Diabetes presents one of the biggest challenges to the NHS, mainly because of its complications.
A national audit has demonstrated how type 1 diabetes patients have worse blood pressure now than before the pandemic. The audit also reveals how only some areas of the UK provide equal access to technologies such as insulin pumps and that specialist services are only sometimes available.
This post will cover type 1 diabetes statistics and risk factors from across the UK. A combination of existing guidelines, recent studies, annual reviews, and ongoing audits paint an interesting picture, including some evidence that COVID-19 may be a trigger.
Type 1 Diabetes vs Type 2 Diabetes: Knowing the Difference
Both type 1 and type 2 diabetes are chronic diseases that affect your blood sugar levels. When you have either disease, your body doesn't regulate blood glucose as it should.
When you have type 2 diabetes, your body doesn't respond to insulin, making it hard to keep blood glucose levels within a healthy range. Type 1 diabetes leads to a lack of insulin due to the immune system attacking insulin-producing cells.
Around 40% are aged 40 and under, with only 2.6% being over 80.
Overall, 56.9% of patients are male, and there's a near-equal distribution of patients between each of England and Wales' social deprivation regions.
White residents make up 91.2% of cases, while Asian make up 3.9%, and black individuals account for 2.5 percent.
How Type 1 Diabetes Develops
The development of type 1 diabetes is an autoimmune reaction that is complex, with experts not fully understanding what triggers it. However, it may take the following course:
Genetics: People who develop type 1 diabetes may find that a first-degree relative has this autoimmune condition. Sometimes, their relatives also have diabetes, but they may have another condition, such as coeliac disease or Graves' disease.
Environmental trigger: Certain environmental triggers may activate the genetic basis for diabetes. Some research points towards certain viruses triggering an autoimmune attack on the pancreatic cells that produce insulin. One 2020 systematic review shows how children with type 1 diabetes are 10 times more likely to have an enterovirus, for example.
Immune response: For reasons that aren't yet clear, the immune system attacks the pancreas's beta cells and mistakes them for foreign bodies. As a result, patients don't produce enough insulin and may develop dangerously high blood sugar levels.
Symptoms develop: When the body can no longer regulate insulin production, type 1 diabetes symptoms set in. Individuals with high blood glucose may become excessively thirsty, urinate frequently, and lose weight. Patients may not receive a diagnosis until serious complications develop, including diabetic ketoacidosis. Around 1/3 of ketoacidosis admissions in the UK occur at the point of type 1 diabetes diagnosis.
Genetics: If you have a sibling with type 1 diabetes, you have a 6 to 7% risk of developing it, or a 30-70% risk if that sibling is a twin. Your risk is 6 to 9% if a biological parent has the condition. Certain genetic mutations may increase your risk, but it isn't clear why.
Vitamin D: Vitamin D deficiency is more common in those with type 1 diabetes. In some studies, up to 85% of those with type 1 juvenile diabetes had a vitamin D deficiency.
Gut microbiome: There's evidence to suggest that some children with type 1 diabetes have a different gut microbiome than those who don't have it.
What the Latest Research Says
Research into type 1 diabetes risk factors is ongoing, with some papers producing surprising findings.
One study shows how COVID-19 may be a virus that attacks pancreatic islet cells, resulting in diabetes. It found a 16% increase in cases in the first 12 months of the pandemic and a 28% increase in the following 12 months. The study is American, but UK statistics also show increased cases during the same period.
When your blood glucose levels remain too high over a long period, you're likely to suffer complications. Not everyone with insulin-dependent diabetes suffers the same side effects, but it's important to be aware of them and how they manifest.
Acute complications are short-term problems that arise in patients with type 1 diabetes. They often occur following poor blood glucose management. They include:
Hypoglycemia: Evidence suggests that patients with type 1 diabetes experience an average of 28 low blood sugar incidents per year. Symptoms include shaking, sweating, irritability, confusion, dizziness, and loss of consciousness.
Hyperglycemia: A condition where blood glucose levels are too high. Symptoms include being thirsty, urinating more often, and blurred vision.
Diabetic ketoacidosis (DKA): This condition arises when you have high blood sugar and is classed as a medical emergency. Symptoms include abdominal pain, nausea, vomiting, and rapid breathing. Evidence shows that women aged between 15 and 25 are 50% more likely to experience a DKA than other type 1 diabetes patients.
Hyperosmolar hyperglycemic state: Otherwise known as HHS, this condition occurs following very high blood glucose level that persist over weeks. Its symptoms include extreme thirst, dry mouth, confusion, and seizures. HHS is rare, with only 20 reported cases in the UK between March 2020 and November 2021.
Infections: Having type 1 diabetes and poor blood sugar control weakens your immune system. As a result, you may struggle to fight off infections. Common diabetes-related infections include UTIs, respiratory infections, and cellulitis.
Gum disease: Dental infections are more likely to occur when blood sugar levels remain high. Oral bacteria thrive in sugary environments. Eventually, some oral infections may result in tooth loss.
Managing type 1 diabetes requires a careful balance of insulin injections and blood sugar monitoring. Various factors can determine how effective your efforts are. If you find that keeping your blood glucose within a normal range is challenging, you're at risk of developing long-term complications.
Some of the long-term complications type 1 diabetes patients develop include:
Peripheral arterial disease: PAD arises when your extremities, such as your legs, suffer due to poor blood flow. Reduced blood flow may make your legs feel painful, resulting in non-healing wounds, such as ulcers. Around 9% of the population suffers from PAD, with type 1 diabetes being among the leading causes.
Diabetic retinopathy: Diabetic retinopathy is a type 1 diabetes complication that arises when high blood sugar levels damage the eye's retina. It results in blurred vision and may require interventions, such as laser surgery. One report suggests that 54.6% of people with type 1 diabetes develop retinopathy.
Kidney disease: Prolonged elevated blood sugar may damage the small blood vessels in the kidneys, resulting in disease. Around 40% of people with diabetes could go on to develop problems, with a small number of patients needing a kidney transplant to survive.
Neuropathy: Nerve damage may occur when you struggle to maintain a healthy blood glucose level. Common nerve damage symptoms include tingling in your hands and feet, wounds in your extremities that don't heal, and losing sensation in affected areas. There's also a small risk of autonomic neuropathy, which results in damage to the nerves that control your bladder, heart's conduction system, and some sexual functions.
Skin conditions: High blood sugar levels increase your risk of developing fungal infections. Around 34% of people with type 1 diabetes develop fungal infections compared to 4.7% of the general population.
Although you'll likely experience some complications when you have type 1 diabetes, not all of them are inevitable. Advances in diabetes care mean you can avoid many and significantly reduce the incidence of some.
Ways to manage type 1 diabetes complications include:
Glucose monitoring: Closely monitoring blood sugar levels makes it easier to bring them under control when they're high. Advanced technologies such as a continuous glucose monitor also help you and your healthcare team identify trends. When risky patterns arise, your medical team can adjust your treatment plan accordingly.
Insulin therapy: Finding the right insulin therapy for you goes a long way towards making type 1 diabetes control easier. Alongside traditional insulin shots, insulin pumps, needleless injections, and automatic treatments that respond to continuous glucose monitoring are available. Having a treatment you're comfortable with means you're more likely to adhere to it and keep your blood glucose levels within a healthy range.
Balanced diet: Healthy eating is an important aspect of type 1 diabetes management. Focus on nutritious whole foods and cut out processed items. If you want to make major dietary changes, discuss them with your doctor first.
Exercise: Finding the right fitness routine can reduce your risk of diabetes-related health problems, including cardiovascular disease. Always discuss any new exercise plans with a doctor, especially when you're new to managing type 1 diabetes.
Routine checkups: Attend any routine checkups your medical team schedules. This includes attending dental appointments, as your dentist can identify early signs of gum disease. Don't neglect visits to your ophthalmologist, as they can spot blood vessel damage that may affect your eyes.
Foot care: Learn about the early signs of peripheral neuropathy and check your feet regularly. Spotting wounds in their early phases can prevent you from developing ulcers.
Blood pressure management: Having an increased risk of heart disease means you should focus on keeping your blood pressure within a healthy range. As you get older, this may mean taking certain medications.
Quit smoking: Smoking can worsen some type 1 diabetes complications as it can damage blood vessels. Try an NHS smoking cessation program if you're struggling to stop.
Manage stress: Reducing your stress levels may also lower your blood pressure, placing less strain on your blood vessels. Try practices such as yoga and meditation.
Education: Talking to a diabetes educator may make it easier for you to manage your condition. Understanding more about type 1 diabetes and how various strategies may help you manage it can help you make informed decisions about your care.
Vaccinations: Before the winter virus season, ask your GP about any vaccines you're eligible for. Patients with type 1 diabetes are a high priority for the COVID-19 vaccine in 2023.
Type 1 diabetes is an autoimmune condition that accounts for 8% of diabetes cases in the UK. The latest research shows that new cases are rising following the COVID-19 pandemic. National median HBA1C levels also remain above recommended guidelines.
Many people who have type 1 diabetes are at risk of developing complications. They include acute infections, heart disease, vision problems, and more. However, reducing the risk of those complications is possible by keeping blood glucose levels within a recommended range and leading a healthy lifestyle.