Type 1 diabetes is a disease resulting in insulin deficiency. In western countries almost all patients have the immune-mediated form of the disease (type 1A). Type 1 diabetes is prominent as a disease of childhood, reaching a peak incidence around the time of puberty, but can present at any age. A ’slow-burning’ variant with slower progression to insulin deficiency occurs in later life and is sometimes called latent autoimmune diabetes of adults (LADA). This may be difficult to distinguish from type 2 diabetes. Clinical clues are: considerable weight loss, hyperglycaemia which fails to correct with diet and tablet treatment, the presence of strong or persistent ketonuria at diagnosis, and autoantibody tests indicating autoimmune disease. The highest rates of type 1 diabetes in the world are seen in Finland and other Northern European countries, with the exception of the island of Sardinia, which for unknown reasons has the second highest rate in the world. The incidence of type 1 diabetes appears to be increasing in most populations. In Europe the annual increase is of the order of 3-4%, and is most marked in children under the age of 5 years. A subtype of type 1 diabetes (type 1B) has recently been described in Japanese patients with an abrupt onset, no autoimmune disease and high serum pancreatic enzyme concentrations at diagnosis. This has not been described in other populations. WHO (1995) estimated that there are 19.4 million people with type 1 diabetes and that the number will rise to 57.2 million by 2025.

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