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Medscape: Is All Type 1 Diabetes the Same?

By Mitchel L. Zoler

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.

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.


See the full article via Medscape

Endocrinology and Diabetes at Children's Mercy Kansas City

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