Type 1 Diabetes Mellitus

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WHO-ICD-10 version:2010

Endocrine, nutritional and metabolic diseases

Diabetes mellitus

OMIM Number

222100

Mode of Inheritance

Autosomal recessive susceptibility heterogeneous

Gene Map Locus

6p21.3

Description

Diabetes Mellitus is a metabolic disorder characterised by persistent hyperglycemia. Type I Diabetes Mellitus or Insulin-Dependent Diabetes Mellitus (IDDM) develops when the immune system destroys pancreatic beta cells and impairs normal level of insulin production. Consequently, glucose builds up in the bloodstream as the cells are unable to utilize it to convert into energy. This build up of blood glucose can cause serious damage to the organs leading to complications related to the heart, kidney (diabetic nephropathy), eye (retinopathy), skin, and nerves. Initial symptoms of IDDM include increased thirst and urination, weight loss, nausea, fatigue, and abdominal pain. Studies indicate IDDM to be genetically heterogeneous in nature and susceptibility of contracting it is dependent on both genes and environmental factors. Variations in human leukocyte antigen (HLA) complex as well as several other genes such as ACE and IL6 is known to be been associated with IDDM.

Epidemiology in the Arab World

View Map
Subject IDCountrySexFamily HistoryParental ConsanguinityHPO TermsVariantZygosityMode of InheritanceReferenceRemarks
222100.1.1United Arab EmiratesFemaleYesYes Type I diabetes mellitusNM_000207.3(INS):c.-152C>GHomozygousAutosomal, RecessiveDeeb et al. 2016; Garin et al. 2010 Sister of 606176.5.1
222100.1.2United Arab EmiratesFemaleYesYes Type I diabetes mellitusNM_000207.3(INS):c.-152C>GHomozygousAutosomal, RecessiveDeeb et al. 2016; Garin et al. 2010 Brother of 606176.5....
222100.G.1.1KuwaitUnknown HyperglycemiaNM_000789.4:c.2306-105_2306-104insTTTTTTTTTTTGAGACGGAGTCTCGCTCTGTCGCCCATACAGTCACTTTTHomozygousAlsaeid et al. 2004 Diabetic children wi...
222100.G.1.2KuwaitUnknown HyperglycemiaNM_000789.4:c.2306-105_2306-104insTTTTTTTTTTTGAGACGGAGTCTCGCTCTGTCGCCCATACAGTCACTTTTHeterozygousAlsaeid et al. 2004 Diabetic children wi...
222100.G.2LebanonUnknown Type I diabetes mellitusNM_005214.4:c.49A>GEi Wafai et al. 2011 39 Lebanese patients...
222100.G.3LebanonUnknown Type I diabetes mellitusNM_005214.4:c.49A>GTaleb et al. 2010 Study group comprisi...
222100.G.4LebanonUnknown Type I diabetes mellitusNM_005214.4:c.49A>GZalloua et al. 2004 Study group comprisi...
222100.G.5.1United Arab Emirates Type I diabetes mellitusNM_005214.4:c.49A>G, NM_015967.7:c.2054-852T>C, NM_015967.7:c.1858=, NC_000010.11:g.6081532C>THeterozygousSharma et al. 2021 139 patients with Ty...

Other Reports

Bahrain

Al-Abbasi and Al-Jenaidi (2003) conducted a study to detect the presence of anti-GAD antibodies, IgG antibodies and anti-islet cell antibodies in a group consisting of type 1 diabetes (IDDM) patients below the age of 15 years and their siblings. The study emphasised on the need for auto-antibodies detection in high-risk siblings of patients with IDDM.

Al-Hermi et al. (2005)  examined prevalence of diabetic nephropathy in patients who were diagnosed with type 1 diabetes (IDDM) for over 5 years at the time of the study . 10 out of 52 patients (31%) were diagnosed with diabetic nephropathy - eight cases of proteinuria and two cases of microalbuminuria were reported. Al-Hermi et al. (2005) recommended screening for microalbuminuria in adolescents who had persistent hyperglycemia and diabetes for more than 5 years.

Kamal et al. (2006) conducted a study to understand the effect of nicotinamide (NA) therapy on insulin requirement and glycemic control in patients with type 1 diabetes (IDDM). The study group consisted of Bahraini residents who were newly diagnosed with IDDM and under the age of 15. The patients were administered 1-2mg/Kg of NA orally, per day, in addition to subcutaneous insulin. Regular follow-up tests were performed every 3 months for a period of 24 months. Insulin requirement was found to have lowered significantly in patients within the study group compared to the control subjects (who did not receive NA) during the follow up sessions. Glycated hemoglobin levels were also noted to have lowered during the 6-month and 12-month follow up sessions in study group patients.

Al-Harbi et al. (2004) studied the association of HLA-DR and -DQ with type 1 diabetes in 107 unrelated patients and 88 healthy controls. The study showed that DRB1*030101, DRB1*040101, DQB1*0201 and DQB1*0302 alleles had strong association with type 1 diabetes among the studied patients. It was also found that DRB1*030101-DQB1*0201 and DRB1*030101-DQB1*0302 genotypes were prevalent among patients indicating higher disease susceptibility.

Al-Jenadi et al. (2005) studied the association of HLA-DRB1 and DBQ1 haplotypes with type 1 diabetes in 126 Bahraini and 78 Lebanese diabetic patients in 2005.  The Lebanese and Bahraini subjects were found to share DRB1*030101, DQB1*0201 as susceptible alleles and DRB1*100101, DQB1*030101 as protective alleles. Additionally, in Bahraini patients, DRB1*040101 was reported to be a susceptible allele, whereas in Lebanese patients, DRB1*130701 was found to be the susceptible allele and DQB1*050101 a protective allele.

Stayoussef et al. (2009) studied HLA class II (DRB1 and DQB1) haplotypes and their association to type 1 diabetes in patients from Bahrain, Lebanon and Tunisia. The study concluded that DRB1*030101-DQB1*0201 genotype conferred susceptibility in patients from all three regions, and DRB1*040101-DQB1*0302 haplotype conferred susceptibility only in Tunisians and Bahrainis. Additionally, the study indicated that DRB1*100101-DQB1*050101 and DRB1*150101-DQB1*060101 were largely protective in Bahraini and Lebanese populations respectively.

Egypt
Iraq
Kuwait

In a study carried out by Shaltout et al. (2002) over a period of 6 years (1992-1997), incidence rate of type 1 diabetes was calculated as 20.1 per 100,000 in Kuwaiti children below 14 years of age (21.1/100,000 in boys, 19.0/100,000 in girls). An upward trend was noticed in the number of reported cases during this study period.

Moussa et al. (2005) reported prevalence of type I diabetes mellitus among school-going children in Kuwait between 6 and 18 years as 269.9 per 100,000 children. Out of 128,918 children, 348 (217 female, 131 male) were identified with type I diabetes mellitus.

Moussa et al. (2005) conducted a pair-matched case-control study consisting of 348 children between 6 and 18 years with type 1 diabetic (IDDM). Patients in the study group had significantly higher mean levels of total cholestrol, Apo A1 and Apo B than controls. The study also showed a correlation between glucose, total sialic acid, lipoprotein(a), total cholestrol, atherogenic index, TG, apolipoprotien levels and glycated haemoglobin (HbA1c) measurements in type 1 diabetic children. A positive family history of IDDM, non-insulin-dependent diabetes (NIDDM), or thyroid disease was shown to be a predisposing factor for IDDM.

Lebanon

The contribution of HLA-DRB1 and DBQ1 alleles to Type I Diabetes Mellitus susceptibility was studied in the Lebanese population by Zalloua et al (2002)Al-Jenaidi et al (2005)Stayoussef et al (2009)Taleb et al (2010), and Ei Wafai et al (2011)

Libya

The annual incidence rate of type 1 diabetes (IDDM) in children below the age of 14 was calculated as 8.1/100,00 by Kadiki et al. (1998) during a 5-year study conducted between 1991 and 1995 in Benghazi, Libya. Incidence rate was found to be higher among girls compared to boys.

Ashabani et al. (2003) studied the incidence of coeliac disease in Libiyan patient with type 1 diabetes. Serological markers were used to screen 234 patients (age group 2-24) and the results were compared with that of 50 control subjects. Intestinal mucosal biopsy samples were collected from 26 patients (with positive anti-gliadin antibodies, tissue transglutaminase IgA and calreticulin antibodies) and 24 (10.3%) of them were confirmed to have coeliac disease.

Morocco
Oman

Soliman et al. (1996) conducted a study to calculate the incidence of type 1 diabetes (IDDM) in Omani children under the age of 14 years. Incidence rates were calculated as 2.45/100.00 in 1993 and 2.62/100,000 in 1994. Soliman et al.(1997) also reported the presenting features and progress of IDDM in a group of 60 children under the age of 15 years diagnosed between 1990 and 1993 in Oman.

El-Haddad and Saad (1998) conducted a study to estimate the prevalence of diabetic retinopathy among 500 randomly selected diabetic patients in Al
Buraimi  hospital, between September 1996 and July 1997. Retinopathy was detected in 36 out of 96 type 1 diabetes (IDDM) patients.

Palestine

Laron et al. (1985) reported a total number of 120,000 Arabs affected by type 1 diabetes, as per the population survey conducted during 1975-1980.

[See: UAE > Punnose et al., 2002].

Somalia
Sudan
Syria
Tunisia

[See: Bahrain > Stayoussef et al., 2009].

United Arab Emirates

Punnose et al. (2002) conducted a retrospective study in Al-Ain to determine the incidence of childhood and adolescent diabetes mellitus in Arab population. 35 patients were reported to have type 1 diabetes - 16 UAE nationals and the remaining 17 patients were from Somalia, Egypt, Sudan, Syria, Morocco, Palestine and Iraq.

Tay et al. 2021 identified three HLA-DR4 haplotypes in seven children with type I diabetes from five Emirati families: HLA-DRB1∗04:01:01-DQB1∗03:02:01:01; HLA- DRB1∗04:02:01-DQB1∗03:02:01; and HLA-DRB1∗04:05:01-DQB1∗02:02:01:02. These haplotypes were previously associated with Type 1 Diabetes in Arabs. The study study additionally reported on HLA-DR4 and HLA-DR3 T1D risk haplotypes in the parents. Haplotypes HLA -A*26-B*08-DRB1*03 and HLA -C∗06-B∗50-DRB1∗03:01-DQ∗02 were also identified, previously associated with diabetes in North Indians. 

Al-Yafei et al. 2022 studied HLA-DRB1 and HLA-DQB1 alleles to understand its association with type 1 diabetes (T1D) in 149 Emirati T1D patients. Four DRB1 alleles – DRB1*03:01, DRB1*04:02, DRB1*11:01, and DRB1*16:02 – showed significant allelic differences in patients and control subjects. With HLA-DQB1, significant differences were noted with five alleles: DQB1*02:01, DQB1*03:02, DQB1*03:01, DQB1*05:01, and DQB1*06:01. Positive association with T1D was observed with diplotypes DRB1*03:01~DQB1*02:01, DRB1*04:02~DQB1*03:02, and DRB1*04:05~DQB1*03:02, whereas negative association was observed with diplotype DRB1*16:02~DQB1*05:02.

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