Type 1 diabetes

There is nothing ordinary about Josu Feijoo, a 47-year-old mountaineer from Vitoria, in the Basque Country – except perhaps that like millions of people around the world he has type 1 diabetes. He lives by his own maxim: the future belongs to those who believe in the beauty of their dreams. A glance at his curriculum tells us that Josu has had more than a few dreams, and he has believed in them enough to transform them into reality.

Type 1 diabetes is a complex and challenging disease due to its physiological, behavioural and psychosocial characteristics. Diabetes care and education is life-long and people who are affected must adapt as they age. In 2011, IDF launched the 3C Study – Coverage, Cost and Care of type 1 diabetes, in collaboration with the Chinese Diabetes Society, in order to understand better how this disease affects people living in the Beijing and Shantou areas.

The 5th edition of the IDF Diabetes Atlas, which was launched on World Diabetes Day, 14 November 2011, presented some daunting figures: the estimated number of adults living with diabetes has soared to 366 million – more than 8% of the global adult population – and is projected to rise to 552 million people by 2030 – just short of 10% of all adults. That means that diabetes is growing at the extraordinary rate of approximately three new cases every 10 seconds.

In this special issue of Diabetes Voice, there is a focus on type 1 diabetes. In tackling the world pandemic of diabetes, and the critical importance of making societal change to arrest the staggering rise in the prevalence of type 2 diabetes, it is easy for the needs of the 10% of people with diabetes who have type 1 diabetes to be forgotten. Yet incidence of type 1 diabetes is also rising – at 3% per year (see page 6) - and as Professor M'Banya points out in his editorial, people with type 1 diabetes worldwide are still dying because of missed diagnoses or inadequate insulin supply.

China is experiencing an increase in the number of people with type 1 diabetes. New cases as well as improved life expectancy among people with established diabetes are behind the rising prevalence. The incidence of type 1 diabetes among children has been put at 0.59 per 100,000 people per year. Although this is farlower than in some other regions, such as northern Europe, our numbers are huge because China has such a large population – in excess of 1.3 billion.

In March 2010, investigators from the Chinese Diabetes Society (CDS ) published a study that captured headlines in the popular as well as the medical media around the world. It estimated that the number of people with diabetes in China had risen in excess of 92 million. With the release of those findings, China took over from India the dubious mantle of diabetes capital of the world.

Seizures provoked by hypoglycaemia are relatively frequent in people with type 1 diabetes. Each year, up to 15% of children with type 1 diabetes experience a severe hypoglycaemic episode, or ‘hypo’, with seizures – often as a result of administering too much insulin. But seizures also can occur during diabetic ketoacidosis – when not enough insulin has been taken. These acute complications often constitute an obstacle to diagnosis of epilepsy in people, especially children and adolescents, with diabetes.