Preface

Diabetes is a leading cause of death in many countries affecting both the young and old at an alarming rate worldwide. Due to the destruction of insulin-producing beta islet cells by the body's own immune system, type 1 diabetes is the most common metabolic and endocrinal disease among children. Finding a cure for this disease has been a major challenge for both basic science and clinical investigators. Owing to rapid research progress in the field, we now have a better knowledge in understanding the cellular and molecular basis responsible for diabetes, the associated complications, and alternative treatments for this chronic inflammatory disease.

This book is intended as an overview of recent progress in type 1 diabetes research worldwide, with a focus on different research areas relevant to this disease. These include: diabetes mellitus and complications, psychological aspects of diabetes, perspectives of diabetes pathogenesis, identification and monitoring of diabetes mellitus, and alternative treatments for diabetes. In preparing this book, leading investigators from several countries in these five different categories were invited to contribute a chapter to this book. We have striven for a coherent presentation of concepts based on experiments and observation from the authors own research and from existing published reports. Therefore, the materials presented in this book are expected to be up to date in each research area.

Complications, such as those lead to severe cardiovascular diseases, caused by diabetes due to chronic inflammation have attracted intensive research in recent years. This section contains four chapters that discuss diabetes mellitus-caused complications due to the effect of glycative and oxidative stress, varied diet and life style, lipid disorders, and daily insulin doses. Better knowledge in these areas may help those who are affected by diabetes to reduce disease-associated long-term complications and to improve their life quality.

Type 1 disease usually occurs at young age and can have significant impact on those affected. Therefore, managing this disease becomes a very challenging daily task for the patients themselves and for their close family members. Frustration may occur while patients deal with their disease conditions, making adherence and proper glycemic control a challenge. To help address these challenges, four chapters discuss psychological aspects of diabetes, which provide updated and useful information regarding psychological factors related to diabetes in children and adolescents, how to

#### X Preface

avoid inadequate coping attitudes and maintain good eating behaviors, and how to improve adherence, metabolic control, and quality of life.

While many aspects of how type 1 diabetes may occur are discussed elsewhere, five chapters are included in this book to address some unique or alternative perspectives of diabetes pathogenesis. For example, a chapter discusses the effect of IRS-2 gene on fulminant type 1 diabetes in animal models. Another chapter discusses the role of obesity in the natural history of type 1 diabetes. Other factors, such as cytokinesinduced beta cell death and the effect of L-Arg/L-Glu coupling on diabetes, are the topics of two other chapters respectively. Aided by recent progress in genomic studies, the fifth chapter discusses the use of meta-analysis of genome-wide association studies to better understand disease relatedness.

Due to the nature of the disease, it is not an easy task to identify disease risk or susceptibility early in life. The classification between type 1 vs. type 2 diabetes has also become less clear nowadays as increasing number of adults can develop symptoms of type 1 diabetes. Four chapters provide insightful discussion addressing this important issue. A chapter discusses evidence showing altering trends in the epidemiology of type 1 diabetes in children and adolescents. Thanks to recent research progress and better understanding of diabetes pathogenesis, a chapter discusses a more comprehensive list of phenotypic markers that may help clinical identification of families at risk. Another chapter suggests that genetic testing of newborns may also be a possibility to help identify disease susceptibility and distinguish different types of diabetes.

Finding a cure for type 1 diabetes remains a major challenge and ultimate goal for diabetes basic and clinical research. Currently, insulin injection is the gold standard for disease treatment. The use of insulin pump therapy has provided continuous subcutaneous insulin infusion for patients. A chapter provides an overview of mathematical modeling of using pump therapy as a management strategy for diabetes therapy. In seeking better treatments for this disease, recent studies suggest that it may be promising approaches using alternative medicine in therapies. Four chapters discuss findings in this area and suggest new aspects of using alternative medicine approaches to treat or ameliorate the disease conditions. These include the potential use of bile acid and probiotics, vitamin D, honey and fatty acids.

Finally, we would like to thank all the authors who have contributed to this book. While there is no doubt that this book may have omitted some important findings in diabetes field, we hope the information included in this book will be useful for both basic science and clinical investigators. We also hope that diabetes patients and their family will benefit from reading the chapters in this book.

> **Dr. Chih-Pin Liu**  The Beckman Research Institute of the City of Hope, Duarte, California, USA

X Preface

avoid inadequate coping attitudes and maintain good eating behaviors, and how to

While many aspects of how type 1 diabetes may occur are discussed elsewhere, five chapters are included in this book to address some unique or alternative perspectives of diabetes pathogenesis. For example, a chapter discusses the effect of IRS-2 gene on fulminant type 1 diabetes in animal models. Another chapter discusses the role of obesity in the natural history of type 1 diabetes. Other factors, such as cytokinesinduced beta cell death and the effect of L-Arg/L-Glu coupling on diabetes, are the topics of two other chapters respectively. Aided by recent progress in genomic studies, the fifth chapter discusses the use of meta-analysis of genome-wide association studies

Due to the nature of the disease, it is not an easy task to identify disease risk or susceptibility early in life. The classification between type 1 vs. type 2 diabetes has also become less clear nowadays as increasing number of adults can develop symptoms of type 1 diabetes. Four chapters provide insightful discussion addressing this important issue. A chapter discusses evidence showing altering trends in the epidemiology of type 1 diabetes in children and adolescents. Thanks to recent research progress and better understanding of diabetes pathogenesis, a chapter discusses a more comprehensive list of phenotypic markers that may help clinical identification of families at risk. Another chapter suggests that genetic testing of newborns may also be a possibility to help

Finding a cure for type 1 diabetes remains a major challenge and ultimate goal for diabetes basic and clinical research. Currently, insulin injection is the gold standard for disease treatment. The use of insulin pump therapy has provided continuous subcutaneous insulin infusion for patients. A chapter provides an overview of mathematical modeling of using pump therapy as a management strategy for diabetes therapy. In seeking better treatments for this disease, recent studies suggest that it may be promising approaches using alternative medicine in therapies. Four chapters discuss findings in this area and suggest new aspects of using alternative medicine approaches to treat or ameliorate the disease conditions. These include the potential

Finally, we would like to thank all the authors who have contributed to this book. While there is no doubt that this book may have omitted some important findings in diabetes field, we hope the information included in this book will be useful for both basic science and clinical investigators. We also hope that diabetes patients and their

**Dr. Chih-Pin Liu** 

Duarte, California,

USA

The Beckman Research Institute of the City of Hope,

identify disease susceptibility and distinguish different types of diabetes.

use of bile acid and probiotics, vitamin D, honey and fatty acids.

family will benefit from reading the chapters in this book.

improve adherence, metabolic control, and quality of life.

to better understand disease relatedness.

**Part 1** 

**Diabetes Mellitus and Complications** 
