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Clinical Gems

Our clinical gems come from the top selling medical books, and text books because knowledge is everything when it comes to diabetes.

International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #11: Epidemiology and Risk Factors for Type 1 Diabetes Mellitus Part 5 of 5

In industrialized countries, 20–40% of T1DM patients younger than 20 years present with diabetic ketoacidosis. After adjusting for age, gender, ethnicity, diabetes type, and family history of diabetes, diabetic ketoacidosis at diagnosis was associated with lower family income, less desirable health insurance coverage, and lower parental education. Younger children present with more severe symptoms at diagnosis, because children younger than 7 years old have lost on average 80% of the islets, compared to 60% in those 7–14 years old and 40% in those older than 14 years.

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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #10: Epidemiology and Risk Factors for Type 1 Diabetes Mellitus Part 4 of 5

Twin and family studies indicate that genetic factors alone cannot explain the etiology of T1DM. Seasonality, increasing incidence and epidemics of T1DM as well as numerous ecological, cross-sectional and retrospective studies suggest a critical role of environmental factors, such as infections with certain viruses (especially enteric infections in early life) and effects of early childhood diet. Natural history studies that follow children at increased risk of T1DM provide the best opportunity to study environmental triggers.

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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #9: Epidemiology and Risk Factors for Type 1 Diabetes Mellitus Part 3 of 5

The first large-scale studies of the prediction of T1DM relied upon the detection of cytoplasmic islet cell autoantibodies (ICA) assays based on indirect immunofluorescence. High titer cytoplasmic ICA is most often associated with the presence of multiple islet autoantibodies and therefore a high risk of progression to diabetes.

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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #8: Epidemiology and Risk Factors for Type 1 Diabetes Mellitus Part 2 of 5

Type 1A diabetes results from a chronic autoimmune destruction of the pancreatic beta cells, probably initiated by exposure of a genetically susceptible individual to some environmental agent(s). This preclinical period is marked by the presence of autoantibodies to pancreatic beta-cell antigens such as insulin, GAD65 (Glutamic Acid Decarboxylase), ICA512 (called also IA-2) or ZnT8 (Zinc Transporter 8), and precedes the onset of hyperglycemia by a few years.

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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #7: Epidemiology and Risk Factors for Type 1 Diabetes Mellitus Part 1 of 5

Type 1 diabetes (T1DM) is one of the most prevalent severe chronic diseases of childhood, affecting more than 170,000 children in the United States, an increase of 23% since 2001. In the US, more than 25,000 children are diagnosed annually with 1:200 children and 1:100 adults diagnosed with T1DM during the lifespan.

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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #6: Classification of Diabetes Mellitus and Other Categories of Glucose Intolerance Part 6 of 6

Impaired glucose tolerance (IGT) and impaired fasting glycemia (IFG) are categorized as stages in the natural history of disordered carbohydrate metabolism. They occur in all individuals as they progress from normal to diabetes, but since the transition through these states is rapid in type 1 diabetes, they are rarely identified in such individuals. Therefore, nearly all of the literature dealing with IGT and IFG is concerned with issues relating to type 2 diabetes, such as risk of developing type 2 diabetes and CVD.

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International Textbook of Diabetes Mellitus, 4th Ed., Excerpt #4: Classification of Diabetes Mellitus and Other Categories of Glucose Intolerance Part 4 of 6

There is accumulating evidence supporting an association of certain psychiatric conditions with type 2 diabetes which can be attributed to side-effects of treatment and a high baseline risk of diabetes in this patient group. Diabetes can be induced by the use of atypical antipsychotics including clozapine, olanzapine, risperidone, quetiapine, ziprasidone, and aripiprazole. These drugs have a direct effect of raising blood glucose and also lead to weight gain, [48] which subsequently may increase blood glucose levels.

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