Type 1 Diabetes in Adults: Principles and Practice PDF

Preface

At a time of dramatic increases in the prevalence of obesity, it is appropriate that type 2 diabetes has received a great deal of attention by the endocrinology community. Clearly, the management of insulin resistance and cardiovascular risk is a critical issue. However, it is equally important to acknowledge and address type 1 diabetes, whose prevalence is also increasing and whose management remains complex. Currently it is estimated that 10-15% of those with diabetes have type 1, and often the diagnosis is challenging since many of those previously thought to have type 2 diabetes actually have late-onset type 1 diabetes (also termed latent autoimmune diabetes in adults, or LADA). Over the last decade the tools for the management of type 1 diabetes have also evolved and so there is an opportunity to more closely replicate normal physiologic insulin secretion with either basal–bolus insulin therapy or continuous subcutaneous insulin infusions. Besides insulin, there are now some added therapies such as pramlintide. While these advancements allow us to better manage our patients with type 1 diabetes, they also add complexity. An updated text to address the concepts behind the care of the person with type 1 diabetes is warranted to review these issues for endocrinologists and primary care providers with an interest in diabetes.

To achieve this goal, we have divided our textbook into four separate sections:

• In the first section, we review the pathogenesis of type 1 diabetes, including polyglandular autoimmunity, and expand our understanding of LADA.
• In the second section, we discuss in detail the management of type 1 diabetes, including blood glucose monitoring; diabetes education, nutrition, and special situations; insulin; and pramlintide therapies.
• In the third section, we review the complications of diabetes: Hyperglycemia and tissue damage, including data from DCCT/EDIC, retinopathy, nephropathy, neuropathy, and hypoglycemia.
• In the fourth and last section, we discuss special settings and situations such as pregnancy, psychology, including depression and eating disorders, and pancreas and islet transplantation.

We would like to acknowledge the mentoring of our senior editors, Dr. Irl Hirsch, Dr. Satish Garg, Dr. Barry J. Goldstein, and Dr. Matthew Riddle.

We hope you find this text to be informative and practical in your day-to-day management of type 1 diabetes patients and all the complex issues that arise in their care.