Prognosis

Untreated type 1 diabetes is 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 in type 1 diabetes, and the decreased incidence of macrovascular disease has been shown to persist for up to 30 years.[159][160][161][162][163][164] [ Cochrane Clinical Answers logo ] ​ Even a few years of intensive glucose control translate to reduced rates of microvascular and macrovascular complications 10 years later.[160][165]​ The American Diabetes Association recommends maintaining glycosylated hemoglobin (HbA1c) <7% to prevent complications in many nonpregnant adults, adolescents, and children with type 1 diabetes.​[1]​ Less stringent goals may be appropriate for very young children; 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]

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.[166]

Older adults with diabetes need increased caregiver input and have higher rates of functional disability, accelerated muscle loss, and coexisting sickness (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.[1]

With careful planning and adequate treatment, most individuals of childbearing potential with type 1 diabetes can have successful pregnancies.

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