Evidence is accumulating that for patients with type 1 diabetes who have a family history of it ― defined as having at least one first-degree relative with type 1 diabetes — the disease is often substantially different from that of people with sporadic type 1 diabetes who have no family background.
The most striking difference: familial cases are associated with many more comorbidities.
Researchers hope that a better understanding how familial and sporadic diabetes differ will yield new insights into how to best tailor treatments for patients with type 1 diabetes in the future.
Results from a recent report on more than 16,000 US residents with type 1 diabetes who were enrolled in a nationwide registry showed that among the 3941 adults and children with a familial background, various comorbidities were much more prevalent compared with more than 12,000 patients who had sporadic type 1 diabetes, which was defined conservatively as not having any relative who was diagnosed with it, including those more removed than first degree.
Among those with familial disease, prevalence rates of hypertension, hyperlipidemia, atherosclerosis, retinopathy/maculopathy/vitreopathy, erectile and sexual dysfunction, gastroesophageal reflux disease, neuropathy, and nephropathy were significantly higher, as were rates of several other comorbidities.
In contrast, people with sporadic cases of type 1 diabetes were significantly more likely to have no comorbidities. Several of the comorbidities among the familial patients clustered in groups of two or three in the studied cohort. The researchers identified these prevalence patterns using a specially designed analytic, data-mining algorithm.
One example of the prevalence differences: 7.0% of the patients with familial disease and 4.4% of those with a sporadic background had both hypertension and hyperlipidemia/dyslipidemia. The relative difference between the two cohorts was greater than 50%.
7% of Type1 Diabetes Cases Are Familial: Differences in Autoimmune Disease
The findings open a new dimension in the growing appreciation of how sporadic and familial cases differ. A 2021 report from Europe that involved assessment of a population-based registry with more than 57,000 children and teenagers with type 1 diabetes from Germany, Austria, Switzerland, and Luxembourg documented a familial prevalence of roughly 7% of the entire pediatric cohort.
The 2021 report also showed that familial disease showed up earlier. The average age of children with familial disease was 7.9 years, compared with 9.7 years among children with sporadic disease. Among the patients with familial disease, there was a higher prevalence of associated autoimmune comorbidity and indications of more aggressive autoimmunity.
The researchers found that autoimmune diseases occurred in 16.7% of those with familial type 1 diabetes compared with 13.6% of those with sporadic disease, a significant, 23% relative difference. Among the autoimmune diseases assessed, celiac disease showed the largest between-group difference, with a 6.2% prevalence among those with familial type 1 diabetes compared with a 4.2% prevalence among patients with sporadic disease.
"The higher prevalence of autoimmune and other comorbidities in people with familial type 1 diabetes might be explained by a shared genetic and environmental background in affected families," explained Beate Karges, MD, a researcher in the Division of Endocrinology and Diabetes, at RWTH Aachen University, Germany, and lead author of the European report.
The results in these two reports plus other findings suggest that the differences in risk profiles among patients with sporadic disease and those with familial type 1 diabetes are related not only to the "pathways of autoimmunity and inflammation" that help determine the "glycemic trajectory of the disease" but also influence "complications of abnormal glycemic control" in patients with familial disease, said Mark A. Clements, MD, PhD, a pediatric endocrinologist at Children's Mercy Hospital in Kansas City, Missouri, who co-authored the more recent, US report.
"If a person with familial disease has stronger autoimmunity and stronger inflammation triggered by the autoimmunity, you can hypothesize that they also have a higher prevalence of other diseases that associate with the autoimmunity and inflammation," said Clements, who is also a professor of pediatrics at the University of Missouri–Kansas City School of Medicine.
Beyond One-Size-Fits-All Type 1 Diabetes Care
While Clements stressed that his group's findings are preliminary and need confirmation and validation with other datasets, they point toward an eventual end to the current practice of "applying the same care paradigm to all patients with type 1 diabetes," he said in an interview.
A goal is to distinguish patients with familial and those with sporadic forms with distinct multivariable risk models, he added. An attraction of the artificial intelligence method he and his associates applied is that it can potentially find "important patterns [of linked comorbidities] that people cannot see."
If future studies could, for example, nail down a strong link between familial type 1 diabetes and an increased risk for developing hypertension, it could have implications for intensifying hypertension surveillance and early treatment, he suggested. "This research is getting at one way to determine a patient's lifetime risk of diabetes-related eye disease, hypertension," and other common diabetes complications.
While many of the potential implications of these findings for practice still need to be worked out, both Clements and Karges see a few immediate applications to diagnosing and managing patients with type 1 diabetes.
Stepped Up Screening
The higher prevalence of autoimmune diseases in patients with familial disease suggests the potential for personalized screening for associated autoimmune diseases, Karges suggested in an interview. "Regular screening for autoimmune thyroid and celiac disease may lead to earlier detection and treatment of comorbidities and improve patient care."
In addition, management of the index case might be aided by "enhanced psychosocial support for families coping with more than one individual with type 1 diabetes," she said.
"Once someone is diagnosed with type 1 diabetes, the risk that another [first-degree] family member also has type 1 diabetes rises fifteenfold," noted Clements.
That's why clinicians who care for patients with type 1 diabetes should be aware of and potentially act on the newly assumed risk in close relatives following an index-case diagnosis. With further research, he hopes that classifying type 1 diabetes as sporadic or familial will also inform the care received by the index patients. And he sees the potential to use detailed assessments of familial cases to work out the genetics that helps drive the comorbidity spikes in these patients.
The study run by Clements and his associates used patients selected from the T!D Exchange Clinic Registry, which enrolled more than 34,000 US residents with type 1 diabetes during 2007–2018 at any of 83 US endocrinology practices. The researchers selected for their study a disproportionately high percentage of people with familial disease, 24% of the 16,232 individuals studied. Clements noted that the roughly 7% prevalence of familial type 1 diabetes seen in the study led by Karges is a much better approximation of how often familial cases arise.
The Karges study used data compiled in the Diabetes Prospective Follow-up Registry, based at Ulm University, Germany, with patients enrolled during 1995–2018.
A key difference between the US and European studies is that the US database included a significant minority of people with adult-onset type 1 diabetes, while the Karges' study exclusively focused on type 1 diabetes in which onset occurred during childhood or adolescence.
Important differences in diet, activity, and other lifestyle and cultural factors also likely distinguish the US-based study and the one that involved patients from Central Europe, Clements noted.
Neither study received commercial funding. Clements is chief medical officer for Glooko and has received research support from Abbott Diabetes Care and Dexcom. Karges has disclosed no relevant financial relationships.
Diabetes Care. 2022;45:e56-e59. Full text
Diabetes Care. 2021;449:1116-24. Abstract
Mitchel L. Zoler is a reporter with Medscape and MDedge based in the Philadelphia region. @mitchelzoler
There are 2 sub categories of Type 1 diabetes: Type 1a including Latent Autoimmune Diabetes of Adults (LADA) Type 1b.How long can you have type 1 diabetes without knowing it? ›
It can take months or years before symptoms of type 1 diabetes are noticed. Type 1 diabetes symptoms can develop in just a few weeks or months. Once symptoms appear, they can be severe.What are the rare versions of type 1 diabetes? ›
8.7 million people live with type 1 diabetes. An estimated 1-5% of all diagnosed cases of diabetes are rare types, such as latent autoimmune diabetes in adults (LADA), maturity-onset diabetes in the young (MODY), cystic fibrosis-related diabetes (CFRD), Cushing's syndrome and others.What triggers type 1 diabetes? ›
What causes type 1 diabetes? Type 1 diabetes occurs when your immune system, the body's system for fighting infection, attacks and destroys the insulin-producing beta cells of the pancreas. Scientists think type 1 diabetes is caused by genes and environmental factors, such as viruses, that might trigger the disease.Can your pancreas start working again type 1 diabetes? ›
Researchers have discovered that patients with type 1 diabetes can regain the ability to produce insulin. They showed that insulin-producing cells can recover outside the body. Hand-picked beta cells from the islets of Langerhans in the pancreas.How long can a type 1 diabetic go without insulin? ›
In the worst-case scenario, just how long would we be able to hang on without it? Conventional wisdom says the answer is roughly 3 to 4 days.What is the life expectancy of a type 1 diabetes? ›
Amongst those who are currently 65 years old, the average man can expect to live until 83 years old and the average woman to live until 85 years old. People with type 1 diabetes have traditionally lived shorter lives, with life expectancy having been quoted as being reduced by over 20 years.Can Type 1 diabetics be temporary? ›
Most people with type 1 diabetes have a period of time after they're diagnosed when their remaining beta cells can pump out enough insulin to control their blood sugar. This is the honeymoon phase. While it lasts, you may not need to take as much insulin.What happens if type 1 diabetes is left untreated? ›
Without insulin, your body will break down its own fat and muscle, resulting in weight loss. This can lead to a serious short-term condition called diabetic ketoacidosis. This is when the bloodstream becomes acidic, you develop dangerous levels of ketones in your blood stream and become severely dehydrated.Does type 1 diabetes run in families? ›
Family history: Since type 1 diabetes involves an inherited susceptibility to developing the disease, if a family member has (or had) type 1, you are at a higher risk. If both parents have (or had) type 1, the likelihood of their child developing type 1 is higher than if just one parent has (or had) diabetes.
Type 1 diabetes. In most cases of type 1 diabetes, people need to inherit risk factors from both parents. We think these factors must be more common in white people because white people have the highest rate of type 1 diabetes.What is the oldest you can be diagnosed with type 1 diabetes? ›
The peak age for being diagnosed with type 1 diabetes is around 13 or 14 years, but people can be diagnosed when they're much younger (including babies) and older (even over 40).Can type 1 diabetes come from stress? ›
Stress doesn't cause diabetes but it can affect your blood sugar levels and how you look after your condition. Having diabetes to manage on top of life's normal ups and downs can itself be a cause of stress.Is type 1 diabetes caused by diet? ›
We're still not sure what causes type 1 diabetes to develop. It's got nothing to do with diet or lifestyle. But researchers and scientists around the world, including our own, are working hard to find answers.Can type 1 diabetes be caused by sugar? ›
There are two main types of diabetes – type 1 and type 2 diabetes. We know that sugar does not cause type 1 diabetes, nor is it caused by anything else in your lifestyle. In type 1 diabetes, the insulin producing cells in your pancreas are destroyed by your immune system.Can vitamin D reverse diabetes 1? ›
Regular doses of vitamin D early in life have been shown to reduce the risk of developing type 1 diabetes. Vitamin D treatment has also been shown to improve glycemic control and insulin sensitivity in people with type 1 and type 2 diabetes and in normal individuals.What foods help repair pancreas? ›
What to eat if you have pancreatitis. To get your pancreas healthy, focus on foods that are rich in protein, low in animal fats, and contain antioxidants. Try lean meats, beans and lentils, clear soups, and dairy alternatives (such as flax milk and almond milk). Your pancreas won't have to work as hard to process these ...Does fasting reset the pancreas? ›
The pancreas can be triggered to regenerate itself through a type of fasting diet, say US researchers. Restoring the function of the organ - which helps control blood sugar levels - reversed symptoms of diabetes in animal experiments.Can type 1 diabetes be controlled without medication? ›
The truth is, while type 1 diabetes can be managed with insulin, diet and exercise, there is currently no cure. However, researchers with the Diabetes Research Institute are now working on treatments to reverse the disease, so that people with type 1 diabetes can live healthy lives without medication.How did diabetics survive before insulin? ›
Before insulin was discovered in 1921, people with diabetes didn't live for long; there wasn't much doctors could do for them. The most effective treatment was to put patients with diabetes on very strict diets with minimal carbohydrate intake. This could buy patients a few extra years but couldn't save them.
Metformin has been shown to have an insulin-sensitizing effect on glycemic control in type 1 diabetes [17, 20].Can Type 1 diabetics live without insulin? ›
Without insulin, people with type 1 diabetes suffer a condition called Diabetic Ketoacidosis (DKA). If left untreated, people die quickly and usually alone. The tragic loss of life from DKA can be prevented. If insulin became freely accessible and affordable, lives could be saved.Why do diabetics feel tired? ›
In people with diabetes, the pancreas does not produce enough insulin, or the body does not use insulin effectively. This causes excess glucose in the blood. Fatigue and weakness may result when the cells do not get enough glucose.Can Type 1 diabetics live 50 years? ›
Thanks to the introduction of insulin therapy in 1922, and numerous advances since then, many people with type 1 diabetes now live into their 50s and beyond.What is the fastest way to get rid of type 1 diabetes? ›
- Taking insulin.
- Counting carbohydrates, fats and protein.
- Monitoring blood sugar often.
- Eating healthy foods.
- Exercising regularly and keeping a healthy weight.
It can be difficult to adjust to life with diabetes. Making changes to diet and lifestyle, monitoring blood sugar, counting carbs, and remembering to take insulin and other medications are often sources of stress. As time goes on, these tasks will get easier. But everyone has days when they feel overwhelmed.What is honeymoon diabetes? ›
The “honeymoon period” is a phase that some people with type 1 diabetes experience shortly after being diagnosed. During this time, a person with diabetes seems to get better and may only need minimal amounts of insulin. Some people even experience normal or near-normal blood sugar levels without taking insulin.Can diabetes 1 cause death? ›
Diabetic ketoacidosis is a severe, life-threatening complication, mostly affecting Type 1 diabetics. DKA can develop when your blood sugar is high and the insulin level is low. The imbalance in the body causes a build-up of ketones, which are toxic. If not treated, it can lead to a diabetic coma and death.What color is urine in diabetes? ›
A water deprivation test involves not drinking any liquid for several hours to see how your body responds. If you have diabetes insipidus, you'll continue to pee large amounts of watery (dilute), light-colored urine when normally you'd only pee a small amount of concentrated, dark yellow urine.What are the 4 types of diabetes? ›
There are four main types of diabetes: Type 1 diabetes, Type 2 diabetes, gestational diabetes, and a condition known as prediabetes, in which you have higher-than-normal blood glucose levels but not quite high enough (yet) to qualify as Type 2 diabetes.
- Type 1 diabetes.
- Type 2 diabetes.
- Gestational diabetes.
- Maturity onset diabetes of the young (MODY)
- Neonatal diabetes.
- Wolfram Syndrome.
- Alström Syndrome.
- Latent Autoimmune diabetes in Adults (LADA)
If left untreated, type-1 diabetes is a life-threatening condition. It's essential that treatment is started early. Diabetes can't be cured, but treatment aims to keep your blood glucose levels as normal as possible and control your symptoms, to prevent health problems developing later in life.What is the life expectancy of a child with type 1 diabetes? ›
In the United States, juvenile diabetes life expectancy is estimated to be 11 years less compared to the general population. Generally, life expectancy will vary from person to person based on their nutrition and their ability to control their blood sugar levels (10).Is type 1 diabetes genetic? ›
Genetic predisposition is thought to be a major risk factor in the development of type 1 diabetes. This can include both family history, as well as the presence of certain genes. In fact, according to research from 2010, there are over 50-plus genes that may be a risk factor for this condition.Can you develop type 1 diabetes later in life? ›
Different factors, such as genetics and some viruses, may cause type 1 diabetes. Although type 1 diabetes usually appears during childhood or adolescence, it can develop in adults.Is diabetes a disability? ›
Specifically, federal laws, such as the Americans with Disabilities Act and the Rehabilitation Act, protect qualified individuals with a disability. Since 2009, amendments and regulations for these laws make clear that diabetes is a disability since it substantially limits the function of the endocrine system.What is the most serious diabetes type? ›
But over time your pancreas makes less insulin and the cells resist the insulin. This causes too much sugar to build up in your blood. High blood sugar levels from Type 2 diabetes can lead to serious health problems including heart disease, stroke or death.Are you born with diabetes? ›
There are many genetic or molecular causes of type 2 diabetes, all of which result in a high blood sugar. As yet, there is no single genetic test to determine who is at risk for type 2 diabetes. To develop type 2 diabetes, you must be born with the genetic traits for diabetes.What does aspirin do for diabetes? ›
How does aspirin treatment reduce hyperglycemia? It is hypothesized that aspirin contributes to decreased basal rates of hepatic glucose production, enhanced tissue insulin sensitivity, decreased insulin clearance, and decreases oxidative stress in diabetic patients [38, 50].What is a good number for type 1 diabetes? ›
The goal is to keep the blood sugar level as close to normal as possible to delay or prevent complications. Generally, the goal is to keep the daytime blood sugar levels before meals between 80 and 130 mg/dL (4.44 to 7.2 mmol/L). After-meal numbers should be no higher than 180 mg/dL (10 mmol/L) two hours after eating.
Type 1 diabetes is not a terminal illness.Can you avoid type 1 diabetes? ›
Type 1 diabetes happens when the body's immune system attacks and destroys insulin-producing beta cells in your pancreas. To prevent type 1, we need to stop the immune system going rogue in the first place, so that it doesn't destroy beta cells. We can't do this at the moment, but scientists are working on it.What is the oldest a Type 1 diabetic has lived? ›
Today's uplifting news comes out of New Zealand, the place that Winsome Johnston, the world's longest living person with Type 1 diabetes, calls home. Ms. Johnston, who has had Type 1 for 78 years, was diagnosed when she was just six years old.Can Type 1 diabetics live alone? ›
It is not uncommon for people with type 1 diabetes to have reservations about living alone. Usually the main concerns for people with type 1 diabetes living on their own are over what happens if short term complications, such as severe hypos or ketoacidosis, occur.Can Type 1 diabetics live without insulin? ›
Without insulin, people with type 1 diabetes suffer a condition called Diabetic Ketoacidosis (DKA). If left untreated, people die quickly and usually alone. The tragic loss of life from DKA can be prevented. If insulin became freely accessible and affordable, lives could be saved.