1 型糖尿病

未治疗的1型糖尿病患者可以因为糖尿病酮症酸中毒（DKA）而死亡。治疗不当的1型糖尿病是慢性并发症（如双眼失明、肾衰竭、截肢和心肌梗死）的危险因素。强化血糖控制已被发现可以降低 1 型糖尿病患者微血管及大血管疾病发生率，[88]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[89]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.http://www.nejm.org/doi/full/10.1056/NEJM199309303291401#t=articlehttp://www.ncbi.nlm.nih.gov/pubmed/8366922?tool=bestpractice.com[90]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.http://circ.ahajournals.org/content/119/22/2886.longhttp://www.ncbi.nlm.nih.gov/pubmed/19470886?tool=bestpractice.com[91]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.http://jamanetwork.com/journals/jamainternalmedicine/fullarticle/724752http://www.ncbi.nlm.nih.gov/pubmed/19636033?tool=bestpractice.com[92]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.ncbi.nlm.nih.gov/pmc/articles/PMC2637991/http://www.ncbi.nlm.nih.gov/pubmed/16371630?tool=bestpractice.com 并且已证实大血管疾病发病率的下降趋势可持续长达 30 年。[93]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.longhttp://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?https://cochranelibrary.com/cca/doi/10.1002/cca.1025/full显示答案 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。[89]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.http://www.nejm.org/doi/full/10.1056/NEJM199309303291401#t=articlehttp://www.ncbi.nlm.nih.gov/pubmed/8366922?tool=bestpractice.com[94]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.longhttp://www.ncbi.nlm.nih.gov/pubmed/20150297?tool=bestpractice.com 美国糖尿病协会 (ADA) 建议将 A1C（糖化血红蛋白）指控在<53 mmol/mol (<7%) 来预防大部分未怀孕的 1 型糖尿病患者出现并发症，该标准在儿童及青少年患者中可适当放宽。[1]American Diabetes Association. Standards of medical care in diabetes - 2018. Diabetes Care. 2018;41(suppl 1):S1-159.https://professional.diabetes.org/content-page/standards-medical-care-diabetes

总体上，心血管疾病是糖尿病患者死亡和发病的主要原因。一项对 15 岁之前诊断为 1 型糖尿病的患者分析发现，30 岁之前的首要死亡原因是糖尿病的急性并发症。30 岁之后，心血管疾病为主要致死原因，但在这个年龄段，急性并发症导致的死亡仍很重要。[95]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。