Diabetes Types: Differences and Management

Compare and contrast the pathophysiology of type 1 and type 2 diabetes mellitus., How do their treatment approaches differ, and what are the long-term complications associated with poor glycemic control?

Type 1 vs. Type 2 Diabetes: Pathophysiology, Treatment, and Complications

Pathophysiology

• Type 1 Diabetes Mellitus (T1DM)
  • An autoimmune disorder in which the immune system attacks pancreatic beta cells, leading to little or no insulin production.
  • Typically diagnosed in childhood or adolescence but can occur at any age.
  • Absolute insulin deficiency requires lifelong insulin therapy.
• Type 2 Diabetes Mellitus (T2DM)
  • A metabolic disorder characterized by insulin resistance and progressive beta-cell dysfunction.
  • Often associated with obesity, physical inactivity, and genetic factors.
  • Insulin levels may be normal or elevated initially, but over time, beta cells fail to produce enough insulin.

Treatment Approaches

• Type 1 Diabetes
  • Requires insulin therapy (basal and bolus insulin regimens).
  • Blood glucose monitoring using continuous glucose monitors (CGMs) or fingerstick tests.
  • Lifestyle management, including carbohydrate counting and regular exercise.
• Type 2 Diabetes
  • First-line treatment includes lifestyle modifications (diet, exercise, weight management).
  • Oral medications such as metformin, sulfonylureas, or SGLT2 inhibitors.
  • Injectable therapies (GLP-1 receptor agonists, insulin) may be needed in advanced cases.
  • Regular monitoring of blood glucose and HbA1c levels.

Long-Term Complications of Poor Glycemic Control

• Microvascular Complications:
  • Diabetic retinopathy – Damage to the retina, leading to vision loss.
  • Diabetic nephropathy – Kidney damage that can progress to chronic kidney disease.
  • Diabetic neuropathy – Nerve damage causing pain, tingling, or numbness in extremities.
• Macrovascular Complications:
  • Increased risk of cardiovascular disease, including heart attack and stroke.
  • Peripheral artery disease (PAD) leading to poor circulation and potential limb amputation.
• Other Complications:
  • Higher susceptibility to infections.
  • Delayed wound healing.
  • Increased risk of cognitive decline and dementia.

Effective management of both types of diabetes is essential to prevent these complications and improve long-term health outcomes. APA