Type 1 diabetes mellitus (synonyms: juvenile diabetes mellitus, which is the obsolete name for type 1 diabetes; other synonyms: type 1 diabetes; type 1 diabetes; primary insulin-dependent diabetes mellitus (IDDM); ICD-10-GM E10.-: Diabetes mellitus, type 1) is the so-called “diabetes”. Type 1 diabetes mellitus is due to autoimmunological (caused by the body itself, type 1a) or idiopathic (cause unknown, type 1b) destruction of the beta cells of the islets of Langerhans (site of insulin production) of the pancreas and usually leads to absolute insulin deficiency. Insulin is an important hormone for regulating glucose (blood sugar) in the blood. About 5-10% of all diabetics have type 1 diabetes. In most cases, the disease begins in childhood and adolescence. Frequency peak: the disease usually appears before the age of 40 (initial manifestation), but can also occur at an older age. New cases peak in the 11- to 13-year-old age group. Note: 42% of type 1 diabetes cases do not manifest until between the ages of 31 and 60. In Germany, approximately 400,000 people have type 1 diabetes mellitus. The incidence (frequency of new cases) is about 8-17 cases per 100,000 inhabitants per year (in Germany), but there are very large differences worldwide. In recent years, the incidence of type 1 diabetes mellitus has been increasing in children under 6 years of age. Course and prognosis: Initial manifestation by hyperglycemia (high blood sugar) with typical symptoms such as polydipsia (excessive thirst), polyuria (increased urination) and weight loss. In approximately 25% of cases, ketoacidotic coma (metabolic derailment (ketoacidosis) in the absence of insulin) is the first sign of type 1 diabetes mellitus (manifestation coma). Typical complications of the disease are diabetic retinopathy (deterioration of vision up to blindness, caused by the high sugar levels), diabetic nephropathy (the kidneys are damaged by microangiopathy (vascular changes affecting the small vessels)) and diabetic neuropathy (chronic disorders of the peripheral nerves or parts of nerves; these mainly lead to sensory disturbances in the affected regions of the body). Diabetes mellitus type 1 is not curable. Those affected must inject themselves with insulin for the rest of their lives (insulin substitution). Compared to non-diabetics, type 1 diabetics have a reduced life expectancy of about 12 years (men 11.11 years; women 12.9 years). On average, type 1 diabetics die at approximately 67 years of age. A 2020 British study indicates a 7-8 life-year reduction in life expectancy for type 1 diabetics. Type 1 diabetics show excess mortality (excess death) even without albuminuria (increased excretion of albumin with urine) compared to the control group without diabetes. The increased mortality (excess mortality) is mainly due to a 4-fold increase in the rate of CHD-associated deaths (coronary heart disease (CHD); coronary artery disease) and acute diabetes complications. Notice: Due to intensified insulin therapy and as a result of changes in lifestyle habits, the BMI (body mass index) of many patients in childhood and adolescence today is above the age- and sex-dependent reference values, which has adverse effects on glycemic control. This leads to elevated HbA1c (long-term blood glucose) levels and an increased incidence of severe hypoglycemia (hypoglycemia with seizures and impaired consciousness). Comorbidities (concomitant diseases): inflammatory bowel disease (IBD) is associated with type 1 diabetes: CED prevalence (disease incidence) of children and adolescents with type 1 diabetes is 0.1 percent, a good three times higher than in the population of the same age; have more frequent severe hypoglycemia (low blood sugar) than patients without CED. Furthermore, celiac disease (a chronic disease of the mucosa of the small intestine caused by hypersensitivity to the cereal protein gluten) is associated with type 1 diabetes mellitus. In patients with type 1 diabetes mellitus, the prevalence (disease frequency) of celiac disease is greater than 5%.Celiac disease also increases the risk of microvascular (concerning the small blood vessels) complications (retino- and nephropathy/disease of the retina and kidneys) in type 1 diabetics. Other comorbidities include thyroid disease (Hashimoto’s thyroiditis/autoimmune thyroiditis (AIT), Graves’ disease; increased 14.2-fold compared with children without diabetes), noninfectious enteritis (inflammation of the intestine) and colitis (inflammation of the colon; increased 5.6-fold), cardiovascular disease (increased 3.1-fold), obstructive pulmonary disease possible, (pulmonary disease in which narrowing or narrowing or obstruction); 1.5-fold increase); and mental disorders and epilepsy (2.0-fold increase each).
