Type 1 diabetes mellitus.

Abstract

1. Francine Ratner Kaufman, MD* 1. *Professor of Pediatrics, The Keck School of Medicine of University of Southern California; Head, Center for Diabetes, Endocrinology and Metabolism, Children’s Hospital of Los Angeles, Los Angeles, CA After completing this article, readers should be able to: 1. Describe the pathogenesis of type 1 diabetes. 2. Review intensive diabetes management protocols, new insulin preparations, and insulin delivery systems. 3. Describe the importance of home glucose and ketone monitoring and the new monitoring methodologies. 4. Elucidate the key elements of the outpatient diabetes examination and screening for diabetes complications. 5. Characterize the importance of the multidisciplinary team in the management and education of children who have type 1 diabetes and their families. Many advances have been made since the Diabetes Control and Complications Trial (DCCT) provided irrefutable evidence of the benefits of following a system of diabetes management that allows for optimal glycemia for patients who have type 1 diabetes. These advances include an ever-increasing armamentarium of types of insulin that have varying onsets and durations of action, insulin delivery systems, improved methods for monitoring glycemia at home, and potential agents that could be used for diabetes prevention or to preserve residual beta-cell function at the time of diagnosis. These exciting advances have enabled the development of comprehensive, intensive diabetes regimens. To increase the success rate for patients and families with these regimens, it is imperative for the multidisciplinary diabetes team and the primary care clinician to work together to support and educate all those who help manage or affect patients. The pathogenesis of diabetes is reviewed in this article, emphasizing the nearness of expanding efforts at primary prevention and beta-cell preservation at the time of diabetes diagnosis. This is followed by an explanation of current and evolving diabetes management protocols, focusing on insulin regimens and delivery systems that can be used for children to improve glycemic control while minimizing hypoglycemia. Finally, the components of the outpatient visit are reviewed to elucidate methods of screening for diabetes complications to allow early intervention that provides …