Type 1 Diabetes

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Type 1 diabetes, once called juvenile or insulin-dependent diabetes, is usually seen in children and adolescents, but can rarely be seen in adults. Unlike Type 2 diabetes, where the pancreas still makes some insulin, in Type 1 the pancreas makes no insulin. Insulin is a hormone that allows glucose, a simple sugar, to enter cells and produce energy. Glucose is the basic fuel that runs our bodies. It comes from the food we eat, and it is stored in the liver. For reasons not yet fully understood, in Type 1 diabetes the cells in the pancreas that produce insulin are attacked and destroyed by the body’s own immune system. This destruction of these vital cells is thought to be triggered by genetic factors, a viral infection, or both. There is no cure for Type 1 diabetes.

Diabetes has many dangerous complications, including eye damage and blindness (retinopathy), nerve damage (neuropathy), kidney damage and failure (nephropathy), and early heart and vascular disease. These complications often occur sooner in the disease progression, and may be more serious, especially when the diabetes is poorly controlled. Sadly, glycemic (sugar) control remains suboptimal in the majority of adolescents and young adults with Type 1 diabetes, leading to earlier complications and shorter life spans. Diabetic control over time is measured by using hemoglobin A1c levels (A1c), which measure diabetic control over approximately a three-month period. Ideally, A1c levels in diabetics should be between 6% and 7%, with closer to 6% being preferable. In 2019, the American Diabetes Association reported that, in type 1 diabetics, only 17% attained A1c levels of 7.5% or less, and 14% had levels of 7% or less.

Several recent studies have been published which looked at using a relatively new technology to improve glycemic control in young Type 1 diabetics. The technology used by these studies was continuous glucose monitoring, or CGM. CGM uses sensors, either implanted under the skin or attached to the skin, to monitor and report glucose levels, usually via a smartphone. This eliminates the need for the patient to do frequent, painful, fingerstick measurements of glucose levels.

By using CGM, the patient can make frequent changes to insulin doses to keep glucose levels lower. In these studies, short-termed though they were, the authors were able to demonstrate slightly lower A1c levels by using CGM. In theory, lower A1c levels will translate to fewer long-term diabetic complications and longer life spans. This new technology, taken to its ultimate degree, will use CGM, a smart phone, and an implanted insulin pump, allowing the pump to release insulin into the body in response to real-time glucose levels provided by a CGM sensor, essentially mimicking the pancreas’s normal functioning.

While much more research is needed, it is possible that in the not-too-distant future, people with Type 1 diabetes may be able to control the disease, eliminate complications, and live longer, healthier lives.

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By Peter Galvin, MD

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