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Management of Type 1 Diabetes

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Atlas of Diabetes

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Abstract

The treatment of type 1 diabetes has a relatively short history; the disease was uniformly fatal before the discovery of insulin in 1922. It is interesting to note that by the late 1920s, it was observed that insulin tended to make “fat people fatter”; however, it was not until the mid-1930s that some basic differences were noted between the two major types of diabetes. Although insulin therapy has prevented certain death in patients with type 1 diabetes, it brought on a new era of problems not formally appreciated. This “era of complications” was notable for the grim realization that about half the patients developed proliferative diabetic retinopathy and between 30 and 40% developed diabetic nephropathy. One of the most important scientific debates of the twentieth century was the relationship between diabetic complications and glycemic control. By the 1980s, new tools, such as home self-monitoring of blood glucose (SMBG), assessment of integrated glycemic control by glycated hemoglobin HbA1c (A1c), continuous subcutaneous insulin infusion (CSII), and human insulins, made it possible to attempt near-normal glycemic control. The announcement of the results of the Diabetes Control and Complications Trial (DCCT) in 1993 ended the debate by demonstrating a strong relationship between blood glucose control and the microvascular and neuropathic complications of type 1 diabetes. Since then, the goals have been to further improve our tools for managing type 1 diabetes and to develop new strategies for treating diabetes-related complications once they develop.

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Authors and Affiliations

  1. University of Washington, Roosevelt, Seattle, WA, USA

    Irl B. Hirsch MD (Professor of Medicine)

  2. Clinical Research & Academic Programs, Diabetes Research Institute, University of Miami Miller School of Medicine, Miami, FL, USA

    Jay S. Skyler MD, MACP (Professor of Medicine, Pediatrics, and Psychology, Deputy Director)

Authors
  1. Irl B. Hirsch MD
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  2. Jay S. Skyler MD, MACP
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Correspondence to Irl B. Hirsch MD .

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Editors and Affiliations

  1. Division of Endocrinology,, Diabetes & Metabolism, University of Miami, Miami, 33136, Florida, USA

    Jay Skyler

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Hirsch, I.B., Skyler, J.S. (2012). Management of Type 1 Diabetes. In: Skyler, J. (eds) Atlas of Diabetes. Springer, Boston, MA. https://doi.org/10.1007/978-1-4614-1028-7_5

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  • DOI: https://doi.org/10.1007/978-1-4614-1028-7_5

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  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4614-1027-0

  • Online ISBN: 978-1-4614-1028-7

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