mmol/L (54 mg/dL). Effectively managing cardiovascular risk factors. As DKA occurs repeatedly in some people with diabetes, risk factors should be identified and approached in a prevention strategy. One of the most serious acute complications of type 1 diabetes is diabetic ketoacidosis (DKA). A honeymoon can last as little as a week or even up to a year. Less discriminatory features include non-White ethnicity, family history, longer duration and milder severity of symptoms prior to presentation, features of the metabolic syndrome, and absence of a family history of autoimmunity. One of the key issues is protecting the cells from immune attack, both rejection and recurrent autoimmunity. May be lower (e.g., 130/80 mm Hg) in patients at high cardiovascular disease risk and higher (e.g., 120 to 160/80 to 105 mm Hg) in pregnancy, Increased weight or body mass index may correlate with increased insulin resistance, Review glucose levels and symptoms of extremes in glucose levels, Assess for compliance, risk of diabetic ketoacidosis, and risk or presence of hypoglycemia, If not using contraception: prescribe prenatal vitamin, discontinue potentially teratogenic medications, and maximize glycemic control, Inspection, pulses, reflexes, sensation/monofilament, Every visit if neuropathy or peripheral vascular disease is present, Inspection alone may be sufficient for children, Periodontal disease may be more severe in patients with type 1 diabetes, First examination three to five years after onset of type 1 diabetes, More frequently as needed for retinopathy, Less frequently may be appropriate for some persons, Repeat if symptoms suggestive of thyroid disease, Consider immunoglobulin A antibody testing for tissue transglutaminase if symptoms suggestive of celiac disease, Pneumococcal polysaccharide vaccine (Pneumovax 23), Give a second dose if the patient is older than 65 years, received a dose five or more years ago, and was younger than 65 years at that time, For unvaccinated adults 19 to 59 years of age, If 60 years or older, administer based on risk of acquiring disease and likelihood of immune response to vaccination, Per Centers for Disease Control and Prevention, Commonly indicated vaccines: tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap); varicella or age-appropriate zoster; age-appropriate human papillomavirus; and measles, mumps, rubella (MMR), Elective vaccines: meningococcal quadrivalent and B vaccines, pneumococcal conjugate vaccine (Prevnar 13), hepatitis A, and Haemophilus influenzae type b (Hib) vaccine, 150 minutes of moderate to vigorous physical activity per week, Ideally should have access to a registered dietitian, Use validated age appropriate tool (i.e., Diabetes Distress Scale). A well-designed double-blind randomized controlled trial of adults with type 1 diabetes who were taking metformin did not show significant improvement in glycemic control. 7Type 2 diabetes should be strongly considered in older individuals. Polydipsia, or feeling thirsty. A diagnosis of monogenic diabetes allows specific treatment with discontinuation of insulin in many cases and has implications for family members and screening for concurrent conditions (19,20). Alternatively, a patch pump attaches an entire unit directly to the skin, does not require a line of plastic tubing to deliver the insulin to the cannula, and receives insulin delivery programming via a wireless handheld unit.
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