Type 1 Diabetes Mellitus: Redefining the Future of Cardiovascular Complications with Novel Treatments

Abstract

Diabetes Mellitus (DM) is a disease that was identified centuries ago, in around 1500 BC (King and Rubin, 2003). The word ‘Diabetes’ means “running through” (Holt, 2004) which is used to describe the excessive output of urine in this disease. “Mellitus” meaning “sweet” identifies the nature of the urine in patients suffering from DM (Widmaier et al., 2004). Thomas Willis was the first to differentiate DM from other polyurias in 1674 (Eknoyan and Nagy, 2005). In 1776, Matthew Dobson demonstrated that the sugar present in the urine was also present in the blood and was associated with its rise (Holt, 2004). In 1848, Claude Bernard’s experiments on the liver showed that glycogen stored in the liver produced sugar and he hypothesized that glycogenolysis caused the disease. Although his discovery that “sugar production is a normal function of the animal” was revolutionary, it did not quite explain the etiology of the disease. In 1889, Oskar Minkowski confirmed that the ablation of the pancreas in dogs resulted in DM (Farmer, 1952). Frederick Banting and Charles Best were the medical scientists that discovered insulin, later in 1921, the lack of which, it was made clear, caused DM (Voet and Voet, 2004). They used the extract of a dog’s fresh pancreas and demonstrated that upon administration of 10mL of extract to blood, blood glucose level is decreased from 0.3% to 0.17% (Rosenfeld, 2002). Some 30 years later, in 1953, Frederick Sanger was able to determine the complete amino acid sequence of the protein for the first time in history (Boron and Boulpaep, 2009). Today, DM is defined as a carbohydrate disorder characterized by impaired insulin secretion and/or peripheral insulin resistance leading to hyperglycemia (Beers and Berkow. 1999). It is considered to be the third leading cause of death after heart disease and cancer in the United States (Voet and Voet, 2004) and its incidence is expected to rise to 366 million people by the year 2030 (Wild et al., 2004). Diabetic patients have symptoms such as, thirst, polyuria, blurring of vision and weight loss. In extreme cases, ketoacidosis may develop leading to coma and ultimately death (Alberti and Zimmet, 1998). Diabetes Mellitus is classified according to etiology to two major types: