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Last Updated: 4/21/2014  

Diabetes Mellitus, Type 1

Diabetes mellitus type 1 accounts for 5% to 10% of all cases of diabetes. Type 1 diabetes is often diagnosed in children, adolescents, and young adults, but can occur at any age.

Diagnosis
  • Ask patients or caregivers about classic acute symptoms of the disease such as polyuria.

  • Perform a physical exam to look for signs of acute complications, such as volume depletion and diabetic ketoacidosis, and precipitating factors such as infection.

  • Measure plasma glucose to confirm the diagnosis. Check other laboratory studies to document metabolic and end-organ complications.

  • Differentiate type 1 diabetes from other forms of diabetes based primarily on clinical factors.

Therapy
  • Set an individualized target for glycemic control, generally with a goal of HbA1c <7%.

  • Treat patients with multiple daily insulin injections to achieve glycemic targets and prevent complications.

  • Take measures to avoid severe hypoglycemia.

  • Aggressively manage blood pressure, preferably with an ACE inhibitor or angiotensin-receptor blocker with a goal blood pressure < 140/90 mm Hg, or lower in select patients.

  • Provide moderate- or high-intensity statin therapy.

  • Treat diabetic nephropathy with ACE inhibitors.

  • Provide pneumococcal vaccination and annual influenza vaccination for all patients with type 1 diabetes.

  • Encourage smoking cessation and exercise.

  • Follow and treat retinopathy.

  • Treat foot ulcers aggressively.

  • Treat painful peripheral neuropathy using tricyclic antidepressants as first-line agents.

DOI: 10.7326/d257
The information included herein should never be used as a substitute for clinical judgment and does not represent an official position of ACP.
Authors and Disclosures:
Maureen D. Passaro, MD has nothing to disclose. Robert E. Ratner, MD is a consultant for Amylin Pharmaceuticals, AstraZeneca, GlaxoSmithKline, Lifescan, Inc., NovoNordisk, Sanofi-Aventis, Takeda, owns stocks in Merck, Johnson & Johnson, Abbott, received grants from Amylin, AstraZeneca, Bayhill Therapeutics, Boehringer Ingelheim, Conjuchem, Inc., Eil Lilly, GlaxoSmithKline, Merck, NovoNordisk, Pfizer, Sanofi-Aventis, Takeda. Ebenezer A. Nyenwe, MD, FWACP, FACP, FACE has nothing to disclose.

The following editors of ACP Smart Medicine have nothing to disclose: Deborah Korenstein, MD, FACP, Editor in Chief; Richard B. Lynn, MD, FACP, Editor; and Davoren Chick, MD, FACP, Editor.

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