Type 1 diabetes affects millions of people throughout the world.
It is characterised by insulin deficiency and is caused by the immune system producing auto-antibodies, which target the pancreas and then partially or completely destroy its beta cells.
Pancreatic beta cells are responsible for secreting insulin, an essential hormone for the regulation of blood glucose levels. Their destruction causes a decrease in the production of insulin which then results in a build-up of glucose in the blood, which can lead to an increased risk of hyperglycaemia and other complications (heart disease, blindness, kidney failure...).
For this reason, people with type 1 diabetes are also considered as being insulin-dependent: a supply of insulin is essential to enable people living with type 1 to maintain stable glucose levels as the body is no longer able to produce it in sufficient quantities.
Why is type 1 diabetes an eminently complex disease?
Because the biological mechanisms that trigger its development have not yet been clearly identified. However, the majority of clinical studies agree that the autoimmune reaction specific to type 1 diabetes is often identified after a person with a genetic predisposition has been exposed to one or more environmental factors. These factors appear to "stress" the body cells responsible for the production of insulin and trigger their self-destruction.
Medical research and the considerable technological advances made over the last decade have nonetheless provided a better overview of the factors leading to the appearance of type 1 diabetes, and has therefore developed better diagnosis techniques, better preventive measures and better treatment.
Type 1 diabetes has two predominant symptoms:
- a frequent urge to urinate;
- a feeling of excessive thirst.
In children the condition frequently results in significant weight loss, whereas in adults it often manifests as weight loss while appetite remains unaffected.
Is it possible to prevent the onset of type 1 diabetes?
Despite numerous studies, a clear path to prevention of the onset of diabetes in people at risk has yet to be found, as, in its early stages of development, the condition does not present any symptoms. The duration of this asymptomatic period may vary considerably, spanning several months or years from one individual to another.
To fully understand the development of type 1 diabetes, a combined set of factors needs to be taken into account.
Although some individuals have a genetic predisposition to diabetes, the causes are wide-ranging and the effects of non-genetic factors remains unclear.
The part played by heredity in type 1 diabetes has not yet been clearly defined. Only 13% of patients have at least one parent with type 1 diabetes. Although the risk of transmission increases if both parents are affected, this statistic suggests that environmental influences are also involved in triggering the condition.
Research carried out in recent years has tried to identify which lifestyles, eating habits and other environmental, perinatal or prenatal factors, can be seen as potential triggers of type 1 diabetes.
A number of studies have been carried out to investigate the effects of a wide range of factors, including:
- the mother's age at the time of pregnancy;
- possible consequences of cesarean section;
- diets low in fibre and high in gluten;
- omega-3 and vitamin D deficiency;
- exposure to viral infections;
- the consumption of cow's milk.
However, the results obtained do not appear sufficiently conclusive to say with any certainty that they are likely causes of type 1 diabetes, and more studies are needed to determine their involvement, if any.
Type 1 diabetes in children
Cases of type 1 diabetes are increasing worldwide, and at the time of diagnosis about three-quarters of cases are in children.
In this particularly fragile segment of the population, care can be very challenging and particular attention must be paid to meticulous and regular blood glucose testing. The stakes are high, as poor blood glucose management can lead to long-term complications.
Childhood is a time when we go through an important phase of development and gradually learn self-reliance while remaining dependent on our parents. Several complications are added to daily life for children with type 1 diabetes, such as regular blood glucose testing and administering insulin.
To give children with type 1 their fullest support, parents must ensure that they correctly manage their child’s blood glucose levels, whilst still promoting their social development.
Treatment of type 1 diabetes via insulin therapies has become increasingly widespread over the past 30 years and has greatly improved the life expectancy of people living with diabetes.
Recent technological advances have also greatly improved quality of life for people with type 1 diabetes, particularly by enabling them to limit the risks of severe hypoglycaemia. Among the latest devices available are continuous blood glucose monitoring devices (CGM). And insulin pumps that can provide regular subcutaneous administration of insulin.
- David M Maahs , Nancy A West, Jean M Lawrence, Elizabeth J Mayer-Davis. Epidemiology of type 1 diabetes. Endocrinol Metab Clin North Am. 2010 Sep;39(3):481-97.doi: 10.1016/j.ecl.2010.05.011.
- Jill M Norris , Randi K Johnson , Lars C Stene..Type 1 diabetes-early life origins and changing epidemiology. Lancet Diabetes Endocrinol. 2020 March ; 8(3): 226–238. doi:10.1016/S2213-8587(19)30412-7.
- Jeffrey A Bluestone, Kevan Herold, George Eisenbarth. Genetics, pathogenesis and clinical interventions in type 1 diabetes . Nature 2010 Apr 29;464(7293):1293-300. doi: 10.1038/nature08933.
- Wei Li, Edgar Huang, Sujuan Gao. Type 1 Diabetes Mellitus and Cognitive Impairments: A Systematic Review. J Alzheimers Dis 2017;57(1):29-36. doi: 10.3233/JAD-161250.
- Anette-G Ziegler, Ezio Bonifacio, Alvin C Powers, John A Todd, Leonard C Harrison, Mark A Atkinson. Type 1 Diabetes Prevention: A Goal Dependent on Accepting a Diagnosis of an Asymptomatic Disease. Diabetes 2016 Nov;65(11):3233-3239. doi: 10.2337/db16-0687.
- F S Wong, T I Tree..Historical and new insights into pathogenesis of type 1 diabetes. Clin Exp Immunol. 2019 Dec;198(3):292-293. doi: 10.1111/cei.13396.
- Simon E Regnell, Åke Lernmark. Early prediction of autoimmune (type 1) diabetes. Diabetologia. 2017 Aug;60(8):1370-1381. doi: 10.1007/s00125-017-4308-1. Epub 2017 May 26.
- Linda A DiMeglio, Carmella Evans-Molina, Richard A Oram Lancet. Type 1 diabetes. 2018 Jun 16;391(10138):2449-2462. doi: 10.1016/S0140-6736(18)31320-5.
- Jessica S Pierce, Chelsea Kozikowski, Joyce M Lee, Tim Wysocki. Type 1 diabetes in very young children: a model of parent and child influences on management and outcomes Pediatr Diabetes. 2017 Feb;18(1):17-25. doi: 10.1111/pedi.12351. Epub 2015 Dec 29.