Type 1 Diabetes, An Issue of Endocrinology and Metabolism Clinics of North America

Mark Atkinson, Michael Haller, Desmond A. Schatz

Description

This issue of Endocrinology and Metabolism Clinics of North America provides the endocrinologist with essential updates on treatment of type 1 diabetes, with an eye toward future trends and developments. The Guest Editors brought together a remarkable group of notable authors, such as Paul Robertson, President of the National Diabetes Association. Topics covered include epidemiology; economics; contemporary management; inpatient management; update on insulin pumps and continuous glucose monitoring systems; update on studies aimed at interdicting and preventing type 1 diabetes; advances in the prediction, natural history, and mechanisms leading to type 1 diabetes; complications; hypoglycemia in type 1 diabetes; new lessons from animal models; the role of the gut in the genesis of type 1 diabetes and other autoimmune diseases; and an update on transplantation for reversing type 1 diabetes.

Sujets

• Médecine
• Spécialités médicales
• Medical
• Metabolism
• Endocrinology

Informations

• Publié par: Saunders
• Date de parution: 28 septembre 2010
• Nombre de lectures: 0
• EAN13: 9781455700271
• Langue: English
• Poids de l'ouvrage: 2 Mo

Extrait

Endocrinology and Metabolism Clinics of North America , Vol. 39, No. 3, September 2010
ISSN: 0889-8529
doi: 10.1016/S0889-8529(10)00052-6

Contributors
Endocrinology and Metabolism Clinics of North America
Type I Diabetes
Desmond A. Schatz
Division of Endocrinology, Department of Pediatrics, University of Florida, PO Box 100296, Gainesville, FL 32610, USA
Michael J. Haller
Division of Endocrinology, Department of Pediatrics, University of Florida, PO Box 100296, Gainesville, FL 32610, USA
Mark A. Atkinson
Department of Pathology, University of Florida, PO Box 100275, Gainesville, FL 32610, USA
ISSN  0889-8529
Volume 39 • Number 3 • September 2010

Contents
Cover
Contributors
Forthcoming Issues
Foreword
Preface
Epidemiology of Type 1 Diabetes
Economics of Type 1 Diabetes
Advances in the Prediction and Natural History of Type 1 Diabetes
Efforts to Prevent and Halt Autoimmune Beta Cell Destruction
Use of Nonobese Diabetic Mice to Understand Human Type 1 Diabetes
The Intestinal Microbiome: Relationship to Type 1 Diabetes
Contemporary Management of Patients with Type 1 Diabetes
Inpatient Management of Adults and Children with Type 1 Diabetes
Toward Closing the Loop: An Update on Insulin Pumps and Continuous Glucose Monitoring Systems
Complications of Type 1 Diabetes
Hypoglycemia in Type 1 Diabetes Mellitus
Update on Transplanting Beta Cells for Reversing Type 1 Diabetes
Index
Endocrinology and Metabolism Clinics of North America , Vol. 39, No. 3, September 2010
ISSN: 0889-8529
doi: 10.1016/S0889-8529(10)00054-X

Forthcoming Issues
Endocrinology and Metabolism Clinics of North America , Vol. 39, No. 3, September 2010
ISSN: 0889-8529
doi: 10.1016/j.ecl.2010.05.013

Foreword

Derek LeRoith, MD, PhD
Division of Endocrinology, Metabolism, and Bone Diseases, Department of Medicine, Mount Sinai School of Medicine, One Gustave L. Levy Place Box 1055, Altran 4-36 New York, NY 10029, USA
E-mail address: [e-mail]


Derek LeRoith, MD, PhD Consulting editors
In this issue highlighting recent advances in type 1 diabetes, the editorial team has expertly compiled articles covering the entire spectrum of the disease. From pathophysiology to clinical management and ongoing bench and clinical research efforts, this edition represents a major contribution to academic and practicing physicians involved in type 1 diabetes research and management.
An article from Drs Maahs, West, Mayer-Davis, and Lawrence starts off this series and discusses the epidemiology of type 1 diabetes. These studies in various countries and ethnic populations are important for improving our understanding of the genetic and environmental factors that are causative for the disease. This improved understanding can lead to new ideas on prevention of the disease.
The article from Drs Tao and Taylor shines a much-needed light on the detailed costs of living with type 1 diabetes. Although type 1 diabetes represents 6% to 7% of the diabetic population, the economic burden for this disorder is much greater. Type 1 diabetes often starts early and the cost over years is cumulative. The costs of concomitant autoimmune disorders, the effect of type 1 diabetes on lifestyle, days off schooling and work, and the emotional toll of living with type 1 diabetes are substantial and are examined in detail in this important article.
In addition to an improved understanding of the genetic and environmental triggers of type 1 diabetes, the past 30 years have seen marked advances in our understanding of the natural history of “pre–type 1 diabetes.” Drs Bonifacio and Ziegler continue this edition with a discussion of biomarkers used in the prediction of type 1 diabetes. In a very scholarly article, they point out the caveats involved in prediction models and emphasize the need for further research.
The pursuit of a “cure” for type 1 diabetes remains the ultimate dream for all involved in diabetes care and research. In a rather erudite article, Drs Haller, Atkinson, and Schatz discuss various therapeutic trials both completed as well as ongoing to achieve primary prevention, secondary prevention, or even reversal of autoimmunity. Using a “bench to the bedside” approach, the authors emphasize the many difficulties investigators and patients face in designing and participating in type 1 diabetes clinical trials.
Drs Thayer, Wilson, and Mathews describe the value of using the nonobese diabetic (NOD) mouse as a model that resembles human type 1 diabetes, including genetic and other pathogenic mechanisms. Although the NOD mouse shares many features of human type 1 diabetes and has been touted as representing an excellent model for studying “prevention” of the disorder, the authors correctly point out some important caveats, namely that the disease process is much more rapid in NOD mice, and their response to various manipulations does not always extrapolate to responses by type 1 patients.
Emerging evidence strongly supports the role of the gut microbiome in various human diseases. For example, the microbiome has been implicated as playing a significant role in obesity as well as inflammatory bowl disease. Drs Neu, Lorca, Kingma, and Triplett describe how the microbiome, through its interaction with gut mucosa, may affect the innate immune system, thereby adding to the potential environmental factors that are causative in the development of autoimmunity and, subsequently, type 1 diabetes.
Moving back from the research front to the patient's bedside, Drs Mehta and Wolfsdorf discuss insulin analogs and technology currently used in the management of type 1 diabetes. The past two decades have seen marked improvements in methods for insulin delivery and blood glucose monitoring, as well as better implementation of lifestyle change emphasis on medical nutritional therapy as a component of diabetes management. These advances have played a key role in our ability to control blood glucose and lower hemoglobin A 1 C .
Given the advances in diabetes management, Drs Tridgell, Tridgell, and Hirsch make a strong case for good (albeit not overzealous) control given recent controversies surrounding intensive glycemic control of hyperglycemia in hospitalized patients. They discuss the benefits of glycemic control in reducing hospital complications and shortening admission while attempting to avoid the potential complications associated with hypoglycemia. In providing practical advice on insulin therapy, this article emphasizes that “sliding scale therapy” should not be considered standard of care. Instead, hospitalized patients with type 1 diabetes should be treated with insulin infusions or basal-bolus regimens using analog insulins.
Moving further along the pathway toward using technology in type 1 diabetes, Drs Aye, Block, and Buckingham explore the development of the artificial pancreas. The closed-loop system has long been considered the Holy Grail for health care professionals treating patients with type 1 diabetes. Although various devices have been developed and are improving at impressive speeds, there remain a number of important challenges. Accuracy of glucose monitoring, delay in insulin effects, and avoidance of hypoglycemia must be perfected before the artificial pancreas becomes a reality.
Despite the many improvements in diabetes management, the risk of complications remains a formidable opponent for patients living with type 1 diabetes. Complications of type 1 diabetes are discussed by Drs Melendez-Ramiraz, Richards, and Cefalu. Although the classic microvascular complications, such as retinopathy, nephropathy, and neuropathy, are clearly related to glycemic control, as shown by the Diabetes Control and Complications Trial, the follow-up study showed that delayed macrovascular effects may also be prevented in the patient with type 1 diabetes, by judicious glycemic control. The authors also discuss the evidence of genetics that may affect complications, such as the emerging studies on haptoglobin genes.
To avoid the complications associated with type 1 diabetes, the primary goal of therapy is to achieve the best possible level hemoglobin A 1 C without causing recurrent severe hypoglycemia. Dr Cryer discusses the pathophysiology of hypoglycemia, hypoglycemia unawareness, and the fear of hypoglycemia that keep many patients from achieving optimal control. This article also reviews the morbidity and rare occurrence of mortality associated with hypoglycemia.
Recurrent hypoglycemia is often cited as a reason to consider pancreatic transplantation. As discussed by Dr Robertson in his article, pancreatic transplantation has a longer and more successful history than islet cell transplantation. Whole pancreas transplantation succeeds in more than 75% to 80% of cases and the patients often remain off insulin therapy and a reduction in microvascular complications has been demonstrated. The same cannot be said, as yet, for pancreatic islet cell transplantation, although there is hope for similar results assuming sufficient donor islets can be obtained in the future. In both cases, immunosuppression is required that in the past led to complications, although newer drug regimens offer the promise of successful transplantation with fewer side effects.
Reading the articles in this issue has been tremendously enlightening. This collection of articles provides a thorough discussion of the past and, more importantly, a glimpse at the future for diabetes research and care. On behalf of the editors, we hope you find this edition of Endocrinology and Metabolism Clinics of North America helpful in furthering your understanding of type 1 diabetes.
Endocrinology and Metabolism Clinics of North America , Vol. 39, No. 3, September 2010
ISSN: 0889-8529
doi: 10.1016/j.ecl.2010.05.012

Preface

Desmond A. Schatz, MD
Division of Endocrinology, Department of Pediatrics, University of Florida, PO Box 1002