Type 1 Diabetes
Textbook of Diabetes
All rights reserved. No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise without written permission from the Publisher. The content and opinions expressed in this book are the sole work of the authors and editors, who have warranted due diligence in the creation and issuance of their work. The publisher, editors, and authors are not responsible for errors or
... ible for errors or omissions or for any consequences arising from the information or opinions presented in this book and make no warranty, express or implied, with respect to its contents. Due diligence has been taken by the publishers, editors, and authors of this book to assure the accuracy of the information published and to describe generally accepted practices. The contributors herein have carefully checked to ensure that the drug selections and dosages set forth in this text are accurate and in accord with the standards accepted at the time of publication. Notwithstanding, since new research, changes in government regulations, and knowledge from clinical experience relating to drug therapy and drug reactions constantly occur, the reader is advised to check the product information provided by the manufacturer of each drug for any change in dosages or for additional warnings and contraindications. This is of utmost importance when the recommended drug herein is a new or infrequently used drug. It is the responsibility of the treating physician to determine dosages and treatment strategies for individual patients. Type I diabetes : etiology and treatment I edited by Mark A. Sperling. p. ; em. --(Contemporary endocrinology) Includes bibliographical references and index. ISBN 978-1-61737-258-2 ISBN 978-1-59259-310-1 (eBook) PREFACE This volume of the Contemporary Endocrinology series focuses on type 1 diabetes mellitus, an entity whose incidence is increasing worldwide, particularly in children aged less than five. Affected individuals carry a life-long burden of dependence on daily insulin administration that provides imperfect metabolic control with significant acute consequences of hypoglycemia and more insidious micro-and macro vascular complications linked to chronic hyperglycemia. Despite intensive research, the disease remains enigmatic. Although evidence for an autoimmune basis is compelling, not all cases of type 1 diabetes have autoimmune markers, and not all autoimmune forms have the same genetic basis. Nevertheless, as recently demonstrated in the parenteral arm of the Diabetes Prevention Trial-1 (DPT -1), a combination of immune markers and consistently diminished first-phase insulin response to glucose can reliably predict the likelihood of developing clinical diabetes. However, current intervention with parenteral insulin is not effective in preventing progression at this stage. A reliably effective intervention would spur population-wide surveys for at-risk individuals, now a practical possibility. Cure by transplantation of the pancreas or islets is showing great promise as better means become available to modulate immunity and prevent rejection. In parallel with these wide-ranging and fundamental basic and clinical investigations, there is an ongoing transfer of technological innovations in designer insulins, insulin delivery systems, and the monitoring of glucose. These innovations permit refinement in managing diabetes mellitus under various circumstances, all aimed at improving the quality of life and preventing or delaying vascular complications. The aim of Type 1 Diabetes: Etiology and Treatment is to fuse these contemporary investigational and practical issues and make them available to those involved in the research and practice oftype 1 diabetes. This volume is not intended to be a comprehensive or exhaustive treatise on the subject of diabetes. As in many such endeavors, the pace of discovery often exceeds the ability to incorporate the latest knowledge into printed text. Nevertheless, we believe that this volume presents contemporary information on contemporary issues by recognized authorities in the field. We hope it stimulates thought and action in the research and care of patients with type 1 diabetes mellitus.