Main description:

Type 1 Diabetes gives an up-to-date review what is known about the disease process, both on the clinical aspects as well as on the basic science (autoimmunity) aspects. It puts primary focus on what has been and is being done to stop and /or prevent Type 1 Diabetes Mellitus autoimmunity in humans and what the future trends are to achieve that ultimate goal.

Feature:

Up to date review on both clinical and basic science aspects

Primary focus to stop/prevent Type 1 Diabetes

Future trends to achieve the goal

Back cover:

Type 1 Diabetes gives an up-to-date review what is known about the disease process, both on the clinical aspects as well as on the basic science (autoimmunity) aspects. It puts primary focus on what has been and is being done to stop and /or prevent Type 1 Diabetes Mellitus autoimmunity in humans and what the future trends are to achieve that ultimate goal.

Contents:

Part I Pathogenesis of Type 1 Diabetes mellitus

Genetics factors

Role of the HLA region

Class I group

Class II genes

Role of other genes in the HLA region

Other T1DM associated genes/ results of the genome-wide screen

Insulin gene region

CTLA4 gene

Others

Environmental factors

Viral agents,

Coxsackie’s B viruses

Rubella,

Mumps

Others

Role of infection in general –hygiene hypothesis

Toxins and other environmental agents

Animal models

NOD

BB rat

Transplantation models

Part II: Type 1 Diabetes Autoimmune process in humans

Predisposition to T1DM autoimmunity

Incidence and prevalence of the disease

Increase worldwide incidence;

Shift of onset of the disease to younger age

Interplay of the genetic and environmental factors

Geographic distribution (North-South differences)

Differences in this interplay in different ethnic population

Preclinical phase of the T1DM autoimmunity

Onset of autoimmunity

Immune cell markers

T effector cells

T regulatory cells

NK and other sets of cellular components

Antigen presenting cells and their interactions

Interplay between the cellular elements (cell to cell and cytokine and chemokines)

Humoral markers

ICA

Biochemical antibodies

Insulin autoantibodies

GAD65 autoantibodies

IA2 and related autoantibodies

Others

Preclinical metabolic abnormalities

Lost of first phase insulin response

First phase insulin response

History and importance

Age dependency

Abnormal postprandial blood sugars

Oral Glucose Tolerance test

Abnormal fasting blood sugars

Current model of the autoimmune process, interplay of cellular, humoral and metabolic changes

Clinical phase of the T1DM autoimmunity

Clinical presentation at onset of the disease

With clinical symptoms

Classical presentation

Diabetic Ketoacidosis

Without clinical symptoms

Early diagnosis using OGTT and fasting blood sugars

Role of risk assessment screening (DPT-1 and other trials)

What is known about the clinical course of this group of patients

LADA, a special late onset form of the disease

Specific clinical characteristics

Specific metabolic characteristics

Clinical presentation and course of the disease after onset

Honeymoon period

Role of insulin therapy in inducing

Metabolic effect of insulin

Immunological effects of insulin therapy on beta cell preservation

Role of early diagnosis without clinical symptoms

Time after loss of measurable insulin/C-peptide production

Long term follow up of cellular and humoral immune markers

Long term follow up of metabolic changes

Glucose metabolism

Lipid and other metabolic derangements

Part III: Clinical management of Type 1 Diabetes Mellitus

1. Towards near normo-glycaemia












1. New insulin formulation










1. Insulin and insulin analogues










1. Short acting








2. Long acting











2. New delivery systems










1. Subcutaneous Insulin pumps








2. Other insulin delivery systems










1. Nasal insulin








2. Inhaled insulin









3. Blood sugar monitoring










1. Glucometers










1. Blood/fingerstics








2. Transcutan modalities








3. Continuous monitoring









4. Artificial pancreas










1. Close loop systems of the past, present and future











2. Short term complications and their prevention and treatment












1. Hypoglycaemia










1. Signs and symptoms








2. Management (special focus on early childhood)








3. Sequels










1. Hypoglycemia unawareness








2. Effect on cognitive functions








3. Metabolic consequences











2. Hyperglycaemia / DKA










1. Sign and symptoms








2. Management








3. Sequels










1. Metabolic derangement in DKA











3. Long term complication and their prevention and treatment










1. Micro-vascular complications










1. Retinopathy








2. Nephropathy








3. Neuropathy









2. Macro- vascular complications










1. Atherothrombotic macrovascular complications of the cardiovascular system











3. Interactions and common pathways affecting the entire vasculature

Part IV. Road to the Cure: Prevention and intervention

1. Prevention Trials












1. Primary

1. No autoimmunity present but risk for disease is beyond general population level and identifiable












1. Genetic risk








2. Other markers for risk for Type 1 diabetes autoimmunity








3. Nutritional Intervention Trial, NIP (omega 3 fatty acid intervention for babies)








4. TEDDY--The Environmental Determinants of Diabetes in the Young: an observational clinical trial.








5. Others









2. No autoimmunity present and risk at the general population level- future opportunities

1. Secondary










1. Autoimmune process started (immune markers detectable)












1. DPT-1 trial








2. ENDIT trial








3. Others








4. Role of both immune suppression and antigen based approaches in prevention setting

1. Intervention trials












1. Newly diagnosed patients with Type 1 diabetes Mellitus










1. Immunosuppressive approach










1. Early clinical trials










1. AZT








2. Cyclosporin








3. Others











2. Recent approaches










1. TrialNet trials










1. MMF/DZB








2. Anti CD20 trial









2. Anti CD3 trials (ITN and European)








3. Thymoglobulin








4. Pros and cons of these and other potential agents in Type 1 diabetes











2. Antigen based approach












1. Heat shock protein (Peptor trial)








2. GAD protein (Dyamid trials)








3. Insulin based trials (Neurocrine; Orban/ITN trials)








4. Pros and cons of these and other potential agents in Type 1 diabetes








 







2. Long-standing disease










1. Islet transplantation










1. Human islets transplantation








2. Pork and other islet transplantation











2. Pancreas and pancreas/kidney transplantation








3. Others











2. Future directions to manage and stop the autoimmune destruction of the beta cells












1. Stem cell research










1. Engineering the human bets cells











2. Immune cell therapy










1. Engineering regulatory T cells











3. Gene therapy