Type 1 Diabetes

Type 1 diabetes is believed to be an autoimmune disease, caused when the immune system destroys the insulin-producing cells in the pancreas. Eventually, the body produces little or no insulin. Normally, insulin acts like a key to unlock the cell wall and allow glucose to get into the cell and be used for fuel. Without enough glucose, the body's cells are starved for energy. Patients must take regular injections of insulin to stay alive.

According to the Centers for Disease Control and Prevention, about 20.8 million Americans have diabetes. Type 1 is the least common form of the condition, accounting for 5 to 10 percent of all cases. It's usually first diagnosed in children, teens and young adults.

Complications of Diabetes

Over time, elevated levels of glucose can damage the walls of the arteries. Patients with diabetes are at risk for a number of medical complications. Patients are two to four times more likely to die of heart disease than non-diabetics. Diabetics are 2 to 4 times more likely to have a stroke.

Diabetic retinopathy (an eye disease affecting the retina) is the leading cause of blindness in people 20 to 74, causing 12,000 to 24,000 new cases each year in the U.S. Diabetes can affect the ability of the kidneys to filter waste from the blood. In the U.S., the condition is the leading cause of kidney failure.

Diabetics are also at risk for nerve damage. Sores that develop (especially on the feet) may not be noticed until they have formed deep ulcers. Poor circulation and impaired wound healing increases the risk of an injury that doesn't heal. To prevent further tissue damage, doctors may decide to amputate the affected area of the limb. More than 60 percent of lower limb amputations (82,000 cases in 2002) are performed in patients with diabetes.

The Diabetes Medalist Program

Researchers at Joslin Diabetes Center in Boston have a program that recognizes patients who have lived with insulin-dependent diabetes for 50 years or more. It's called the Diabetes Medalist Program. The first 50-year bronze medal was presented in 1970. Since then more than 2,400 recipients have been recognized. In 1996, coordinators expanded the program to include a 75-year medal for those who have lived with Type 1 diabetes for at least 75 years.

The Medalist program offered a unique opportunity to bring together researchers and patients. The 50-year medalists are asked to participate in a study to help investigators understand what factors may contribute to health and longevity in patients with type 1 diabetes. Data so far indicates that, compared to the overall population of patients with type 1 diabetes, those who have long standing disease have different risk profiles for complications, like kidney, eye and nerve disease.

George King, M.D. (featured in story), Endocrinologist/Research Director at Joslin and Professor of Medicine at Harvard Medical School, says the study has shown about 10 percent of patients with long standing type 1 diabetes still produce some insulin. This finding is contrary to the popular belief that patients with type 1 diabetes are unable to make insulin. King says that if researchers can find a way to expand the numbers of those still-healthy, insulin-producing cells, patients may be able to reduce or eliminate their use of insulin therapy.

Investigators also want to find out what factors may protect these long-standing patients from the complications that other diabetics face. One possible key is exercise. King says almost all the volunteers in the study participated in some form of vigorous exercise regularly.

Joslin researchers have started a second study of patients who have received the 50-year medal. The investigators want to examine components in the blood and DNA that may reduce the risk of complications for insulin-dependent patients and contribute to health and longevity.

For more information on the Diabetes Medalist program or the studies, log onto the website for Joslin Diabetes Center at: http://www.joslin.org/Action_Medalist.asp.

For information about the Diabetes Medalist, log onto the website for Joslin Diabetes Center at: http://www.joslin.org/Action_Medalist.asp.

For general information on diabetes: American Diabetes AssociationCenters for Disease Control and PreventionNational Institute of Diabetes and Digestive and Kidney Diseases