Type 1 diabetes (T1D) is a complex autoimmune disease that presents significant challenges for both patients and health care providers. The absence of functional β-cells in the pancreas results in a lifelong struggle for glucose regulation and necessitates meticulous management for survival. This paper highlights the intricacies of glucose regulation and the difficulties in maintaining stable blood glucose levels through exogenous means. Moreover, it explores the limitations faced by health care providers in managing T1D, leading to a superficial approach to care. The ultimate cure for T1D lies in prevention, although our current understanding of its etiology remains incomplete. By adopting an integrative approach to T1D care, health care providers can play a vital role in enhancing the management of this chronic condition. This paper aims to inspire a holistic perspective on T1D care and encourage further exploration and implementation of integrative strategies to improve the lives of individuals living with this complex disease.
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References
1.
NorrisJM, JohnsonRK, SteneLC. Type 1 diabetes-early life origins and changing epidemiology. Lancet Diabetes Endocrinol, 2020; 8:226–238.
2.
PattersonCC, KarurangaS, SalpeaP, et al.Worldwide estimates of incidence, prevalence and mortality of type 1 diabetes in children and adolescents: Results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract, 2019; 157:107842.
3.
NgoST, SteynFJ, McCombePA. Gender differences in autoimmune disease. Front Neuroendocrinol, 2014; 35:347–369.
GregoryGA, RobinsonTIG, LinklaterSE, et al.Global incidence, prevalence, and mortality of type 1 diabetes in 2021 with projection to 2040: A modelling study. Lancet Diabetes Endocrinol, 2022; 10:741–760.
6.
RoepBO, ThomaidouS, van TienhovenR, ZaldumbideA. Type 1 diabetes mellitus as a disease of the β-cell (do not blame the immune system?). Nat Rev Endocrinol. 2021; 17:150–161.
7.
ClicDungerDB, SperlingMA, AceriniCL, et al.European Society for Paediatric Endocrinology/Lawson Wilkins Pediatric Endocrine Society consensus statement on diabetic ketoacidosis in children and adolescents. Pediatrics, 2004; 113:e133–e140.
8.
SteckAK, RewersMJ. Genetics of type 1 diabetes. Clin Chem, 2011; 57:176–185.
9.
NobleJA, ValdesAM. Genetics of the HLA region in the prediction of type 1 diabetes. Curr Diab Rep, 2011; 11:533–542.
10.
KnipM, VeijolaR, VirtanenSM, et al.Environmental triggers and determinants of type 1 diabetes. Diabetes, 2005; 54:S125–S136.
11.
HuY, WongFS, WenL. Antibiotics, gut microbiota, environment in early life and type 1 diabetes. Pharmacol Res, 2017; 119:219–226.
12.
WenL, LeyRE, VolchkovPY, et al.Innate immunity and intestinal microbiota in the development of type 1 diabetes. Nature, 2008; 455:1109–1113.
13.
DesaiS, DeshmukhA. Mapping of type 1 diabetes mellitus. Curr Diabetes Rev, 2020; 16:438–441.
14.
Rodriguez-CalvoT, von HerrathMG. Enterovirus infection and type 1 diabetes: Closing in on a link?. Diabetes, 2015; 64:1503–1505.
15.
RubinoF, AmielSA, ZimmetP, et al.New-onset diabetes in COVID-19. N Engl J Med, 2020; 383:789–790.
16.
AchenbachP, BonifacioE, KoczwaraK, ZieglerAG. Natural history of type 1 diabetes. Diabetes, 2005; 54:S25–S31.
17.
ChenYL, HuangYC, QiaoYC, et al.Climates on incidence of childhood type 1 diabetes mellitus in 72 countries. Sci Rep, 2017; 7:12810.
18.
Di StasioE, MaggiD, BerardescaE, et al.Blue eyes as a risk factor for type 1 diabetes. Diabetes Metab Res Rev, 2011; 27:609–613.
19.
ZieglerAG, BaumgartlHJ, EdeG, et al.Low-pigment skin type and predisposition for development of type I diabetes. Diabetes Care, 1990; 13:529–531.
20.
DesaiSR, DeshmukhAA. A peripheral concept on etiology of type 1 diabetes mellitus. Pharm Reason, 2019; 2:21–24.
21.
BrownCT, Davis-RichardsonAG, GiongoA, et al.Gut microbiome metagenomics analysis suggests a functional model for the development of autoimmunity for type 1 diabetes. PLoS One, 2011; 6:e25792.
22.
KosticAD, GeversD, SiljanderH, et al.The dynamics of the human infant gut microbiome in development and in progression toward type 1 diabetes. Cell Host Microbe, 2015; 17:260–273.
23.
CandonS, Perez-ArroyoA, MarquetC, et al.Antibiotics in early life alter the gut microbiome and increase disease incidence in a spontaneous mouse model of autoimmune insulin-dependent diabetes. PLoS One, 2015; 10:e125448.
24.
HuY, JinP, PengJ, et al.Different immunological responses to early-life antibiotic exposure affecting autoimmune diabetes development in NOD mice. J Autoimmun, 2016; 72:47–56.
25.
TaiN, PengJ, LiuF, et al.Microbial antigen mimics activate diabetogenic CD8 T cells in NOD mice. J Exp Med, 2016; 213:2129–2146.
26.
CalcinaroF, DionisiS, MarinaroM, et al.Oral probiotic administration induces interleukin-10 production and prevents spontaneous autoimmune diabetes in the non-obese diabetic mouse. Diabetologia, 2005; 48:1565–1575.
27.
ZhengP, LiZ, ZhouZ. Gut microbiome in type 1 diabetes: A comprehensive review. Diabetes Metab Res Rev, 2018; 34:e3043.
28.
DelongT, WilesTA, BakerRL, et al.Pathogenic CD4 T cells in type 1 diabetes recognize epitopes formed by peptide fusion. Science, 2016; 351:711–714.
29.
ManneringSI, RubinAF, WangR, BhattacharjeeP. Identifying new hybrid insulin peptides (HIPs) in type 1 diabetes. Front Immunol, 2021; 12:667870.
30.
VerduciE, MameliC, AmatrudaM, et al.Early nutrition and risk of type 1 diabetes: The role of gut microbiota. Front Nutr, 2020; 7:612377.
31.
GabyA. Nutritional Medicine, Second Edition. Concord, NH: Concord Fritz Perlberg Publishing,, 2017:1164–1174.
32.
BantingFG, BestCH. The internal secretion of the pancreas. 1922. Indian J Med Res, 2007; 125:251–266.
33.
Canadian Medical Hall of Fame. Sir Frederick Banting, MD. Online document at: https://www.cdnmedhall.ca/laureates/frederickbanting Accessed July26, 2023.
34.
KalraS, MukherjeeJJ, VenkataramanS, et al.Hypoglycemia: The neglected complication. Indian J Endocrinol Metab, 2013; 17:819–834.
RiddellMC, PetersAL. Exercise in adults with type 1 diabetes mellitus. Nat Rev Endocrinol, 2022; 19:98–111.
37.
BrockmanNK, SigalRJ, KennyGP, et al.Sex-related differences in blood glucose responses to resistance exercise in adults with type 1 diabetes: A secondary data analysis. Can J Diabetes, 2020; 44:267–273.e1.
38.
Biason-LauberA, Böni-SchnetzlerM, HubbardBP, et al.Identification of a SIRT1 mutation in a family with type 1 diabetes. Cell Metab, 2013; 17:448–455.
39.
CodnerE. Estrogen and type 1 diabetes mellitus. Pediatr Endocrinol Rev, 2008; 6:228–234.
40.
Bartoli-LeonardF, WilkinsonFL, SchiroA, et al.Suppression of SIRT1 in diabetic conditions induces osteogenic differentiation of human vascular smooth muscle cells via RUNX2 signaling. Sci Rep, 2019; 9:878.
41.
MovahedA, RajP, NabipourI, et al.Efficacy and safety of resveratrol in type 1 diabetes patients: A two-month preliminary exploratory trial. Nutrients, 2020; 12:161.
42.
YangY, LiuY, WangY, et al.Regulation of SIRT1 and its roles in inflammation. Front Immunol, 2022; 13:831168.
43.
PoljsakB, KovačV, MilisavI. Healthy lifestyle recommendations: Do the beneficial effects originate from NAD+ amount at the cellular level?. Oxid Med Cell Longev, 2020; 2020:8819627.
44.
TrammellSA, SchmidtMS, WeidemannBJ, et al.Nicotinamide riboside is uniquely and orally bioavailable in mice and humans. Nat Commun, 2016; 7:12948.
45.
MouchiroudL, HoutkooperRH, AuwerxJ. NAD⁺ metabolism: A therapeutic target for age-related metabolic disease. Crit Rev Biochem Mol Biol, 2013; 48:397–408.
46.
CodnerE, SotoN, LopezP, et al.Diagnostic criteria for polycystic ovary syndrome and ovarian morphology in women with type 1 diabetes mellitus. J Clin Endocrinol Metab, 2006; 91:2250–2256.
47.
Szymczak-PajorI, ŚliwińskaA. Analysis of association between vitamin D deficiency and insulin resistance. Nutrients, 2019; 11:794.
48.
BajajS, KhanA. Antioxidants and diabetes. Indian J Endocrinol Metab, 2012; 16:S267–S271.
49.
da SilvaSB, CostaJP, PintadoME, et al.Antioxidants in the prevention and treatment of diabetic retinopathy—A review. J Diabetes Metab, 2010; 1:111.
50.
MolloR, ZaccardiF, ScaloneG, et al.Effect of α-lipoic acid on platelet reactivity in type 1 diabetic patients. Diabetes Care, 2012; 35:196–197.
51.
ScaramuzzaA, GianiE, RedaelliF, et al.Alpha-lipoic acid and antioxidant diet help to improve endothelial dysfunction in adolescents with type 1 diabetes: A pilot trial. J. Diabetes Res, 2015; 2015:474561.
52.
MannaP, SilPC. Arjunolic acid: Beneficial role in type 1 diabetes and its associated organ pathophysiology. Free Radic Res, 2012; 46:815–830.
53.
PourhanifehMH, HosseinzadehA, DehdashtianE, et al.Melatonin: new insights on its therapeutic properties in diabetic complications. Diabetol Metab Syndr, 2020; 12:30.
54.
McDonaldD, HydeE, DebeliusJW, et al.American gut: An open platform for citizen science microbiome research. mSystems, 2018; 3:e00031-18.
55.
ZhangF, FanD, HuangJ, ZuoT. The gut microbiome: Linking dietary fiber to inflammatory diseases. Med Microecol, 2022; 14:100070.
56.
YangR, ChenZ, CaiJ. Fecal microbiota transplantation: Emerging applications in autoimmune diseases. J of Autoimmun. Published online April 26,, 2023:103038.
57.
de GrootP, NikolicT, PellegriniS, et al.Faecal microbiota transplantation halts progression of human new-onset type 1 diabetes in a randomised controlled trial. Gut, 2021; 70:92–105.
UikeyR, KarAC. A review on Purisha Pariksha in Ayurveda. Ayu, 2015; 36:125–129.
60.
ZwiernikJ, ArłukowiczT, ZwiernikB, et al.Therapeutic applicability of helminths in autoimmune diseases—Literature overview. Prz Gastroenterol, 2019; 14:168–172.
61.
MughalMAS, KhanMK, AbbasZ, et al.Helminth protection against type-1 diabetes: An insight into immunomodulatory effect of helminth-induced infection. Mol Biol Rep, 2021; 48:6581–6588.
62.
ZacconeP, CookeA. Helminth mediated modulation of Type 1 diabetes (T1D). Int J Parasitol, 2013; 43:311–318.
63.
HuangH, HuD, ChenZ, et al.Immunotherapy for type 1 diabetes mellitus by adjuvant-free Schistosoma japonicum-egg tip-loaded asymmetric microneedle patch (STAMP). J Nanobiotechnology, 2022; 20:377.
64.
ChengCW, AdamsGB, PerinL, et al.Prolonged fasting reduces IGF-1/PKA to promote hematopoietic-stem-cell-based regeneration and reverse immunosuppression. Cell Stem Cell, 2014; 14:810–823.
65.
ChengCW, VillaniV, BuonoR, et al.Fasting-mimicking diet promotes Ngn3-driven β-cell regeneration to reverse diabetes. Cell, 2017; 168:775–788.e12.
LongoVD, PandaS. Fasting, circadian rhythms, and time-restricted feeding in Healthy Lifespan. Cell Metab, 2016; 23:1048–1059.
68.
KoivistoVA. Sauna-induced acceleration in insulin absorption from subcutaneous injection site. Br Med J, 1980; 280:1411–1413.
69.
SharmaRD, RaghuramTC, RaoNS. Effect of fenugreek seeds on blood glucose and serum lipids in type I diabetes. Eur J Clin Nutr, 1990; 44:301–306.
70.
ShanmugasundaramE, RajeswariG, BaskaranK, et al.Use of Gymnema sylvestre leaf extract in the control of blood glucose in insulin-dependent diabetes mellitus. J Ethnopharmacol, 1990; 30:281–294.
71.
TackCJ, LanceeGJ, HeerenB, et al.Glucose control, disease burden, and educational gaps in people with type 1 diabetes: Exploratory Study of an Integrated Mobile Diabetes App. JMIR Diabetes, 2018; 3:e17.
72.
Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) Study Research Group. Mortality in type 1 diabetes in the DCCT/EDIC versus the general population. Diabetes Care, 2016; 39:1378–1383.
73.
GuilliamsT. The Role of Stress and the HPA Axis in Chronic Disease Management: Principles and Protocols for Healthcare Professionals, 2nd ed. Stevens Point, WI: Point Institute, 2020.
74.
BaslerAJ. Pilot study investigating the effects of Ayurvedic Abhyanga massage on subjective stress experience. J Altern Complement Med, 2011; 17:435–440.
75.
TraceyKJ. The inflammatory reflex. Nature, 2002; 420:853–859.
76.
MinichDM. A review of the science of colorful, plant-based food and practical strategies for “Eating the Rainbow.”. J Nutr Metab, 2019; 2019:2125070.
