1 型糖尿病

未经治疗的 1 型糖尿病患者可能会因糖尿病酮症酸中毒而死亡（请参阅糖尿病酮症酸中毒专题）。1 型糖尿病患者血糖水平持续升高是导致失明、肾衰竭、截肢和心脏病发作等慢性并发症的危险因素。已证明强化血糖控制可降低 1 型糖尿病患者微血管及大血管疾病发病率。[122]White NH, Sun W, Cleary PA, et al. Effect of prior intensive therapy in type 1 diabetes on 10-year progression of retinopathy in the DCCT/EDIC: comparison of adults and adolescents. Diabetes. 2010 May;59(5):1244-53. http://www.ncbi.nlm.nih.gov/pubmed/20150283?tool=bestpractice.com [123]Nathan DM, Genuth S, Lachin J; The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993 Sep 30;329(14):977-86. https://www.nejm.org/doi/10.1056/NEJM199309303291401 http://www.ncbi.nlm.nih.gov/pubmed/8366922?tool=bestpractice.com [124]Pop-Busui RL, Low PA, Waberski BH, et al. Effects of prior intensive insulin therapy on cardiac autonomic nervous system function in type 1 diabetes mellitus: the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study (DCCT/EDIC). Circulation. 2009 Jun 9;119(22):2886-93. https://www.ahajournals.org/doi/full/10.1161/circulationaha.108.837369 http://www.ncbi.nlm.nih.gov/pubmed/19470886?tool=bestpractice.com [125]Nathan DM, Zinman B, Cleary PA, et al; Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Research Group. Modern-day clinical course of type 1 diabetes mellitus after 30 years' duration: the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications and Pittsburgh Epidemiology of Diabetes Complications experience (1983-2005). Arch Intern Med. 2009 Jul 27;169(14):1307-16. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/724752 http://www.ncbi.nlm.nih.gov/pubmed/19636033?tool=bestpractice.com [126]Nathan DM, Cleary PA, Backlund JY, et al; Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Study Research Group. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med. 2005 Dec 22;353(25):2643-53. https://www.nejm.org/doi/10.1056/NEJMoa052187 http://www.ncbi.nlm.nih.gov/pubmed/16371630?tool=bestpractice.com 研究显示，大血管疾病发病率的下降已持续长达 30 年。[127]Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) Study Research Group. Intensive diabetes treatment and cardiovascular outcomes in type 1 diabetes: the DCCT/EDIC Study 30-year follow-up. Diabetes Care. 2016 May;39(5):686-93. http://care.diabetesjournals.org/content/39/5/686.long http://www.ncbi.nlm.nih.gov/pubmed/26861924?tool=bestpractice.com [ ] How does intensive glucose control compare with conventional glucose control in adults with type 1 diabetes mellitus?/cca.html?targetUrl=https://cochranelibrary.com/cca/doi/10.1002/cca.1025/full展示答案 即使仅予数年的强化血糖控制亦可以降低10年以后发生微血管及大血管并发症风险。[123]Nathan DM, Genuth S, Lachin J; The Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993 Sep 30;329(14):977-86. https://www.nejm.org/doi/10.1056/NEJM199309303291401 http://www.ncbi.nlm.nih.gov/pubmed/8366922?tool=bestpractice.com [128]Albers JW, Herman WH, Pop-Busui R, et al. Effect of prior intensive insulin treatment during the Diabetes Control and Complications Trial (DCCT) on peripheral neuropathy in type 1 diabetes during the Epidemiology of Diabetes Interventions and Complications (EDIC) Study. Diabetes Care. 2010 May;33(5):1090-6. http://care.diabetesjournals.org/content/33/5/1090.long http://www.ncbi.nlm.nih.gov/pubmed/20150297?tool=bestpractice.com 英国国家卫生与临床优化研究所（National Institute for Health and Care Excellence, NICE）建议，对于大多数非妊娠成人 1 型糖尿病患者，维持糖化血红蛋白（HbA1c）< 48 mmol/mol（6.5%），以预防并发症。[36]National Institute for Health and Care Excellence. Type 1 diabetes in adults: diagnosis and management. Jul 2021 [internet publication]. https://www.nice.org.uk/guidance/ng17 [34]National Institute for Health and Care Excellence. Diabetes (type 1 and type 2) in children and young people: diagnosis and management. Dec 2020 [internet publication]. https://www.nice.org.uk/guidance/ng18 对于包括儿童在内的一些患者群体，目标可适当放宽。[45]American Diabetes Association. Standards of medical care in diabetes - 2021. Diabetes Care. 2021;44(suppl 1):S1-S232. https://care.diabetesjournals.org/content/44/Supplement_1

总体而言，心血管疾病是糖尿病患者死亡和发病的主要原因；他汀类药物治疗能降低该风险。针对 15 岁之前诊断为 1 型糖尿病的患者，进行了一项分析，结果发现，30 岁之前的首要死亡原因为糖尿病急性并发症。30 岁之后，心血管疾病为主要死亡原因，但在这个年龄段，急性并发症仍是导致死亡的重要原因。[129]Gagnum V, Stene LC, Jenssen TG, et al. Causes of death in childhood-onset type 1 diabetes: long-term follow-up. Diabet Med. 2017 Jan;34(1):56-63. http://www.ncbi.nlm.nih.gov/pubmed/26996105?tool=bestpractice.com

大部分 1 型糖尿病女性患者在充分的准备及治疗下，可以顺利妊娠。