Typ-1-Diabetes
Zuletzt bearbeitet: Zuletzt revidiert:
Zuletzt revidiert von:Lino Witte
Definition:
Insulinmangel durch Zerstörung der Betazellen in der Bauchspeicheldrüse.
Häufigkeit:
Inzidenz in Deutschland 15 Fälle pro 100.000 Einwohner*innen.
Symptome:
Zu Beginn der Erkrankung oft reduzierter Allgemeinzustand, Polyurie, Polydipsie und Gewichtsverlust.
Befunde:
Bei fulminantem Beginn ketoazidotisches Koma möglich mit Hyperglykämie, Kussmaulatmung mit Azetongeruch, abdominellen Beschwerden und Bewusstseinsstörung.
Diagnostik:
Diagnosestellung durch Blutzuckermessung und klinische Symptomatik. Im Zweifel Bestimmung Diabetes-assoziierter Autoantikörper, HbA1c und/oder oraler Glukosetoleranztest.
Therapie:
Standard ist die intensivierte Insulintherapie.
- Deutsche Diabetes Gesellschaft (DDG). Therapie des Diabetes mellitus Typ 1. AWMF Leitlinie 057-013. S3, Stand 2018. www.awmf.org
- Deutsche Gesellschaft für Allgemeinmedizin (DEGAM). Hausärztliche Risikoberatung zur kardiovaskulären Prävention. AWMF-Leitlinie Nr. 053-024. S3, Stand 2016. www.degam.de
- Deutsche Diabetes Gesellschaft (DDG). Diabetes und Straßenverkehr. AWMF-Leitlinie Nr. 057-026. S2e, Stand 2017. www.awmf.org
- Deutsche Diabetes Gesellschaft e. V. (DDG). Diagnostik, Therapie und Verlaufskontrolle des Diabetes mellitus im Kindes- und Jugendalter. AWMF-Leitlinie Nr. 057-016. S3, Stand 2015. www.awmf.org
- Deutsche Diabetes Gesellschaft (DDG). Therapie des Diabetes mellitus Typ 1. AWMF-Leitlinie Nr. 057-013. S3, Stand 2018. www.awmf.org
- Daneman D. Type 1 diabetes. Lancet 2006; 367: 847-58. PubMed
- Informationen für Patienten und Fachleute aus erster Hand. Schwerpunkt: Endokrinologie/Diabetologie. Diabetes mellitus Typ 1. Professor Dr. med. W.A. Scherbaum Direktor der Klinik für Endokrinologie, Diabetologie und Rheumatologie des Universitätsklinikums Düsseldorf. www.typ-1-diabetes.info
- Heidemann C, Du Y, Schubert I, Rathmann W, Scheidt-Nave C. Prävalenz und zeitliche Entwicklung des bekannten Diabetes mellitus. Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1) Bundesgesundheitsbl 2013; 56:668–677 edoc.rki.de
- Onkamo P, Vaananen S, Karvonen M, Tuomilehto J. Worldwide increase in incidence of type I diabetes: the analysis of the data on published incidence trends. Diabetologia 1999; 42: 1395-403. PubMed
- Devendra D, Liu E, Eisenbarth GS. Type 1 diabetes: recent developments. BMJ 2004; 328: 750-4. PubMed
- Das Informationssystem der Gesundheitssberichterstattung des Bundes. www.gbe-bund.de
- Yu L, Robles DT, Abiru N, Kaur P, Rewers M, Kelemen K, et al. Early expression of anti-insulin autoantibodies of man and the NOD mouse: evidence for early determination of subsequent diabetes. Proc Natl Acad Sci USA 2000;97: 1701-6. PubMed
- Imagawa A, Hanafusa T, Itoh N, Waguri M, Yamamoto K, Miyagawa J, et al. Immunological abnormalities in islets at diagnosis paralleled further deterioration of glycaemic control in patients with recent-onset type I (insulin-dependent) diabetes mellitus. Diabetologia 1999; 42: 574-8. pubmed.ncbi.nlm.nih.gov
- Davis AK, DuBose SN, Haller MJ, et al. Prevalence of detectable C-peptide according to age at diagnosis and duration of type 1 diabetes. Diabetes Care December 17, 2014. Published online before print December 17, 2014, . doi:10.2337/dc14-1952 DOI
- Hyoty H, Taylor KW. The role of viruses in human diabetes. Diabetologia 2002;45: 1353-61. PubMed
- Hober D, Sauter P. Pathogenesis of type 1 diabetes mellitus: interplay between enterovirus and host. Nat Rev Endocrinol 2010;6:279-289 PubMed
- Gale EA. A missing link in the hygiene hypothesis? Diabetologia 2002;45: 588-94. PubMed
- Bach JF. The effect of infections on susceptibility to autoimmune and allergic diseases. N Engl J Med 2002;347: 911-20. New England Journal of Medicine
- Martin S, Wolf-Eichbaum D, Duinkerken G, Scherbaum WA, Kolb H, Noordzij JG, et al. Development of type 1 diabetes despite severe hereditary B-lymphocyte deficiency. N Engl J Med 2001;345: 1036-40 New England Journal of Medicine
- Lambert AP, Gillespie KM, Thomson G, et al. Absolute risk of childhood-onset type 1 diabetes defined by human leukocyte antigen class II genotype: a population-based study in the United Kingdom. J Clin Endocrinol Metab 2004; 89: 4037-43. PubMed
- Atkinson MA, Eisenbarth GS. Type 1A diabetes: new perspectives on disease pathogenesis and treatment. Lancet 2001;358: 221-9. PubMed
- Erlich H, Valdes AM, Noble J, et al. HLA DR-DQ haplotypes and genotypes and type 1 diabetes risk: analysis of the type 1 diabetes genetics consortium families. Diabetes 2008; 57(4): 1084-92. pubmed.ncbi.nlm.nih.gov
- Kakleas K, Karayianni C, Critselis E, et al. The prevalence and risk factors for coeliac disease among children and adolescents with type 1 diabetes mellitus. Diabetes Res Clin Pract 2010;90:202-208. PubMed
- Khardori R. Type 1 Diabetes Mellitus. Medscape, last updated June 27, 2020. emedicine.medscape.com
- Insel RA, Dunne JL, Atkinson MA, et al. Staging presymptomatic type 1 diabetes: a scientific statement of JDRF, the Endocrine Society, and the American Diabetes Association. Diabetes Care 2015; 38(10): 1964-74. www.ncbi.nlm.nih.gov
- Lombardi A, Tsomos E, Hammerstad SS, et al. Interferon alpha: The key trigger of type 1 diabetes. Journal of Autoimmunity 2018; 94(1): 7-15. pubmed.ncbi.nlm.nih.gov
- Redondo MJ, Jeffrey J, Fain PR, et al. Concordance for islet autoimmunity among monozygotic twins. N Engl J Med 2008; 359(26): 2849-50. pubmed.ncbi.nlm.nih.gov
- Harjutsalo V, Podar T, Tuomilehto J. Cumulative incidence of type 1 diabetes in 10,168 siblings of Finnish young-onset type 1 diabetic patients. Diabetes 2005; 54: 563-69. PubMed
- Norris JM, Beaty B, Klingensmith G, Yu Liping, Hoffman M, Chase HP, et al. Lack of association between early exposure to cow's milk protein and beta-cell autoimmunity. Diabetes Autoimmunity Study in the Young (DAISY). . JAMA 1996; 276: 609-14. www.ncbi.nlm.nih.gov
- Yeung WC, Rawlinson WD, Craig ME. Enterovirus infection and type 1 diabetes mellitus: systematic review and meta-analysis of observational molecular studies. BMJ 2011; 342: d35. www.bmj.com
- Beyerlein A, Wehweck F, Ziegler AG, et al. Respiratory infections in early life and the development of islet autoimmunity in children at increased type 1 diabetes risk: evidence from the BABYDIET study. JAMA Pediatr 2013; 167(9): 800-7. pubmed.ncbi.nlm.nih.gov
- Devendra D, Eisenbarth GS. Interferon Alpha--A Potential Link in the Pathogenesis of Viral-Induced Type 1 Diabetes and Autoimmunity. Cl Immunol 2004; 111(3): 225-33. pubmed.ncbi.nlm.nih.gov
- Norris JM, Barriga K, Klingensmith G, Hoffman M, Eisenbarth GS, Erlich HA, et al. Timing of initial cereal exposure in infancy and risk of islet autoimmunity. JAMA 2003; 290: 1713-20. www.ncbi.nlm.nih.gov
- Ziegler AG, Schmid S, Huber D, Hummel M, Bonifacio E. Early infant feeding and risk of developing type 1A diabetes-associated autoantibodies. JAMA 2003; 290: 1721-8. www.ncbi.nlm.nih.gov
- Deutsche Diabetes Gesellschaft e. V. (DDG). Diagnostik, Therapie und Verlaufskontrolle des Diabetes mellitus im Kindes- und Jugendalter. AWMF-Leitlinie Nr. 057-016. Stand 2015. www.awmf.org
- Usher-Smith JA, Thompson MJ, Sharp SJ, Walter FM. Factors associated with the presence of diabetic ketoacidosis at diagnosis of diabetes in children and young adults; a systematic review. BMJ 2011; 343: d4092. BMJ (DOI)
- WHO. Definition and diagnosis of diabetes mellitus and intermediate hyperglycaemia. www.who.int
- DEGAM. Hausärztliche Risikoberatung zur kardiovaskulären Prävention. AWMF-Leitlinie Nr. 053-024. S3, Stand 2016. www.degam.de
- Roden M. Diabetes mellitus – Definition, Klassifikation und Diagnose. Wien Klin Wochenschr 2016; 128(S2): 37-40. www.oedg.at
- Astrup AS, Tarnow L, Rossing P, et al. Improved prognosis in type 1 diabetic patients with nephropathy: A prospective follow-up study. Kidn Int 2005; 68:1250–1257 www.ncbi.nlm.nih.gov
- Deutsche Diabetes Gesellschaft. Praxisempfehlung. Diabetes, Sport und Bewegung. Thieme. Stuttgart. Diabetologie 2019. 14 (Suppl 2): S.214–S221. www.ddg.info
- Orchard TJ, Secrest AM, Miller RG, Costacou T. In the absence of renal disease, 20 year mortality risk in type 1 diabetes is comparable to that of the general population. Diabetologia. 2010;53(11):2312-2319. PubMed
- Groop PH, Thomas MC, Moran JL, et al; FinnDiane Study Group. The presence and severity of chronic kidney disease predicts all-cause mortality in type 1 diabetes. Diabetes. 2009;58(7):1651-1658. PubMed
- Sustained effect of intensive treatment of type 1 diabetes mellitus on development and progression of diabetic nephropathy: the Epidemiology of Diabetes Interventions and Complications (EDIC) study. JAMA 2003; 290: 2159-67. www.ncbi.nlm.nih.gov
- Lipska K, Parker M, Moffet H, Huang E, Karter A. Association of Initiation of Basal Insulin Analogs vs NeutralProtamine Hagedorn Insulin With Hypoglycemia-RelatedEmergency Department Visits or Hospital Admissions and With Glycemic Control in Patients With Type 2 Diabetes JAMA 2018 Jul 3;320(1):53-62. www.ncbi.nlm.nih.gov
- Thalange N, Bereket A, Larsen J, et al. Insulin analogues in children with Type 1 diabetes: a 52-week randomized clinical trial. Diabet Med 2013 Feb; 30(2): 216-25. PubMed
- Davies MJ, Gross JL, Ono Y, et al. Efficacy and safety of insulin degludec given as part of basal-bolus treatment with mealtime insulin aspart in type 1 diabetes: a 26-week randomized, open-label, treat-to-target non-inferiority trial. Diabetes Obes Metab. 2014 Oct 16 (10): 922-30. www.ncbi.nlm.nih.gov
- IQWIG. 2009. [A08-01] Kurzwirksame Insulinanaloga bei Kindern und Jugendlichen mit Diabetes mellitus Typ 1. www.iqwig.de
- IQWIG. 2010. [A05-01] Langwirksame Insulinanaloga zur Behandlung des Diabetes mellitus Typ 1. www.iqwig.de
- Gemeinsamer Bundesausschuss. G-BA-Beschluss zu Insulinanaloga. März 2010. www.g-ba.de
- Steineck I, Cederholm J, Eliasson B, et al. Insulin pump therapy, multiple daily injections, and cardiovascu- lar mortality in 18,168 people with type 1 diabetes: observational study. BMJ 2015; 350: h3234. www.bmj.com
- Russell SJ, El-Khatib FH, Sinha M, et al. Outpatient Glycemic Control with a Bionic Pancreas in Type 1 Diabetes. N Engl J Med 2014. doi:DOI: 10.1056/NEJMoa1314474 DOI
- arznei-telegramm. Dapagliflozin (FORXIGA) nicht mehr bei Typ-1-Diabetes zugelassen. a-t 2021; 52: 87. www.arznei-telegramm.de
- Hals IK, Fiskvik Fleiner H, Reimers N, et al. Investigating optimal β-cell-preserving treatment in latent autoimmune diabetes in adults: Results from a 21-month randomized trial.. Diabetes Obes Metab 2019; 21: 2219-27. pmid:31148332. www.ncbi.nlm.nih.gov
- Gemeinsamer Bundesausschuss (GBA). Kontinuierliche Glukosemessung mit Real-Time-Messgeräten künftig GKV-Leistung für insulinpflichtige Diabetiker. Pressemitteilung 16.06.2016. www.g-ba.de
- Deutsche Gesellschaft für Allgemeinmedizin (DEGAM). Hausärztliche Risikoberatung zur kardiovaskulären Prävention. AWMF-Leitlinie Nr. 053-024. S3. Stand 2017. www.awmf.org
- Belch J, MacCuish A, Campbell I, et al. The prevention og progression of arterial disease and diabetes (POPADAD) trial: factorial randomised placebo controlled trial of aspirin and antioxidants in ptientes with diabetes and asymptomatic perpheral arterial disease. BMJ 2008; 337: a1840. PubMed
- Arguedas JA, Leiva V, Wright JM. Blood pressure targets for hypertension in people with diabetes mellitus. Cochrane Database Syst Rev 2013 Oct 30;10:CD008277 Cochrane (DOI)
- The SPRINT Research Group. A Randomized Trial of Intensive versus Standard Blood-Pressure Control. NEJM 2015; 373(22): 2103-16. www.ncbi.nlm.nih.gov
- arznei-telegramm. ACCORD-STUDIE - Therapieempfehlungen bei Typ-2-Diabetes auf dem Prüfstand. a-t 2010; 41: 35-7. www.arznei-telegramm.de
- Deutsche Gesellschaft für Kardiologie – Herz-und Kreislaufforschung e.V. (2019)/Deutsche Hochdruckliga e.V. ESC/ESH Pocket Guidelines. Management der arteriellen Hypertonie, Version 2018. Börm Bruckmeier Verlag GmbH, Grünwald leitlinien.dgk.org
- Arzneimittelkommission der deutschen Ärzteschaft. „UAW-News“ - International. Deutsches Ärzteblatt 2000; 97(13): A-863. www.aerzteblatt.de
- Sollinger HW, Odorico JS, Becker YT, et al. One Thousand Simultaneous Pancreas-Kidney Transplants at a Single Center With 22-Year Follow-Up. Ann Surg 2009; 250: 618-30. pubmed.ncbi.nlm.nih.gov
- KV Berlin. DMP: Diabetes mellitus Typ 1. Letzter Zugriff 16.12.22. www.kvberlin.de
- Gesundheitsinformation. Disease-Management-Programm bei Typ-1-Diabetes. Stand 11.08.21. Letzter Zugriff 16.12.22. www.gesundheitsinformation.de
- The Diabetes Control and Complications Trial Research Group. Epidemiology of severe hypoglycemia in the diabetes control and complications trial. Am J Med 1991; 90: 450-9. PubMed
- Graveling AJ, Frier BM. Hypoglycaemia: an overview. Prim. Care Diabetes 2009; 3(3): 131-9. pubmed.ncbi.nlm.nih.gov
- Jones JM, Lawson ML, Daneman D, Olmsted MP, Rodin G. Eating disorders in adolescent females with and without type 1 diabetes: cross ectional study. BMJ 2000; 320: 1563-6. www.ncbi.nlm.nih.gov
- Programm für Nationale VersorgungsLeitlinien. BÄK, KBV, AWMF. Nationale VersorgungsLeitlinie (NVL) Diabetes. www.leitlinien.de
- Heller T, Blum M, Spraul M, Wolf G, Müller UA. Folgeerkrankungen des Diabetes mellitus in Deutschland: Prävalenzen in Deutschland. Dtsch Med Wochenschr 2014; 139: 786–91. www.thieme-connect.de
- Finne P, Reunanen A, Stenman S, Groop P-H, Grönhagen-Riska C. Incidence of end-stage renal disease in patients with type 1 diabetes. JAMA 2005; 294: 1782-7. www.ncbi.nlm.nih.gov
- Lind M, Bounias I, Olsson M, et al. Glycaemic control and incidence of heart failure in 20985 patients with type 1 diabetes: an observational study. Lancet 2011; 378: 140-6. PubMed
- Lind M, Svensson A-M, Kosiborod M, et al. Glycemic Control and Excess Mortality in Type 1 Diabetes. N Engl J Med 2014; 371: 1972-82. doi:10.1056/NEJMoa1408214 DOI
- Husley RR, Peters SAE, Mishra GD, Woodward M. Risk of all-cause mortality and vascular events in women versus men with type 1 diabetes: a systematic review and meta-analysis. The Lancet Diabetes & Endocrinology. Published Online: 05 February 2015 . doi:http://dx.doi.org/10.1016/S2213-8587(14)70248-7 www.ncbi.nlm.nih.gov
- Carey IM , Critchley JA, DeWilde S, et al. Risk of Infection in Type 1 and Type 2 Diabetes Compared With the General Population: A Matched Cohort Study. Diabetes Care 2018; 41(3): 513-22. pubmed.ncbi.nlm.nih.gov
- Crawford F, Cezard G, Chappell FM, et al. A systematic review and individual patient data meta-analysis of prognostic factors for foot ulceration in people with diabetes: the international research collaboration for the prediction of diabetic foot ulcerations (PODUS). Health Technol Assess. 2015 Jul;19(57):1-210. www.ncbi.nlm.nih.gov
- Lavery LA, Higgins KR, Lanctot DR, et al. Home monitoring of foot skin temperatures to prevent ulceration. Diabetes Care 2004; 27: 2642-7. PubMed
- Edwards J, Stapley S. Debridement of diabetic foot ulcers. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD003556. DOI: 10.1002/14651858.CD003556.pub2. DOI
- Kranke P, Bennett MH, Martyn-St et al. Hyperbaric oxygen therapy for chronic wounds. Cochrane Database Syst Rev. 2015;6:CD004123. DOI:10.1002/14651858.CD004123.pub4 DOI
- Larkin ME, Barnie A, Braffett BH, et al. Musculoskeletal Complications in Type 1 Diabetes. Diabetes Care. 2014 Apr 10. www.ncbi.nlm.nih.gov
- Cooper MN, de Klerk NH, Jones TW, Davis EA. Clinical and demographic risk factors associated with mortality during early adulthood in a population-based cohort of childhood-onset type 1 diabetes. Diabet Med 2014; 31(12): 1550-8. doi:10.1111/dme.12522 DOI
- Meißner T. Therapie-Tipps bei alten Typ-1-Diabetikern. CME 2019; 16: 28. link.springer.com
- Deutsche Diabetes Gesellschaft (DDG). Diabetes und Straßenverkehr. AWMF-Leitlinie Nr. 057-026. S2e, Stand 2017. www.awmf.org
- Lino Witte, Dr. med., Arzt in Weiterbildung Innere Medizin, Frankfurt
- Günther Egidi, Dr. med., Arzt für Allgemeinmedizin, Bremen (Review)
- Caroline Beier, Dr. med., Fachärztin für Allgemeinmedizin, Hamburg