Type 1 Diabetes Mellitus

By: Allison Ashurst, Ciara Charlick, Timmy LaPointe, Brooke Mason, Andrea Taratuta
Prevalence & Incidence

● 1 in 300 people in the United

States by 18 years old1

● Highest in Northern Europe

and lowest in Asia1

● Incidence increasing by 2% to
5% all over the world1
 Etiology
Who is at risk?
● Early adolescence

● Adult onset recognition is becoming more common 2

How do you get T1DM?

● Predisposed to autoimmune disease, destroying one’s own
beta cells= hyperglycemia & insulin dependence3

● HLA-DR3, 4, 7 and w9
○ DR3 & DR4 = Associated with Caucasians
○ DR7 & DRw9 = Associated with African Americans4
Prevention

● No "cure" exists

● Potential preventive strategies

target: T cells, building tolerance to
beta-cell proteins, & beta-cell
replacement1
Pathology
Type of cells involved:

● Pancreatic β cells5 Insulin

autoimmune
antibody
● Destruction is directly by CD8 T
cells5

● Process is mediated by macrophages and

dendritic cells that present beta cell antigen
to naïve CD4 T cells through the MHC5
● Through cytokine signaling, CD4 T cells are
activated, which in turn activates CD8 T
cells5
Disease Course T1DM is associated with
human enteroviruses
and a potential viral ➢ Initial interaction of genes and
agent is congenital environmental factors5
rubella infection5,6 ➢ Triggers an immune-mediated
response with the
appearance of different
autoantibodies as the first sign
of β-cell destruction5
➢ Eventually followed by the loss
of first-phase insulin response5
➢ The progression to clinical
diabetes is triggered by the
development of a more
aggressive T cell phenotype5

Insulitis: inflammation of
pancreatic islets5
Diagnosis & Treatment
Diagnosis:

- Based on blood glucose concentration

(amount of glucose in the blood)
- 3 tests to base off:
- Fasting blood glucose
concentration
- Random blood glucose
concentration
- Oral glucose tolerance test
Treatment:

- Insulin
- Injection with an insulin pen
- Insulin pump7
Signs & Symptoms

- Polydipsia8
- “Abnormally great thirst as a symptom of disease”
- Polyuria8
- “Production of abnormally large volumes of dilute urine”
- Weight loss8

- Typically symptoms are found in children 8

- Other signs and symptoms of T1D 8
- Shortness of breath

- Abdominal pain

- Vomiting
Prognosis
● Mortality Rate
○ Normal lifespan9
○ Increased risk of mortality9

● Associated Problems - Lifelong

○ Microvascular compilations:
■ Retinopathy, neuropathy, nephropathy10
○ Macrovascular complications:
■ Atherosclerosis10
○ Hyperglycemia and ketoacidosis10
○ Decline in cognitive function and overall weakness10
Prognosis cont.
● Treatment
○ Insulin is an effective treatment in regulating patient’s glucose levels 11

● Long Term Disabilities

○ Heart disease 12
○ Neurocognitive changes 12

● Rehabilitation
○ Not required
○ PT prognosis
■ PT’s help improve quality of life, avoid or lessen related problems
associated with diabetes, and help add physical activity into the
lives of their patients 13
Implications for PT’s
● Involvement for Physical Therapists
○ Education of exercise14
○ Common problems for patients with Type 1 Diabetes14
○ Screening for medical issues14
Precautions & Self-Care
Things To Watch Out For:
● Missing sensation in feet
● HYPOGLYCEMIA15

What Can The PT Do?

● Mostly teach self treatment
Clinical Pearls
Questions for you –

1. What type of cell is destroyed in 2. What type of genes are associated

T1DM? with T1DM?
a. CD8 T cells
a. HLA DR 3, 4, 7, & w9
b. Pancreatic β cells
b. HLA DR 5, 6, 8, r10
c. Pancreatic α cells
c. HLA DRc
d. CD4 T cells
d. HLA DR 1, 2, 3, 5t
Questions for you –

1. What type of cell is destroyed in 2. What type of genes are associated

T1DM? with T1DM?
a. CD8 T cells
a. HLA DR 3, 4, 7, & w9
b. Pancreatic β cells
b. HLA DR 5, 6, 8, r10
c. Pancreatic α cells
c. HLA DRc
d. CD4 T cells
d. HLA DR 1, 2, 3, 5t
Questions??
References
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2. Vanderniet JA, Jenkins AJ, Donaghue KC. Epidemiology of Type 1 Diabetes [published online ahead of print, 2022
Aug 17]. Curr Cardiol Rep. 2022;10.1007/s11886-022-01762-w. doi:10.1007/s11886-022-01762-w
3. Primavera M, Giannini C, Chiarelli F. Prediction and Prevention of Type 1 Diabetes. Front Endocrinol (Lausanne).
2020;11:248. Published 2020 Jun 2. doi:10.3389/fendo.2020.00248
4. Fletcher J, Mijovic C, Odugbesan O, Jenkins D, Bradwell AR, Barnett AH. Trans-racial studies implicate HLA-DQ as a
component of genetic susceptibility to type 1 (insulin-dependent) diabetes. Diabetologia. 1988;31(12):864-870.
doi:10.1007/BF00265368.
5. Echeverri AF, Tobón GJ. Autoimmune diabetes mellitus (Type 1A) In: Anaya JM, Shoenfeld Y, Rojas-Villarraga A, et
al., editors. Autoimmunity: From Bench to Bedside [Internet]. Bogota (Colombia): El Rosario University Press; 2013
Jul 18. Chapter 29. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459476/
6. Christen U, Bender C, von Herrath MG. Infection as a cause of type 1 diabetes?. Curr Opin Rheumatol. 2012;24(4):417-
423. doi:10.1097/BOR.0b013e3283533719
7. DiMeglio LA, Evans-Molina C, Oram RA. Type 1 diabetes. Lancet. 2018;391(10138):2449-2462. doi:10.1016/S0140-
6736(18)31320-5
8. Ziegler R, Neu A. Diabetes in Childhood and Adolescence. Dtsch Arztebl Int. 2018;115(9):146-156.
doi:10.3238/arztebl.2018.0146
9. Secrest AM, Washington RE, Orchard TJ. Mortality in Type 1 Diabetes. PubMed. Published 2018.
https://www.ncbi.nlm.nih.gov/books/NBK567986/#:~:text=The%20overall%20mortality%20rate%20was
10. DiMeglio LA, Evans-Molina C, Oram RA. Type 1 diabetes. The Lancet. 2018;391(10138):2449-2462.
doi:10.1016/s0140-6736(18)31320-5
References
11. Akil AAS, Yassin E, Al-Maraghi A, Aliyev E, Al-Malki K, Fakhro KA. Diagnosis and treatment of type 1 diabetes at the dawn
of the personalized medicine era. Journal of Translational Medicine. 2021;19(1). doi:10.1186/s12967-021-02778-6

12. Haslacher H, Fallmann H, Waldhäusl C, Hartmann E, Wagner OF, Waldhäusl W. Type 1 diabetes care: Improvement by
standardization in a diabetes rehabilitation clinic. An observational report. Gudina EK, ed. PLOS ONE. 2018;13(3):e0194135.
doi:10.1371/journal.pone.0194135·

13. Avruskin, A., 2022. Guide | Physical Therapy Guide to Diabetes. [online] Choosept.com. Available at:
<https://www.choosept.com/guide/physical-therapy-guide-diabetes> [Accessed 27 September 2022].

14. Larkin ME, Barney A, Cleary P, et al. Musculoskeletal complications in type 1 diabetes. Diabetes care.
https://pubmed.ncbi.nlm.nih.gov/24722493/. Published April 10, 2014. Accessed September 27, 2022.

15. Lucier J, Weinstock RS. Diabetes Mellitus Type 1 . National Library of Medicine.
https://www.ncbi.nlm.nih.gov/books/NBK507713/. Published May 11, 2022. Accessed September 27, 2022.