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Typ 1-diabetes

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Definition:
Typ 1-diabetes kännetecknas av en autoimmun destruktion av betacellerna i pankreas (bukspottkörteln) med utveckling av absolut insulinbrist och kronisk hyperglykemi. Detta kan i sin tur leda till ökad risk för hjärt-kärlsjukdom.
Förekomst:
Vanligast är att individer <20 år insjuknar. Det finns ungefär 50 000 patienter med typ 1-diabetes i Sverige, varav 7 000 barn.
Symtom:
Kan variera från lindriga symtom med polyuri, ökad törst och viktnedgång till mer allvarliga symtom, som till exempel kräkningar, buksmärta och nedsatt medvetandenivå (särskilt vid diabetisk ketoacidos ).
Kliniska fynd:
Vid långsamt insjuknande kan kliniska fynd saknas helt. Vid diabetisk ketoacidos kan allvarlig dehydrering, frekventa kräkningar, polyuri trots dehydrering, viktnedgång, kräkningar, acetonlukt, hyperventilation, nedsatt medvetandegrad, försämrad perifer cirkulation med snabb hjärtfrekvens och hypotension med perifer cyanos förekomma.
Diagnostik:
Bygger på att plasmaglukos ligger över vissa gränsvärden. Typiska symtom/fynd kan bidra till diagnosen. I regel förekommer autoantikroppar mot betaceller. 
Behandling:
Består av regelbunden insulinbehandling och behandling av andra riskfaktorer för hjärt-kärlsjukdom, såsom dyslipidemi eller hypertoni. Egenbehandling med regelbunden fysisk aktivitet, varierad kost och rökfrihet.
  1. Dock AM. (2015-04-01). Vad är LADA?. Hämtad från https://ki.se/forskning/vad-ar-lada (2018-02-02). ki.se  
  2. Sjöholm Å. Fulminant diabetes typ 1 – en ny form med snabbt insjuknande. Lakartidningen.se 2021-03-29. lakartidningen.se  
  3. International Diabetes Federation (2011). Global IDF/ISPAD Guideline for Diabetes in Childhood and Adolescence. (Hämtad 2018-02-02) www.idf.org  
  4. Daneman D. Type 1 diabetes. Lancet 2006; 367: 847-58. PubMed  
  5. Ludvigsson J. Increasing Incidence but Decreasing Awareness of Type 1 Diabetes in Sweden. Diabetes Care. 2017 Oct;40(10):e143-e144. doi: 10.2337/dc17-1175. DOI  
  6. Berhan Y, Waernbaum I, Lind T, et al. Diabetes. Thirty years of prospective nationwide incidence of childhood type 1 diabetes: the accelerating increase by time tends to level off in Sweden. 2011 Feb;60(2):577-81. PMID: 21270269. PubMed  
  7. Patterson CC, Dahlquist GG, Gyürüs E, et al. Incidence trends for childhood type 1 diabetes in Europe during 1989–2003 and predicted new cases 2005–20: a multicentre prospective registration study. Lancet 2009; 373: 2027-33. PubMed  
  8. Atkinson MA, von Herrath M, Powers AC, et al. Current Concepts on the Pathogenesis of Type 1 Diabetes—Considerations for Attempts to Prevent and Reverse the Disease. Diabetes Care 2015; 38(6): 979-988. www.ncbi.nlm.nih.gov  
  9. Atkinson MA, Roep BO, Posgai A, Wheeler DCS, Peakman M. The challenge of modulating β-cell autoimmunity in type 1 diabetes. Lancet Diabetes Endocrinol. 2019;7(1):52-64. PMID: 30528099. PubMed  
  10. Pitkaniemi J, Onkamo P, Tuomilehto J, Arjas E. Increasing incidence of Type 1 diabetes--role for genes? BMC Genet 2004; 5: 5. PubMed  
  11. Hals IK, Fiskvik Fleiner H, Reimers N, et al. Investigating optimal β-cell-preserving treatment in latent autoimmune diabetes in adults: Results from a 21-month randomized trial. Diabetes Obes Metab 2019; 21(10): 2219-2227. pmid:31148332 PubMed  
  12. Davis AK, DuBose SN, Haller MJ, et al. Prevalence of detectable C-peptide according to age at diagnosis and duration of type 1 diabetes. Diabetes Care December 17, 2014. Published online before print December 17, 2014, . doi:10.2337/dc14-1952 DOI  
  13. Redondo MJ, Rewers M, Yu L, Garg S, Pilcher CC, Elliott RB, et al. Genetic determination of islet cell autoimmunity in monozygotic twin, dizygotic twin, and non-twin siblings of patients with type 1A diabetes: prospective twin study. BMJ 1999;318: 698-702. British Medical Journal  
  14. Taplin CE, Barker JM. Autoantibodies in type 1 diabetes. Autoimmunity 2008; 41(1): 11-18. pmid:18176860 PubMed  
  15. Kakleas K, Karayianni C, Critselis E, et al. The prevalence and risk factors for coeliac disease among children and adolescents with type 1 diabetes mellitus. Diabetes Res Clin Pract 2010;90:202-208. PubMed  
  16. Harjutsalo V, Podar T, Tuomilehto J. Cumulative incidence of type 1 diabetes in 10,168 siblings of Finnish young-onset type 1 diabetic patients. Diabetes 2005; 54: 563-69. PubMed  
  17. Lampousi AM, Carlsson S, Löfvenborg JE. Dietary factors and risk of islet autoimmunity and type 1 diabetes: a systematic review and meta-analysis. EBioMedicine. 2021 Oct;72:103633. doi: 10.1016/j.ebiom.2021.103633. Epub 2021 Oct 14. PMID: 34656932 PubMed  
  18. Filippi CM, von Herrath MG.. Viral Trigger for Type 1 Diabetes. Diabetes 2008; 57(11): 2863–2871. pmid:18971433 PubMed  
  19. Devendra D, Eisenbarth GS. Interferon alpha - a potential link in viral induced diabetes and autoimmunity. Clin Immunol 2004 (in press).
  20. Gale EA. A missing link in the hygiene hypothesis? Diabetologia 2002;45: 588-94. PubMed  
  21. Bach JF. The effect of infections on susceptibility to autoimmune and allergic diseases. N Engl J Med 2002;347: 911-20. New England Journal of Medicine  
  22. WHO: Use of Glycated Haemoglobin (HbA1c) in the Diagnosis of Diabetes Mellitus WHO/NMH/CHP/CPM/11.1
  23. National Clinical Guideline Centre (UK). 2015. Type 1 diabetes in adults: diagnosis and management. PMID:26334079. PubMed  
  24. Verge CF, Gianani R, Kawasaki E. Number of autoantibodies (against insulin, GAD or ICA512/IA2) rather than particular autoantibody specificities determines risk of type 1 diabetes.. J Autoimmun 1996; 9: 379-383. pmid:8816974 PubMed  
  25. American diabetes association. Standards of medical care in diabetes - 2017. Diabetes Care 2017; 40(Suppl1): S4-S5. pmid:27979887 PubMed  
  26. The diabetes control and complications trial research group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 1993;329: 977-86. New England Journal of Medicine  
  27. American Diabetes Association. Insulin administration. Diabetes Care 2004; 27 (suppl 1): 106-9.
  28. Nathan DM, DCCT/EDIC research group. The diabetes control and complications trial/epidemiology of diabetes interventions and complications study at 30 years: overview.. Diabetes Care 2014; 37(1): 9-16. pmid:24356592 PubMed  
  29. Socialstyrelsen. Nationella riktlinjer för diabetesvård. 2018. (Hämtad 2018-11-07) www.socialstyrelsen.se  
  30. Lind M, Pivodic A, Svensson AM, et al. HbA1c level as a risk factor for retinopathy and nephropathy in children and adults with type 1 diabetes: Swedish population based cohort study. BMJ 2019 Aug 28; 366:l4894. pmid: 31462492 PubMed  
  31. Boyko EJ, Zelnick LR, Braffet B, et al. Risk of Foot Ulcer and Lower-Extremity Amputation Among Participants in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study. Diabetes Care 2022; 45: 357-364. pmid:35007329 PubMed  
  32. Sustained effect of intensive treatment of type 1 diabetes mellitus on development and progression of diabetic nephropathy: the Epidemiology of Diabetes Interventions and Complications (EDIC) study. JAMA 2003; 290: 2159-67. Journal of the American Medical Association  
  33. Nathan DM, Cleary PA, Backlund JY, et al, for the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study Research Group. Intensive diabetes treatment and cardiovascular disease in patients with Type 1 diabetes. N Engl J Med 2005; 353: 2643-53. PMID:16371630. PubMed  
  34. Socialstyrelsen (2011). Kost vid diabetes – en vägledning till hälso- och sjukvården. www.socialstyrelsen.se  
  35. Šoupal J, Petruželková L, Grunberger G, et al. Glycemic Outcomes in Adults With T1D Are Impacted More by Continuous Glucose Monitoring Than by Insulin Delivery Method: 3 Years of Follow-Up From the COMISAIR Study. Diabetes Care 2019; pii: dc190888. (E-published ahead of print September 10, 2019). pmid:31530663 PubMed  
  36. American Diabetes Association. Standards of Medical Care in Diabetes—2017 Abridged for Primary Care Providers. Clin Diabetes 2017; 35(1): 5-26. pmid:28144042 PubMed  
  37. ASCEND Study Collaborative Group. Effects of n-3 Fatty Acid Supplements in Diabetes Mellitus. N Engl J Med 2018. pmid:30146932 PubMed  
  38. Reynolds AN, Akerman AP, Mann J. Dietary fibre and whole grains in diabetes management: Systematic review and meta-analyses. PLoS Med. 2020;17(3):e1003053. PMID:32142510. PubMed  
  39. FYSS. 2016. Fysisk aktivitet vid diabetes mellitus - typ 1-diabetes. (Hämtad 201802-12) www.fyss.se  
  40. Lambert AP, Gillespie KM, Thomson G, et al. Absolute risk of childhood-onset type 1 diabetes defined by human leukocyte antigen class II genotype: a population-based study in the United Kingdom. J Clin Endocrinol Metab 2004; 89: 4037-43. PubMed  
  41. Hermansen K, Bendtson I, Borch-Johnsen K, Sandahl Christiansen J, Henriksen JE, Lervang H-H, Nørgaard K. Insulinpumpebehandlingen i Danmark. Ugeskr Læger 2004; 166: 3685-9. PubMed  
  42. Benchell-Weissberg J, Antisdel-Lomaglio J, Sehadri R. Insulin pump therapy. Diabetes Care 2003; 26: 1079-87. PubMed  
  43. Pickup J, Keen H. Continuous subcutaneous insulin infusion at 25 years. Diabetes Care 2002; 25: 593-8. PubMed  
  44. Steineck I, Cederholm J, Eliasson B, et al. Insulin pump therapy, multiple daily injections, and cardiovascular mortality in 18,168 people with type 1 diabetes: observational study. BMJ 2015; 350: h3234. pmid:26100640 PubMed  
  45. Blair JC, McKay A, Ridyard C, et al. Continuous subcutaneous insulin infusion versus multiple daily injection regimens in children and young people at diagnosis of type 1 diabetes: pragmatic randomised controlled trial and economic evaluation. BMJ 2019;365:l1226. doi.org  
  46. Bergenstal RM, Tamborlane WV, Ahmann A, et al. Effectiveness of Sensor-augmented insulin-pump therapy in type 1 diabetes. N Engl J Med, June 29, 2010. content.nejm.org  
  47. Brown SA, Kovatchev BP, Raghinaru D, et al. Six-Month Randomized, Multicenter Trial of Closed-Loop Control in Type 1 Diabetes. N Engl J Med 2019; 381: 1707-17. pmid:31618560 PubMed  
  48. Hussain MA, Theise ND. Stem-cell therapy for diabetes mellitus. Lancet 2004; 364: 203-5. PubMed  
  49. European medicines agency. Summary of opinion. 2019-02-28. www.ema.europa.eu  
  50. ASCEND Study Collaborative Group. Effects of Aspirin for Primary Prevention in Persons with Diabetes Mellitus. N Engl J Med 2018. pmid:30146931 PubMed  
  51. Reddy M, Rilstone S, Cooper P, et al. Supporting patients with type 1 diabetes. Br J Nurs. 2016 Mar 24-Apr 13;25(6):330-4. PMID: 26965473. PubMed  
  52. Psykosocialt stöd till familjer med barn som har diabetes typ 1. SBU 2019 www.sbu.se  
  53. Finne P, Reunanen A, Stenman S, Groop P-H, Grönhagen-Riska C. Incidence of end-stage renal disease in patients with type 1 diabetes. JAMA 2005; 294: 1782-7. PubMed  
  54. Rossing P, Risikofaktorer for progression af diabetisk nefropati. Oversiktsartikkel. Ugeskr Læger 2000; 162: 5057-61. PubMed  
  55. Hovind P, Tarnow L, Rossing P, et al. Predictors for the development of microalbuminuria and macroalbuminuria in patients with type 1 diabetes: inception cohort study. BMJ 2004; 328: 1105-08.
  56. Lind M, Bounias I, Olsson M, et al. Glycaemic control and incidence of heart failure in 20985 patients with type 1 diabetes: an observational study. Lancet 2011; 378: 140-6. PubMed  
  57. Jones JM, Lawson ML, Daneman D, Olmsted MP, Rodin G. Eating disorders in adolescent females with and without type 1 diabetes: cross ectional study. BMJ 2000; 320: 1563-6. British Medical Journal  
  58. Nathan DM, et al. Diabetes: Advances in Diagnosis and Treatment. JAMA. 2015 Sep 8;314(10):1052-62. PubMed  
  59. Cooper MN, de Klerk NH, Jones TW, Davis EA.. Clinical and demographic risk factors associated with mortality during early adulthood in a population-based cohort of childhood-onset type 1 diabetes. Diabet Med 2014; 31(12): 1550-8. doi:10.1111/dme.12522 DOI  
  60. Huxley RR, Peters SA, Mishra GD, et al. Risk of all-cause mortality and vascular events in women versus men with type 1 diabetes: a systematic review and meta-analysis. Lancet Diabetes Endocrinol 2015; Mar;3(3): 198-206. pmid:25660575 PubMed  
  61. Livingstone SJ, Levin D, Looker HC, et al. Estimated life expectancy in a Scottish cohort with type 1 diabetes, 2008-2010. JAMA. 2015;313(1):37-44. PMID:25562264. PubMed  
  62. DCCT/EDIC Research Group. JAMA. Association between 7 years of intensive treatment of type 1 diabetes and long-term mortality. 6;313(1):45-53. PMID:25562265. PubMed  
  63. Havas S, Donner T. Tight control of type 1 diabetes: Recommendations for patients. Am Fam Physician 2006; 74: 971-8. PubMed  
  • Johan Jendle, specialist i endokrinologi och professor i medicin, Örebro universitet
  • Remy Waardenburg, specialist i allmänmedicin, medicinsk redaktör Medibas