Clinical Gems

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.

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.

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.

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.

Type 1 diabetes in children and youth is typically characterized by weight loss, polyuria, polydipsia, blurring of vision, very high plasma glucose concentrations, and ketonuria.

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.

The other specific types of diabetes are less common and can be broadly classed as genetic, exocrine pancreatic, endocrine, and drug-induced causes. A more comprehensive breakdown is provided in Table 1.2 and the more common types are discussed briefly later.

Type 1 indicates the processes of β-cell destruction that may ultimately lead to diabetes in which insulin is required for survival in order to prevent the development of ketoacidosis, coma, and death.

A critical requirement for orderly epidemiologic, genetic and clinical research, and indeed for the management of diabetes mellitus and other forms of glucose intolerance is an appropriate classification system. Furthermore, a hallmark in the process of understanding the etiology of a disease and studying its natural history is the ability to identify and differentiate its various forms and place them into a rational etiopathologic framework.

In the Look AHEAD study, about 15% had symptoms of mild–moderate depression, about 17% were current users of antidepressant medication, and about 4% both [13]. Other studies in the USA have described higher rates, up to 25%, of more severe depression, with all ethnic groups (white, African-American, Latinos and others) recording similar rates.