Untreated type 1 diabetes is a fatal condition due to diabetic ketoacidosis (see our topic Diabetic ketoacidosis). Consistently raised glucose levels in type 1 diabetes is a risk factor for chronic complications such as blindness, renal failure, foot amputations, and heart attacks. Intensive glycaemic control has been shown to decrease the incidence of microvascular and macrovascular disease in type 1 diabetes. The decreased incidence of macrovascular disease has been shown to persist for up to 30 years. [ ] Even a few years of intensive glucose control translate to reduced rates of microvascular and macrovascular complications 10 years later. The National Institute for Health and Care Excellence (NICE) in the UK recommends maintaining glycosylated haemoglobin (HbA1c) <48 mmol/mol (6.5%) to prevent complications in most non-pregnant adults with type 1 diabetes. Less stringent targets may be appropriate for some patient groups including children.
Overall, cardiovascular disease is the major cause of death and a major cause of morbidity for patients with diabetes; statin therapy can reduce the risk. One analysis of patients with type 1 diabetes diagnosed before the age of 15 years found that the leading cause of death before the age of 30 years was acute complications of diabetes. After the age of 30 years, cardiovascular disease was predominant, although death attributable to acute complications was still important in this age group.
With careful planning and adequate treatment, most women with type 1 diabetes can have successful pregnancies.
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