Prognosis

Untreated type 1 diabetes can be a fatal condition due to diabetic ketoacidosis. Poorly controlled type 1 diabetes is a risk factor for chronic complications such as blindness, renal failure, foot amputations, and heart attacks. Intensive glycemic control has been shown to decrease the incidence of microvascular and macrovascular disease, and the decreased incidence of macrovascular disease has been shown to persist for up to 30 years.[225][226][227][228][229][230] [ Cochrane Clinical Answers logo ] ​​​ Even a few years of intensive glucose control translate to reduced rates of microvascular and macrovascular complications 10 years later.[226][231]​​​ The American Diabetes Association and International Society for Pediatric and Adolescent Diabetes (ISPAD) recommend maintaining glycosylated hemoglobin (HbA1c) <7% (<53 mmol/mol) to prevent complications in most nonpregnant adults, adolescents, and children with type 1 diabetes.​[1]​ Less stringent goals may be appropriate for very young children; some older adults; people with a history of severe or frequent hypoglycemia; and those with limited life expectancies, advanced microvascular or macrovascular complications, or comorbid conditions.​​[1]​ Between 2013 and 2022, pediatric registry data show that the proportion of patients achieving HbA1c targets of <7% (<53 mmol/mol) increased from 19% to 39%, parallel to increased use of diabetes technology.[232] The proportion of participants with insulin pump use increased from 43% in 2013 to 60% in 2022 and the proportion using continuous glucose monitoring (CGM) increased from 19% in 2016 to 82% in 2022.[232]

Overall, cardiovascular disease is the major cause of death and a major cause of morbidity for patients with diabetes. One analysis of patients with type 1 diabetes diagnosed before the age of 15 years found that the leading cause of death before the age of 30 years was acute complications of diabetes. After the age of 30 years cardiovascular disease was predominant, although death attributable to acute complications was still important in this age-group.[233]

Between 1990 and 2019, the age standardised prevalence of type 1 diabetes increased among older people ages ≥65 years, concomitant with a substantial decrease in associated mortality.[234]​ The increasing numbers of older people with type 1 diabetes can be attributed to improvements in care that have extended their lifespan and highlight a need for clinical guidelines targeted to older adults with type 1 diabetes.[235]​ Older adults with diabetes need increased caregiver input and have higher rates of functional disability, accelerated muscle loss, (e.g., hypertension, stroke, heart, and kidney disease), and premature death than those without diabetes.[1]​ They are also at increased risk for several common geriatric syndromes (e.g., cognitive impairment, depression, urinary incontinence, falls, persistent pain, and frailty).[1]​ They may be at higher risk of hypoglycemia for many reasons, including irregular meal intake, difficulties in performing complex self-care activities (e.g., glucose monitoring and insulin dose adjustment) due to cognitive and physical decline, and worsening kidney function.[1]

While individuals of childbearing potential with diabetes are at a higher risk of miscarriage and having infants with major congenital malformations than the general population with careful planning and adequate treatment, most can have successful pregnancies.[156]

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