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Type 1 diabetes is defined as a state of hyperglycemia due to insulin deficiency caused by autoimmune pancreatic beta-cell destruction. The risk among individuals in the general population has been estimated at 0.5%. A family history of diabetes and a personal history of conditions associated with type 1 diabetes (ie, autoimmune diseases) increase the risk. Currently, the American Diabetes Association (ADA) recommends screening asymptomatic patients for type 1 diabetes autoimmune markers in the context of clinical research trials. All patients with diabetes should be referred to a diabetes self-management education program and for medical nutrition therapy. Medical nutrition therapy has been shown to lower the A1c by up to 1.9% in patients with type 1 diabetes. The mainstay of management is a regimen of multiple daily injections of insulin or continuous subcutaneous insulin delivered via an insulin pump. For most patients, a regimen consisting of 50% of the total daily dose prescribed as basal insulin and 50% prescribed as bolus insulin is used. Currently, pramlintide is the only Food Drug Administration (FDA)-approved adjunct to insulin therapy for patients with type 1 diabetes. Patients with type 1 diabetes should be screened regularly for hypertension and other associated conditions and complications.

Case 1. Diego is a 4-year-old-boy brought to your office by his mother for an annual physical examination. He is healthy, does not take any drugs, and has no current health concerns. However, his mother has type 1 diabetes and asks if Diego is at risk of developing type 1 diabetes.

Definition

Type 1 diabetes is defined as a state of hyperglycemia due to insulin deficiency caused by autoimmune pancreatic beta-cell destruction.1 It is categorized in three stages: stage 1 (asymptomatic, normal fasting glucose, with multiple islet antibodies); stage 2 (asymptomatic, fasting glucose 100-125 mg/dL, with multiple islet antibodies); and stage 3 (symptomatic, fasting glucose more than 125 mg/dL, with multiple islet antibodies).1,2

Risk Factors

The risk of type 1 diabetes among individuals in the general population in the United States and Europe has been estimated at 0.5%.3 A family history of diabetes or a personal history of conditions associated with type 1 diabetes (ie, autoimmune diseases) increases the risk of type 1 diabetes. Environmental factors (eg, viral infections, vitamin D deficiency) also may increase the risk.4

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