**7. Conclusion**

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

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

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

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

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

**•** Diabetes increases the risk of heart disease and stroke. 50% of people with diabetes die of

**•** Combined with reduced blood flow, neuropathy in the feet increases the chance of foot

**•** Diabetic retinopathy is an important cause of blindness, and occurs as a result of long-term accumulated damage to the small blood vessels in the retina. After 15 years of diabetes, approximately2%ofpeoplebecomeblind, andabout 10%developseverevisualimpairment.

and gene regulation and identify much needed new therapeutic targets.

OR14J1 gene, A to C, could be linked to epigenetic processes [39].

cardiovascular disease (primarily heart disease and stroke).

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

ulcers and eventual limb amputation.

of several newer medications.

82 Type 1 Diabetes

diabetes and renal failure.

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

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 HLA alleles have a large effect.

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