**6. Complications**

The management of type 1 diabetes and modalities for prevention of complications has evolved, such that the majority of patients with excellent care and education should avoid major microvascular complications. The finding from the Diabetes Control and Complications Trial (DCCT) follow-up study of "metabolic memory", namely long term benefit from early intensive glucose management is very encouraging [56]. Intensive management and strict guidelines for lipid lowering and early introduction of renoprotective medications are the norm. Laser therapy for advanced retinal disease is also the norm and "anti- Vascular endo‐ thelial growth factor (VEGF)" ocular therapy for macular edema is being extensively studied. Effective prevention of microvascular complications requires detection of early lesions, including determination of lipids, blood pressure, microalbuminuria, retinal exams. Preven‐ tative foot care and cardiovascular evaluation are also essential, with macrovascular disease a major problem for patients with long-term diabetes. Patients with type 1 diabetes have more severe progressive coronary artery atherosclerosis for any level of Low-density lipoprotein (LDL) cholesterol (57-586-57). Neuropathy remains difficult to treat [59] despite introduction of several newer medications.

**•** Diabetes is among the leading causes of kidney failure. 10-20% of people with diabetes die

Update of Type 1 Diabetes http://dx.doi.org/10.5772/55960 83

**•** Diabetic neuropathy is damage to the nerves as a result of diabetes, and affects up to 50% of people with diabetes. Although many different problems can occur as a result of diabetic neuropathy, common symptoms are tingling, pain, numbness, or weakness in the feet and

**•** The overall risk of dying among people with diabetes is at least double the risk of their peers

Type 1 diabetes has become perhaps the most intensively studied autoimmune illness results from autoimmune destruction of the insulin-producing ß-cells in the islets of Langerhans. This process occurs in genetically susceptible subjects, is probably triggered by one or more environmental agents, and usually progresses over many months or years during which the subject is asymptomatic and euglycemic. This long latent period is a reflection of the large

Polymorphisms in MHC genes and Non-MHC genes account for genetic susceptibility of the diseases. Genes in both the MHC and elsewhere in the genome have influence risk, but only

There are a number of autoantigens within the pancreatic ß-cells that may play important roles in the initiation or progression of autoimmune islet injury and its autoimmunity which might be a good prediction factor. Environmental factors that may affect risk include pregnancy-

Pathology Department, Salmaniya Medical Complex, Ministry of Health, Manama, King‐

[1] Marian RowersChallenges in Diagnosing Type 1 diabetes in Different Populations.

number of functioning β-cells that must be lost before hyperglycemia occurs.

related and perinatal influences, viruses, and ingestion of cows' milk and cereals.

of kidney failure.

without diabetes.

HLA alleles have a large effect.

**Author details**

dom of Bahrain

**References**

Mohamed M. Jahromi\*

Address all correspondence to: mjahromi@yahoo.com

Diabetes Metab J. (2012). , 36, 90-97.

**7. Conclusion**

hands.

Patients with diabetes and renal failure have a particularly poor prognosis when on dialysis. Every effort should be directed toward "early" renal transplantation in patients with type 1 diabetes and renal failure.

Genetic factors and key gene mutations have been implicated in the pathogenesis of diabetes. However, increasing evidence suggests that complex interactions between genes and the environment may play a major role in many common human diseases such as diabetes and its complications [39, 59-73]. Furthermore, the increased risk for both type 1 diabetes and type 2 diabetescanbecontrolledthroughmedications,changesindietaryhabitsandincreasedexercise; subjects with diabetes continue to be plagued with numerous life-threatening complications. This continued development of diabetic complications even after achieving glucose control suggestsametabolicmemoryofpriorglycemicexposureandindicatesamissinglinkindiabetes etiology which recent studies have suggested may be attributed to epigenetic changes in target cells without alterations in gene coding sequences. Exploring a role for epigenetics in diabetic complications could allow for new insights clarifying the interplay between the environment and gene regulation and identify much needed new therapeutic targets.

Diabetic microvascular complications have been reported to be encountered with impairment in the olfactory system. Recently we have shown that polymorphism in the olfactory receptor, OR14J1C, may lead to an olfactory impairment that could be due to presence of microvascular diseases or other complication directly related to type 1 diabetes. The genetic alteration in the OR14J1 gene, A to C, could be linked to epigenetic processes [39].

#### **6.1. What are common consequences of diabetes?**

Over time, diabetes can damage the heart, blood vessels, eyes, kidneys, and nerves.

