Type 1 diabetes in adults: diagnosis and management

Context

Type 1 diabetes affects over 370,000 adults in the UK. It results from destruction of the cells that normally make insulin. Loss of insulin secretion results in high blood glucose and other metabolic and haematological abnormalities, which have both short‑term and long‑term adverse effects on health.

Over years, type 1 diabetes causes tissue damage which, if not detected and managed early, can result in disability: blindness, kidney failure, periodontitis, and foot ulceration leading to amputation, as well as premature heart disease, stroke and death. The risk of all of these complications is greatly reduced by treatment that keeps circulating glucose levels to as near normal as possible, reducing tissue damage. Disability from complications that are not avoided can often be prevented by early detection and active management.

Type 1 diabetes is treated by insulin replacement and supported by active management of other cardiovascular risk factors, such as hypertension and high circulating lipids. Modern insulin replacement therapy aims to recreate normal fluctuations in circulating insulin concentrations. This supports a flexible lifestyle with minimal restrictions and, properly done, can improve blood glucose levels, reducing the risk of both structural complications and episodes of hypoglycaemia.

Flexible insulin therapy usually involves self‑injecting multiple daily doses of insulin, with doses adjusted based on taken or planned exercise, intended food intake and other factors, including current blood glucose, which the insulin user needs to test on a regular basis. This self‑management needs the insulin user to have the skills and confidence to manage the regimen.

One of the most important roles of healthcare professionals providing diabetes care to adults with type 1 diabetes is to ensure that systems are in place to provide informed expert support, education and training for insulin users, as well as a range of other more conventional biomedical services and interventions.

Although type 1 diabetes in adults is not rare, it is not common enough that all healthcare professionals who deal with it are able to acquire and maintain all the necessary skills for its management. The aim of this guideline is to provide evidence‑based, practical advice on supporting adults with type 1 diabetes to live full, largely unrestricted, lives and to avoid the short‑term and long‑term complications of both the disease and of its treatment.