Cukrzyca typu 1 – Rokowania, prognozy i postęp choroby

Cukrzyca typu 1
Rokowania, prognozy i postęp choroby

Cukrzyca typu 1 (T1DM) jest autoimmunologiczną chorobą prowadzącą do bezwzględnego niedoboru insuliny wskutek selektywnego niszczenia komórek beta trzustki. Pomimo historycznie złych prognoz, obecnie obserwuje się znaczną poprawę rokowania, choć pacjenci z T1DM żyją średnio o 12 lat krócej niż osoby bez cukrzycy. Kluczowym czynnikiem determinującym długoterminowe przeżycie jest ścisła kontrola glikemii (HbA1c), która redukuje ryzyko powikłań mikronaczyniowych i neuropatycznych. Inne istotne elementy zarządzania to kontrola ciśnienia tętniczego (zalecane wartości ≤130/80 mmHg), profil lipidowy, masa ciała, zaprzestanie palenia oraz edukacja pacjenta. Modele prognostyczne uwzględniające wiek, HbA1c, stosunek obwodu talii do bioder, stosunek albuminy do kreatyniny oraz poziom cholesterolu HDL wykazują dobrą zdolność predykcyjną (statystyka C ~0,73-0,79) i mogą wspierać indywidualizację terapii oraz identyfikację pacjentów wysokiego ryzyka.

Prognozy dla pacjentów z cukrzycą typu 1

Czynniki wpływające na rokowanie
Predykcja ryzyka niekorzystnych wyników klinicznych
Biomarkery prognostyczne

Powikłania i ich wpływ na rokowanie

Powikłania sercowo-naczyniowe
Powikłania nerek i oczu

Nowoczesne podejście do poprawy rokowania

Zalecenia w zakresie poprawy jakości opieki

Wnioski końcowe

Kolejne rozdziały

Prognozy dla pacjentów z cukrzycą typu 1

Cukrzyca typu 1 (T1DM) jest chorobą autoimmunologiczną charakteryzującą się selektywnym niszczeniem komórek beta trzustki, prowadzącym do bezwzględnego niedoboru insuliny. Choroba ta wiąże się z podwyższonym ryzykiem poważnych powikłań naczyniowych i zgonu, jednakże prognozy dla pacjentów uległy znaczącej poprawie w ostatnich dekadach.¹²³

Historycznie, cukrzyca typu 1 znacząco skracała życie chorych – 90 lat temu diagnoza była praktycznie wyrokiem śmierci. Połowa pacjentów umierała w ciągu dwóch lat od rozpoznania, a ponad 90% w ciągu pięciu lat. Obecnie, dzięki postępom w medycynie, rokowania są znacznie lepsze, choć nadal obserwuje się skrócenie oczekiwanej długości życia.⁴

Szkockie badanie opublikowane w JAMA wykazało, że 20-letni pacjenci z cukrzycą typu 1 żyją średnio o 12 lat krócej niż ich rówieśnicy bez cukrzycy. Jednak w ostatnich latach obserwuje się znaczącą poprawę – dane wskazują, że śmiertelność i liczba lat życia skorygowanych niepełnosprawnością (DALY) wśród osób starszych (≥65 lat) z T1DM znacząco spadły w latach 1990-2019.⁵⁶

Czynniki wpływające na rokowanie

Najważniejszym czynnikiem determinującym długoterminowe rokowanie jest kontrola glikemii. Badania wykazują, że pacjenci z lepszą kontrolą glikemii żyją dłużej niż ci z gorszą kontrolą. Ścisła kontrola glikemii znacząco zmniejsza ryzyko powikłań mikronaczyniowych i neuropatycznych.⁷⁸

Do najważniejszych czynników wpływających na rokowanie należą:

Kontrola glikemii (HbA1c)
Kontrola ciśnienia tętniczego
Profil lipidowy
Kontrola masy ciała
Zaprzestanie palenia tytoniu
Edukacja pacjenta, świadomość, motywacja i poziom inteligencji
Wczesna identyfikacja i leczenie powikłań

⁹¹⁰

Pacjenci z cukrzycą typu 1, którzy przeżyli okres 10-20 lat od początku choroby bez poważnych powikłań, mają wysokie prawdopodobieństwo utrzymania względnie dobrego stanu zdrowia. Ponad 60% pacjentów z cukrzycą typu 1 nie rozwija poważnych powikłań w długoterminowej perspektywie, jednak pozostali doświadczają ślepoty, schyłkowej niewydolności nerek (ESRD), a w niektórych przypadkach przedwczesnego zgonu.¹¹

Predykcja ryzyka niekorzystnych wyników klinicznych

Przewidywanie ryzyka poważnych zdarzeń klinicznych jest istotne dla identyfikacji pacjentów wysokiego ryzyka, którzy mogą odnieść korzyści z intensywnej interwencji. Opracowano kilka modeli prognostycznych, które mogą pomóc w klasyfikacji ryzyka u pacjentów z cukrzycą typu 1.¹²

Model prognostyczny opisany przez badaczy obejmuje łatwo dostępne cechy kliniczne i może różnicować pacjentów z cukrzycą typu 1 o dobrym i złym rokowaniu. Ostateczny model prognostyczny obejmował takie czynniki jak wiek, poziom hemoglobiny glikowanej, stosunek obwodu talii do bioder, stosunek albuminy do kreatyniny oraz poziom cholesterolu HDL.¹³

Zdolność dyskryminacyjna modelu prognostycznego była odpowiednia we wszystkich kohortach, ze statystyką C wynoszącą 0,79 w EDC, 0,74 w EDC recent i 0,73 w CACTI w porównaniu ze statystyką C wynoszącą 0,74 w zestawie rozwojowym. Taki model prognostyczny może być pomocny w praktyce klinicznej i stratyfikacji ryzyka w badaniach klinicznych.¹⁴

Opracowano również modele diagnostyczne łączące cechy kliniczne z biomarkerami, które mają wysoką dokładność w identyfikacji cukrzycy typu 1 wymagającej szybkiej insulinoterapii. Model integrujący wiek w momencie diagnozy, BMI, przeciwciała GADA, IA-2 i genetyczny wskaźnik ryzyka T1D (T1D GRS) pozwala oszacować ryzyko cukrzycy typu 1 wymagającej szybkiej insulinoterapii od momentu diagnozy.¹⁵¹⁶

Biomarkery prognostyczne

Obecność co najmniej dwóch autoprzeciwciał skierowanych przeciwko antygenom wyspowym w surowicy jest praktycznie pre-diagnostyczna dla cukrzycy typu 1. Większość dzieci posiadających te biomarkery, niezależnie od rodzinnej historii choroby, rozwinie cukrzycę wymagającą insulinoterapii.¹⁷

Przekonujące dowody wskazują, że odpowiedzi autoimmunologiczne skierowane przeciwko dwóm lub więcej autoantygenum wyspowym: insulinie, dekarboksylazie kwasu glutaminowego (GAD), antygenowi 2 wysepek (IA-2) i transporterowi cynku 8 (ZnT8), są związane z progresją do jawnej choroby.¹⁸

Badanie na kohorcie Diabetes Autoimmunity Study in the Young (DAISY) wykazało, że 89% dzieci, u których rozwinęła się cukrzyca typu 1, miało dwa lub więcej autoprzeciwciał związanych z wyspami. Dostarczono również dowodów sugerujących, że podgrupa przeciwciał przeciwko cytoplazmatycznym komórkom wysp (ICA) jest związana z szybszą progresją do cukrzycy wymagającej insuliny u krewnych pacjentów z cukrzycą typu 1 z przeciwciałami GAD65 i IA-2, w porównaniu do krewnych z przeciwciałami GAD65 i IA-2 bez ICA.¹⁹

Powikłania i ich wpływ na rokowanie

Cukrzyca typu 1 jest trudnym schorzeniem do właściwego i konsekwentnego zarządzania przez całe życie. Z tego powodu T1D wiąże się z kilkoma powikłaniami. Blisko 50% osób z cukrzycą typu 1 rozwinie poważne powikłania w ciągu swojego życia. Niektórzy mogą utracić wzrok, a inni rozwinąć schyłkową niewydolność nerek.²⁰

Powikłania sercowo-naczyniowe

Osoby żyjące z cukrzycą typu 1 mają zwiększone ryzyko chorób sercowo-naczyniowych (CVD), które są główną przyczyną zachorowalności i śmiertelności w tej populacji. Ryzyko rośnie z każdym niekontrolowanym czynnikiem ryzyka.²¹

Ryzyko sercowo-naczyniowe zwiększa się z każdym niekontrolowanym czynnikiem ryzyka, nawet u osób z dobrą kontrolą glikemii, co podkreśla znaczenie kompleksowego zarządzania ryzykiem CVD w tej populacji. Populacyjne skale ryzyka, nawet te specjalnie zaprojektowane dla pacjentów z cukrzycą typu 2, nie szacują dokładnie ryzyka przyszłych chorób sercowo-naczyniowych w populacji z cukrzycą typu 1.²²²³

W praktycznym podejściu do zarządzania ryzykiem sercowo-naczyniowym u pacjentów z T1D, oprócz promowania zdrowego stylu życia, w tym diety śródziemnomorskiej, fundamentami zmniejszającymi obciążenie CVD są zaprzestanie palenia, kontrola ciśnienia tętniczego na poziomie 130/80 mmHg i utrzymanie optymalnej kontroli glikemii.²⁴

Powikłania nerek i oczu

Ryzyko schyłkowej niewydolności nerek (ESRD) i retinopatii proliferacyjnej jest dwukrotnie wyższe u mężczyzn niż u kobiet, gdy początek cukrzycy występuje przed 15 rokiem życia. Te powikłania znacząco wpływają na jakość życia i rokowanie.²⁵

Opracowano modele predykcyjne śmiertelności specyficzne dla pacjentów z cukrzycą rozpoczynających dializoterapię. Ostateczny model predykcyjny zawierał siedem predyktorów: wiek, palenie tytoniu, historię powikłań makronaczyniowych, czas trwania cukrzycy, skalę Karnofsky’ego, poziom albuminy w surowicy i poziom hemoglobiny. Statystyka c modelu końcowego wynosiła 0,810, co wskazuje na dobrą zdolność dyskryminacyjną.²⁶²⁷

Nowoczesne podejście do poprawy rokowania

Postęp w opiece nad pacjentami z cukrzycą typu 1 doprowadził do znaczącej poprawy rokowania w ostatnich dekadach. Wśród najważniejszych czynników poprawiających prognozy wyróżnia się:²⁸

Lepsze metody śledzenia poziomu cukru we krwi przy pomocy domowych glukometrów i ciągłych monitorów glukozy. Utrzymywanie poziomu cukru we krwi blisko normy wiąże się z dłuższym życiem.
Nowe leki i inne terapie zapobiegające i leczące powikłania cukrzycy, takie jak choroby serca i nerek. Obie są głównymi przyczynami przedwczesnej śmierci u osób z cukrzycą typu 1.

²⁹

Badania wykazały, że po 27 latach uczestnicy grupy poddanej ścisłej kontroli glikemii byli mniej narażeni na zgon niż ci w grupie poddanej konwencjonalnej kontroli. To sugeruje, że ścisła kontrola jest jednym ze sposobów na poprawę przeżywalności u osób z cukrzycą typu 1.³⁰

Wyniki badań sugerują, że cukrzyca typu 1 nie jest już czynnikiem przyczyniającym się do zmniejszenia oczekiwanej długości życia ze względu na poprawę opieki medycznej w ciągu ostatnich trzech dekad. Jednak wysoki poziom glukozy na czczo został zidentyfikowany jako główny czynnik przyczyniający się do DALY z powodu cukrzycy typu 1 wśród osób w wieku ≥65 lat, co wskazuje, że kontrola glikemii nadal jest nieoptymalna i stanowi wyzwanie w tej populacji.³¹

Zalecenia w zakresie poprawy jakości opieki

Nowe zalecenia w standardach opieki nad chorymi na cukrzycę ADA 2025 podkreślają, że inicjatywy poprawy jakości i zespoły interprofesjonalne są ważne dla wspierania zrównoważonych i skalowalnych zmian procesowych, które poprawiają jakość opieki i wyniki zdrowotne.³²

Korzyści z kontroli glikemii i kontroli chorób współistniejących w cukrzycy typu 1 muszą być wyważone względem ryzyka hipoglikemii i krótkoterminowych kosztów zapewnienia wysokiej jakości opieki zapobiegawczej. Jednakże badania wykazały oszczędności kosztów dzięki zmniejszeniu ostrych powikłań związanych z cukrzycą w ciągu 1-3 lat od rozpoczęcia skutecznej opieki zapobiegawczej.³³

Dla osób, które osiągnęły pierwsze 20 lat po diagnozie bez żadnych powikłań, rokowanie jest dobre. Perspektywy dla pacjentów z cukrzycą typu 1 systematycznie się poprawiają, co daje optymistyczne dowody dla wszystkich osób z T1DM, zwłaszcza tych zdiagnozowanych w młodym wieku.³⁴³⁵

Wnioski końcowe

Cukrzyca typu 1 pozostaje poważnym schorzeniem z podwyższonym ryzykiem powikłań i przedwczesnego zgonu, jednak dzięki postępom w diagnostyce, monitorowaniu i leczeniu, rokowanie pacjentów uległo znacznej poprawie w ciągu ostatnich dekad.³⁶

Absolutne przewidywania ryzyka u indywidualnych pacjentów z cukrzycą typu 1 są ważne dla terminowej identyfikacji pacjentów z wysokim ryzykiem poważnych wyników, aby umożliwić strategie zapobiegania rozwojowi takich powikłań i zmniejszenia kosztów opieki zdrowotnej. Modele prognostyczne i diagnostyczne mogą pomóc w identyfikacji pacjentów wysokiego ryzyka i być przydatne w praktyce klinicznej oraz stratyfikacji ryzyka w badaniach klinicznych.³⁷³⁸

Kompleksowe podejście do leczenia obejmujące ścisłą kontrolę glikemii, leczenie chorób współistniejących, wczesne wykrywanie i leczenie powikłań oraz edukację pacjentów ma kluczowe znaczenie dla poprawy rokowania i jakości życia pacjentów z cukrzycą typu 1.³⁹⁴⁰

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Materiały źródłowe

#1 Prediction and Prevention of Type 1 Diabetes: Update on Success of Prediction and Struggles at Prevention
https://pmc.ncbi.nlm.nih.gov/articles/PMC4592445/
Type 1 diabetes mellitus (T1DM) is the archetypal example of a T cell-mediated autoimmune disease characterized by selective destruction of pancreatic cells. […] The detection of at least two islet autoantibodies in the blood is virtually pre-diagnostic for T1DM. The majority of children who carry these biomarkers, regardless of whether they have an a priori family history of the disease, will develop insulin-requiring diabetes. […] Unfortunately the significant progress in improving prediction of T1DM has not yet been paralleled by safe and efficacious intervention strategies aimed at preventing the disease. […] The current opinion is that both genetic and environmental factors contribute to the risk of progression to clinical disease. […] A number of candidates have been identified, including dietary factors (breast feeding vs. infant formula, highly hydrolysed infant formula vs. conventional infant formula, early/late exposure to gluten, vitamin D deficiency etc.), exposure to certain viral elements or helminths anthropometric and psychosocial factors.
#2 Type 1 Diabetes: Causes, Symptoms, Complications & Treatment
https://my.clevelandclinic.org/health/diseases/21500-type-1-diabetes
Type 1 diabetes is a challenging condition to manage properly, especially consistently throughout your lifetime. Because of this, T1D is associated with several complications. Close to 50% of people with Type 1 diabetes will develop a serious complication over their lifetime. Some may lose eyesight while others may develop end-stage kidney disease. […] For those who reach the first 20 years after diagnosis without any complications, the prognosis (outlook) is good.
#3 People with type 1 diabetes are living longer – Harvard Health
https://www.health.harvard.edu/blog/people-type-1-diabetes-living-longer-201501087611
Ninety years ago, type 1 diabetes was a death sentence: half of people who developed it died within two years; more than 90% were dead within five years. […] A Scottish study published this week in JAMA shows that at the age of 20, individuals with type 1 diabetes on average lived 12 fewer years than 20-year-olds without it. […] A second study in the same issue of JAMA showed that people with type 1 diabetes with better blood sugar control lived longer than those with poorer blood sugar control. […] This suggests that tight control is one way to improve survival in people with type 1 diabetes. […] After 27 years, participants in the tight control group were less likely to have died than those in the conventional control group. […] Better ways to track blood sugar with home glucose monitors and even continuous glucose monitors. Keeping blood sugar close to normal is linked with longer life.
#4 People with type 1 diabetes are living longer – Harvard Health
https://www.health.harvard.edu/blog/people-type-1-diabetes-living-longer-201501087611
Ninety years ago, type 1 diabetes was a death sentence: half of people who developed it died within two years; more than 90% were dead within five years. […] A Scottish study published this week in JAMA shows that at the age of 20, individuals with type 1 diabetes on average lived 12 fewer years than 20-year-olds without it. […] A second study in the same issue of JAMA showed that people with type 1 diabetes with better blood sugar control lived longer than those with poorer blood sugar control. […] This suggests that tight control is one way to improve survival in people with type 1 diabetes. […] After 27 years, participants in the tight control group were less likely to have died than those in the conventional control group. […] Better ways to track blood sugar with home glucose monitors and even continuous glucose monitors. Keeping blood sugar close to normal is linked with longer life.
#5 People with type 1 diabetes are living longer – Harvard Health
https://www.health.harvard.edu/blog/people-type-1-diabetes-living-longer-201501087611
Ninety years ago, type 1 diabetes was a death sentence: half of people who developed it died within two years; more than 90% were dead within five years. […] A Scottish study published this week in JAMA shows that at the age of 20, individuals with type 1 diabetes on average lived 12 fewer years than 20-year-olds without it. […] A second study in the same issue of JAMA showed that people with type 1 diabetes with better blood sugar control lived longer than those with poorer blood sugar control. […] This suggests that tight control is one way to improve survival in people with type 1 diabetes. […] After 27 years, participants in the tight control group were less likely to have died than those in the conventional control group. […] Better ways to track blood sugar with home glucose monitors and even continuous glucose monitors. Keeping blood sugar close to normal is linked with longer life.
#6 Global burden of type 1 diabetes in adults aged 65 years and older, 1990-2019: population based study | The BMJ
https://www.bmj.com/content/385/bmj-2023-078432
Mortality and DALYs among older people (65 years) with T1DM decreased considerably from 1990 to 2019. Both were lower in women, those living in countries or regions with a high sociodemographic index, and those younger than 79 years. Management of high fasting plasma glucose levels remains a major challenge for older people with T1DM, and targeted clinical guidelines are needed. […] The results suggest that T1DM is no longer a contributory factor in decreased life expectancy owing to improvements in medical care over the three decades. […] A high fasting plasma glucose level was identified as the major contributor to DALYs from T1DM among people aged 65 years, indicating that blood glucose control is still suboptimal and a challenge among this population. […] The findings are important for health practice and future research, and provide optimistic evidence for all people with T1DM, especially those with a diagnosis at a young age.
#7 People with type 1 diabetes are living longer – Harvard Health
https://www.health.harvard.edu/blog/people-type-1-diabetes-living-longer-201501087611
Ninety years ago, type 1 diabetes was a death sentence: half of people who developed it died within two years; more than 90% were dead within five years. […] A Scottish study published this week in JAMA shows that at the age of 20, individuals with type 1 diabetes on average lived 12 fewer years than 20-year-olds without it. […] A second study in the same issue of JAMA showed that people with type 1 diabetes with better blood sugar control lived longer than those with poorer blood sugar control. […] This suggests that tight control is one way to improve survival in people with type 1 diabetes. […] After 27 years, participants in the tight control group were less likely to have died than those in the conventional control group. […] Better ways to track blood sugar with home glucose monitors and even continuous glucose monitors. Keeping blood sugar close to normal is linked with longer life.
#8 Type 1 Diabetes Mellitus: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/117739-overview
Control of blood glucose, hemoglobin A1c (HbA1c), lipids, blood pressure, and weight significantly affects prognosis. Excess weight gain with intensified diabetes treatment is associated with hypertension, insulin resistance, dyslipidemia, and extensive atherosclerotic cardiovascular disease. […] Patients with diabetes face a lifelong challenge to achieve and maintain blood glucose levels as close to the normal range as possible. With appropriate glycemic control, the risk of microvascular and neuropathic complications is decreased markedly. In addition, aggressive treatment of hypertension and hyperlipidemia decreases the risk of macrovascular complications. […] The benefits of glycemic control and control of comorbidities in type 1 DM must be weighed against the risk of hypoglycemia and the short-term costs of providing high-quality preventive care. However, studies have shown cost savings due to a reduction in acute diabetes-related complications within 1-3 years of starting effective preventive care.
#9 Type 1 Diabetes Mellitus: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/117739-overview
Control of blood glucose, hemoglobin A1c (HbA1c), lipids, blood pressure, and weight significantly affects prognosis. Excess weight gain with intensified diabetes treatment is associated with hypertension, insulin resistance, dyslipidemia, and extensive atherosclerotic cardiovascular disease. […] Patients with diabetes face a lifelong challenge to achieve and maintain blood glucose levels as close to the normal range as possible. With appropriate glycemic control, the risk of microvascular and neuropathic complications is decreased markedly. In addition, aggressive treatment of hypertension and hyperlipidemia decreases the risk of macrovascular complications. […] The benefits of glycemic control and control of comorbidities in type 1 DM must be weighed against the risk of hypoglycemia and the short-term costs of providing high-quality preventive care. However, studies have shown cost savings due to a reduction in acute diabetes-related complications within 1-3 years of starting effective preventive care.
#10
https://link.springer.com/article/10.1007/s13300-024-01616-4
Population-based risk scales, even those specifically designed for patients with T2D, do not accurately estimate the risk of future cardiovascular disease in the population with T1D. […] In this practical approach proposal, we highlight the key points for cardiovascular prevention specifically for individuals living with T1D. In addition to promoting a healthy lifestyle, including the Mediterranean diet, the cornerstones for reducing CVD burden include smoking cessation, BP control at 130/80 mmHg, and the maintenance of optimal glycaemic control. […] The intention of our proposal for the management and follow-up of cardiovascular risk in patients living with T1D is to facilitate positive changes in the cardiovascular risk of this population.
#11 Type 1 Diabetes Mellitus: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/117739-overview
Type 1 DM is associated with a high morbidity and premature mortality. More than 60% of patients with type 1 DM do not develop serious complications over the long term, but many of the rest experience blindness, end-stage renal disease (ESRD), and, in some cases, early death. The risk of ESRD and proliferative retinopathy is twice as high in men as in women when the onset of diabetes occurs before age 15 years. […] Patients with type 1 DM who survive the period 10-20 years after disease onset without fulminant complications have a high probability of maintaining reasonably good health. Other factors affecting long-term outcomes are the patients education, awareness, motivation, and intelligence level. A new recommendation in the ADAs Standards of Care in Diabetes2025 stresses that quality improvement initiatives and interprofessional teams are important for supporting sustainable and scalable process changes that improve quality of care and health outcomes.
#12 Predicting major outcomes in type 1 diabetes: a model development and validation study
https://pmc.ncbi.nlm.nih.gov/articles/PMC4399797/
Type 1 diabetes is associated with a higher risk of major vascular complications and death. A reliable method that predicts these outcomes early in the disease process would be helpful in risk classification. We therefore developed such a prognostic model and quantified its performance in independent cohorts. […] Our prognostic model that uses easily accessible clinical features can discriminate between type 1 diabetes patients with good and poor prognosis. Such a prognostic model may be helpful in clinical practice and for risk stratification in clinical trials. […] Absolute risk predictions in individual patients with type 1 diabetes are important to timely identify the patients at high risk of major outcomes in order to enable strategies to prevent the development of such complications and to reduce health care costs.
#13 Predicting major outcomes in type 1 diabetes: a model development and validation study
https://pmc.ncbi.nlm.nih.gov/articles/PMC4399797/
We here describe a prognostic model based on easily accessible patient and clinical characteristics for the composite of the major outcomes and death, which would allow straightforward application of the model in practice. This model may help to identify patients with type 1 diabetes at high risk of major outcome events. […] The final prognostic model included age, glycated haemoglobin, waist-hip ratio, albumin/creatinine ratio, and HDL cholesterol. […] The discriminative ability of the prognostic model was adequate in all cohorts with C-statistic of 0.79 in EDC, 0.74 in EDC recent and 0.73 in CACTI compared to a C-statistic of 0.74 in the development set. […] Predicting major outcomes permits establishment of a risk profile for individual patients with type 1 diabetes. Physicians may consider active intervention in the identified high risk patients.
#14 Predicting major outcomes in type 1 diabetes: a model development and validation study
https://pmc.ncbi.nlm.nih.gov/articles/PMC4399797/
We here describe a prognostic model based on easily accessible patient and clinical characteristics for the composite of the major outcomes and death, which would allow straightforward application of the model in practice. This model may help to identify patients with type 1 diabetes at high risk of major outcome events. […] The final prognostic model included age, glycated haemoglobin, waist-hip ratio, albumin/creatinine ratio, and HDL cholesterol. […] The discriminative ability of the prognostic model was adequate in all cohorts with C-statistic of 0.79 in EDC, 0.74 in EDC recent and 0.73 in CACTI compared to a C-statistic of 0.74 in the development set. […] Predicting major outcomes permits establishment of a risk profile for individual patients with type 1 diabetes. Physicians may consider active intervention in the identified high risk patients.
#15 Development and validation of multivariable clinical diagnostic models to identify type 1 diabetes requiring rapid insulin therapy in adults aged 18â50 years | BMJ Open
https://bmjopen.bmj.com/content/9/9/e031586
Objective To develop and validate multivariable clinical diagnostic models to assist distinguishing between type 1 and type 2 diabetes in adults aged 1850. […] Type 1 diabetes was defined by rapid insulin requirement (within 3 years of diagnosis) and severe endogenous insulin deficiency (C-peptide 200pmol/L). […] Type 1 diabetes was present in 13% of participants in the development cohort. […] Clinical diagnostic models integrating clinical features with biomarkers have high accuracy for identifying type 1 diabetes with rapid insulin requirement, and could assist clinicians and researchers in accurately identifying patients with type 1 diabetes. […] We have developed, evaluated and validated clinical diagnostic models combining age at diagnosis, BMI, GADA, IA-2 and T1D GRS to provide estimates of a patients risk of having type 1 diabetes requiring rapid insulin therapy from diagnosis.
#16 Development and validation of multivariable clinical diagnostic models to identify type 1 diabetes requiring rapid insulin therapy in adults aged 18â50 years | BMJ Open
https://bmjopen.bmj.com/content/9/9/e031586
Model performance was optimised in the model combining all five predictors (ROC AUC 0.97). […] These models have the potential to help robustly classify diabetes in research cohorts, and may have particular utility where genetic but not antibody data is available, a common situation in many biobanks. […] In conclusion, clinical diagnostic models integrating clinical features with biomarkers have high accuracy for identifying type 1 diabetes with rapid insulin requirement in white participants aged 1850 years at diabetes diagnosis, and may assist clinicians in identifying patients with type 1 diabetes in clinical practice.
#17 Prediction and Prevention of Type 1 Diabetes: Update on Success of Prediction and Struggles at Prevention
https://pmc.ncbi.nlm.nih.gov/articles/PMC4592445/
Type 1 diabetes mellitus (T1DM) is the archetypal example of a T cell-mediated autoimmune disease characterized by selective destruction of pancreatic cells. […] The detection of at least two islet autoantibodies in the blood is virtually pre-diagnostic for T1DM. The majority of children who carry these biomarkers, regardless of whether they have an a priori family history of the disease, will develop insulin-requiring diabetes. […] Unfortunately the significant progress in improving prediction of T1DM has not yet been paralleled by safe and efficacious intervention strategies aimed at preventing the disease. […] The current opinion is that both genetic and environmental factors contribute to the risk of progression to clinical disease. […] A number of candidates have been identified, including dietary factors (breast feeding vs. infant formula, highly hydrolysed infant formula vs. conventional infant formula, early/late exposure to gluten, vitamin D deficiency etc.), exposure to certain viral elements or helminths anthropometric and psychosocial factors.
#18 Prediction and Prevention of Type 1 Diabetes: Update on Success of Prediction and Struggles at Prevention
https://pmc.ncbi.nlm.nih.gov/articles/PMC4592445/
The time has come to carefully design adequately powered longitudinal studies in humans to determine to what extent changes in the gut microbiota or in the metabolome, affect islet autoimmunity and T1DM progression. […] Over the past two decades major efforts have been devoted to identify islet autoantigens which are targets of T1DM-specific autoimmune responses. […] Compelling evidence indicates that islet autoantibody responses directed to two or more of the islet autoantigens: insulin, glutamic acid decarboxylase (GAD), islet antigen 2 (IA-2), and zinc transporter 8 (ZnT8) are associated with progression to overt disease. […] There is a wealth of studies demonstrating that a combination of islet autoantibody biomarkers gives a high predictive value for T1DM progression, and great sensitivity without significant loss of specificity.
#19 Prediction and Prevention of Type 1 Diabetes: Update on Success of Prediction and Struggles at Prevention
https://pmc.ncbi.nlm.nih.gov/articles/PMC4592445/
A study on the Diabetes Autoimmunity Study in the Young (DAISY) cohort showed that 89% of children who progressed to T1DM had two or more islet-related autoantibodies. […] We provided evidence to suggest that a subset of cytoplasmic islet cell antibodies (ICA) is related to a more rapid progression to insulin-requiring diabetes in GAD65 and IA-2 antibody positive relatives of T1DM patients, compared to relatives with GAD65 and IA-2 antibodies without ICA. […] In conclusion, measurement of serum antibodies directed against proteins in cells (insulin, GAD, IA-2 and ZnT8) can effectively assess T1DM risk, and further research is warranted to correlate autoantibody profiles as well as mechanistic biomarkers with progression to clinical T1DM in at risk individuals.
#20 Type 1 Diabetes: Causes, Symptoms, Complications & Treatment
https://my.clevelandclinic.org/health/diseases/21500-type-1-diabetes
Type 1 diabetes is a challenging condition to manage properly, especially consistently throughout your lifetime. Because of this, T1D is associated with several complications. Close to 50% of people with Type 1 diabetes will develop a serious complication over their lifetime. Some may lose eyesight while others may develop end-stage kidney disease. […] For those who reach the first 20 years after diagnosis without any complications, the prognosis (outlook) is good.
#21
https://link.springer.com/article/10.1007/s13300-024-01616-4
People living with type 1 diabetes (T1D) have an increased risk of cardiovascular disease (CVD), which is the leading cause of morbidity and mortality in this population. The risk increases with each uncontrolled risk factor. […] Cardiovascular risk increases with each uncontrolled risk factor, even in individuals with good glycaemic control, underscoring the relevance of comprehensive CVD risk management in this population. […] This document is intended to be a proposal suggesting a practical approach for the evaluation, classification, and management of CVD risk in individuals living with T1D, considering the use of carotid ultrasound to guide treatment. […] The objective is to regularly assess and quantify the risk of CVD in individuals with T1D, thus allowing the personalization of the most timely (effective and safe) treatment and patient follow-up.
#22
https://link.springer.com/article/10.1007/s13300-024-01616-4
People living with type 1 diabetes (T1D) have an increased risk of cardiovascular disease (CVD), which is the leading cause of morbidity and mortality in this population. The risk increases with each uncontrolled risk factor. […] Cardiovascular risk increases with each uncontrolled risk factor, even in individuals with good glycaemic control, underscoring the relevance of comprehensive CVD risk management in this population. […] This document is intended to be a proposal suggesting a practical approach for the evaluation, classification, and management of CVD risk in individuals living with T1D, considering the use of carotid ultrasound to guide treatment. […] The objective is to regularly assess and quantify the risk of CVD in individuals with T1D, thus allowing the personalization of the most timely (effective and safe) treatment and patient follow-up.
#23
https://link.springer.com/article/10.1007/s13300-024-01616-4
Population-based risk scales, even those specifically designed for patients with T2D, do not accurately estimate the risk of future cardiovascular disease in the population with T1D. […] In this practical approach proposal, we highlight the key points for cardiovascular prevention specifically for individuals living with T1D. In addition to promoting a healthy lifestyle, including the Mediterranean diet, the cornerstones for reducing CVD burden include smoking cessation, BP control at 130/80 mmHg, and the maintenance of optimal glycaemic control. […] The intention of our proposal for the management and follow-up of cardiovascular risk in patients living with T1D is to facilitate positive changes in the cardiovascular risk of this population.
#24
https://link.springer.com/article/10.1007/s13300-024-01616-4
Population-based risk scales, even those specifically designed for patients with T2D, do not accurately estimate the risk of future cardiovascular disease in the population with T1D. […] In this practical approach proposal, we highlight the key points for cardiovascular prevention specifically for individuals living with T1D. In addition to promoting a healthy lifestyle, including the Mediterranean diet, the cornerstones for reducing CVD burden include smoking cessation, BP control at 130/80 mmHg, and the maintenance of optimal glycaemic control. […] The intention of our proposal for the management and follow-up of cardiovascular risk in patients living with T1D is to facilitate positive changes in the cardiovascular risk of this population.
#25 Type 1 Diabetes Mellitus: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/117739-overview
Type 1 DM is associated with a high morbidity and premature mortality. More than 60% of patients with type 1 DM do not develop serious complications over the long term, but many of the rest experience blindness, end-stage renal disease (ESRD), and, in some cases, early death. The risk of ESRD and proliferative retinopathy is twice as high in men as in women when the onset of diabetes occurs before age 15 years. […] Patients with type 1 DM who survive the period 10-20 years after disease onset without fulminant complications have a high probability of maintaining reasonably good health. Other factors affecting long-term outcomes are the patients education, awareness, motivation, and intelligence level. A new recommendation in the ADAs Standards of Care in Diabetes2025 stresses that quality improvement initiatives and interprofessional teams are important for supporting sustainable and scalable process changes that improve quality of care and health outcomes.
#26 Predicting Mortality in Patients with Diabetes Starting Dialysis | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0089744
A prediction model for mortality in diabetic dialysis patients could be a helpful tool in clinical decision-making. […] The primary aim of this study was to construct a prediction model to predict 1-year mortality in diabetic dialysis patients. […] A prediction model containing seven predictors has been identified in order to predict 1-year mortality for diabetic incident dialysis patients. Predictive performance of the model was good. Before implementing the model in clinical practice, for example for counseling patients regarding their prognosis, external validation is necessary. […] The final prediction model contained seven predictors; age, smoking, history of macrovascular complications, duration of diabetes mellitus, Karnofsky scale, serum albumin and hemoglobin level. […] The c-statistic of the final model was 0.810, which is only slightly lower than that of the full model (0.816).
#27 Predicting Mortality in Patients with Diabetes Starting Dialysis | PLOS One
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0089744
Despite these limitations this prediction model is the first model that predicts mortality in diabetic incident dialysis patients with good discriminative ability, indicated by the c-statistic of 0.810. […] In conclusion; a prediction algorithm for 1-year all-cause mortality has been developed for incident diabetic dialysis patients. The performance of this model is good as indicated by good outcomes for discrimination and calibration.
#28 People with type 1 diabetes are living longer – Harvard Health
https://www.health.harvard.edu/blog/people-type-1-diabetes-living-longer-201501087611
Ninety years ago, type 1 diabetes was a death sentence: half of people who developed it died within two years; more than 90% were dead within five years. […] A Scottish study published this week in JAMA shows that at the age of 20, individuals with type 1 diabetes on average lived 12 fewer years than 20-year-olds without it. […] A second study in the same issue of JAMA showed that people with type 1 diabetes with better blood sugar control lived longer than those with poorer blood sugar control. […] This suggests that tight control is one way to improve survival in people with type 1 diabetes. […] After 27 years, participants in the tight control group were less likely to have died than those in the conventional control group. […] Better ways to track blood sugar with home glucose monitors and even continuous glucose monitors. Keeping blood sugar close to normal is linked with longer life.
#29 People with type 1 diabetes are living longer – Harvard Health
https://www.health.harvard.edu/blog/people-type-1-diabetes-living-longer-201501087611
New drugs and other therapies to prevent and treat complications of diabetes, such as heart disease and kidney disease. Both are major causes of early death in people with type 1 diabetes. […] In the Scottish study, 21% of deaths among younger people (under age 50) with type 1 diabetes occurred as a result of diabetic coma and related causes.
#30 People with type 1 diabetes are living longer – Harvard Health
https://www.health.harvard.edu/blog/people-type-1-diabetes-living-longer-201501087611
Ninety years ago, type 1 diabetes was a death sentence: half of people who developed it died within two years; more than 90% were dead within five years. […] A Scottish study published this week in JAMA shows that at the age of 20, individuals with type 1 diabetes on average lived 12 fewer years than 20-year-olds without it. […] A second study in the same issue of JAMA showed that people with type 1 diabetes with better blood sugar control lived longer than those with poorer blood sugar control. […] This suggests that tight control is one way to improve survival in people with type 1 diabetes. […] After 27 years, participants in the tight control group were less likely to have died than those in the conventional control group. […] Better ways to track blood sugar with home glucose monitors and even continuous glucose monitors. Keeping blood sugar close to normal is linked with longer life.
#31 Global burden of type 1 diabetes in adults aged 65 years and older, 1990-2019: population based study | The BMJ
https://www.bmj.com/content/385/bmj-2023-078432
Mortality and DALYs among older people (65 years) with T1DM decreased considerably from 1990 to 2019. Both were lower in women, those living in countries or regions with a high sociodemographic index, and those younger than 79 years. Management of high fasting plasma glucose levels remains a major challenge for older people with T1DM, and targeted clinical guidelines are needed. […] The results suggest that T1DM is no longer a contributory factor in decreased life expectancy owing to improvements in medical care over the three decades. […] A high fasting plasma glucose level was identified as the major contributor to DALYs from T1DM among people aged 65 years, indicating that blood glucose control is still suboptimal and a challenge among this population. […] The findings are important for health practice and future research, and provide optimistic evidence for all people with T1DM, especially those with a diagnosis at a young age.
#32 Type 1 Diabetes Mellitus: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/117739-overview
Type 1 DM is associated with a high morbidity and premature mortality. More than 60% of patients with type 1 DM do not develop serious complications over the long term, but many of the rest experience blindness, end-stage renal disease (ESRD), and, in some cases, early death. The risk of ESRD and proliferative retinopathy is twice as high in men as in women when the onset of diabetes occurs before age 15 years. […] Patients with type 1 DM who survive the period 10-20 years after disease onset without fulminant complications have a high probability of maintaining reasonably good health. Other factors affecting long-term outcomes are the patients education, awareness, motivation, and intelligence level. A new recommendation in the ADAs Standards of Care in Diabetes2025 stresses that quality improvement initiatives and interprofessional teams are important for supporting sustainable and scalable process changes that improve quality of care and health outcomes.
#33 Type 1 Diabetes Mellitus: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/117739-overview
Control of blood glucose, hemoglobin A1c (HbA1c), lipids, blood pressure, and weight significantly affects prognosis. Excess weight gain with intensified diabetes treatment is associated with hypertension, insulin resistance, dyslipidemia, and extensive atherosclerotic cardiovascular disease. […] Patients with diabetes face a lifelong challenge to achieve and maintain blood glucose levels as close to the normal range as possible. With appropriate glycemic control, the risk of microvascular and neuropathic complications is decreased markedly. In addition, aggressive treatment of hypertension and hyperlipidemia decreases the risk of macrovascular complications. […] The benefits of glycemic control and control of comorbidities in type 1 DM must be weighed against the risk of hypoglycemia and the short-term costs of providing high-quality preventive care. However, studies have shown cost savings due to a reduction in acute diabetes-related complications within 1-3 years of starting effective preventive care.
#34 Type 1 Diabetes: Causes, Symptoms, Complications & Treatment
https://my.clevelandclinic.org/health/diseases/21500-type-1-diabetes
Type 1 diabetes is a challenging condition to manage properly, especially consistently throughout your lifetime. Because of this, T1D is associated with several complications. Close to 50% of people with Type 1 diabetes will develop a serious complication over their lifetime. Some may lose eyesight while others may develop end-stage kidney disease. […] For those who reach the first 20 years after diagnosis without any complications, the prognosis (outlook) is good.
#35 Global burden of type 1 diabetes in adults aged 65 years and older, 1990-2019: population based study | The BMJ
https://www.bmj.com/content/385/bmj-2023-078432
Mortality and DALYs among older people (65 years) with T1DM decreased considerably from 1990 to 2019. Both were lower in women, those living in countries or regions with a high sociodemographic index, and those younger than 79 years. Management of high fasting plasma glucose levels remains a major challenge for older people with T1DM, and targeted clinical guidelines are needed. […] The results suggest that T1DM is no longer a contributory factor in decreased life expectancy owing to improvements in medical care over the three decades. […] A high fasting plasma glucose level was identified as the major contributor to DALYs from T1DM among people aged 65 years, indicating that blood glucose control is still suboptimal and a challenge among this population. […] The findings are important for health practice and future research, and provide optimistic evidence for all people with T1DM, especially those with a diagnosis at a young age.
#36 Global burden of type 1 diabetes in adults aged 65 years and older, 1990-2019: population based study | The BMJ
https://www.bmj.com/content/385/bmj-2023-078432
Mortality and DALYs among older people (65 years) with T1DM decreased considerably from 1990 to 2019. Both were lower in women, those living in countries or regions with a high sociodemographic index, and those younger than 79 years. Management of high fasting plasma glucose levels remains a major challenge for older people with T1DM, and targeted clinical guidelines are needed. […] The results suggest that T1DM is no longer a contributory factor in decreased life expectancy owing to improvements in medical care over the three decades. […] A high fasting plasma glucose level was identified as the major contributor to DALYs from T1DM among people aged 65 years, indicating that blood glucose control is still suboptimal and a challenge among this population. […] The findings are important for health practice and future research, and provide optimistic evidence for all people with T1DM, especially those with a diagnosis at a young age.
#37 Predicting major outcomes in type 1 diabetes: a model development and validation study
https://pmc.ncbi.nlm.nih.gov/articles/PMC4399797/
Type 1 diabetes is associated with a higher risk of major vascular complications and death. A reliable method that predicts these outcomes early in the disease process would be helpful in risk classification. We therefore developed such a prognostic model and quantified its performance in independent cohorts. […] Our prognostic model that uses easily accessible clinical features can discriminate between type 1 diabetes patients with good and poor prognosis. Such a prognostic model may be helpful in clinical practice and for risk stratification in clinical trials. […] Absolute risk predictions in individual patients with type 1 diabetes are important to timely identify the patients at high risk of major outcomes in order to enable strategies to prevent the development of such complications and to reduce health care costs.
#38 Predicting major outcomes in type 1 diabetes: a model development and validation study
https://pmc.ncbi.nlm.nih.gov/articles/PMC4399797/
We here describe a prognostic model based on easily accessible patient and clinical characteristics for the composite of the major outcomes and death, which would allow straightforward application of the model in practice. This model may help to identify patients with type 1 diabetes at high risk of major outcome events. […] The final prognostic model included age, glycated haemoglobin, waist-hip ratio, albumin/creatinine ratio, and HDL cholesterol. […] The discriminative ability of the prognostic model was adequate in all cohorts with C-statistic of 0.79 in EDC, 0.74 in EDC recent and 0.73 in CACTI compared to a C-statistic of 0.74 in the development set. […] Predicting major outcomes permits establishment of a risk profile for individual patients with type 1 diabetes. Physicians may consider active intervention in the identified high risk patients.
#39 Type 1 Diabetes Mellitus: Practice Essentials, Background, Pathophysiology
https://emedicine.medscape.com/article/117739-overview
Control of blood glucose, hemoglobin A1c (HbA1c), lipids, blood pressure, and weight significantly affects prognosis. Excess weight gain with intensified diabetes treatment is associated with hypertension, insulin resistance, dyslipidemia, and extensive atherosclerotic cardiovascular disease. […] Patients with diabetes face a lifelong challenge to achieve and maintain blood glucose levels as close to the normal range as possible. With appropriate glycemic control, the risk of microvascular and neuropathic complications is decreased markedly. In addition, aggressive treatment of hypertension and hyperlipidemia decreases the risk of macrovascular complications. […] The benefits of glycemic control and control of comorbidities in type 1 DM must be weighed against the risk of hypoglycemia and the short-term costs of providing high-quality preventive care. However, studies have shown cost savings due to a reduction in acute diabetes-related complications within 1-3 years of starting effective preventive care.
#40
https://link.springer.com/article/10.1007/s13300-024-01616-4
Population-based risk scales, even those specifically designed for patients with T2D, do not accurately estimate the risk of future cardiovascular disease in the population with T1D. […] In this practical approach proposal, we highlight the key points for cardiovascular prevention specifically for individuals living with T1D. In addition to promoting a healthy lifestyle, including the Mediterranean diet, the cornerstones for reducing CVD burden include smoking cessation, BP control at 130/80 mmHg, and the maintenance of optimal glycaemic control. […] The intention of our proposal for the management and follow-up of cardiovascular risk in patients living with T1D is to facilitate positive changes in the cardiovascular risk of this population.