Diabete mellito di tipo I
ll diabete di tipo 1 rappresenta la tipica forma autoimmune del diabete. L’insorgenza è tipica dell’età infanto-giovanile, ma può essere possibile a ogni età. Nel 5-10% degli adulti che sviluppano diabete dopo i 40 anni viene riconosciuta una eziologia autoimmune. Frequentemente questa forma di diabete è associata ad altre malattie autoimmuni, quali il morbo di Addison, malattia di Graves, tiroide autoimmune, celiachia e gastrite autoimmune.
Suscettibilità genetica. La distruzione autoimmune delle cellule beta-pancreatiche può avvenire in soggetti geneticamente suscettibili. Questa suscettibilità è sicuramente poligenica e viene influenzata da geni situati nella regione del sistema maggiore di istocompatibilità di classe II (MHC).
Evento precipitante. Solo una minoranza dei soggetti con suscettibilità genetica sviluppa il DM, per cui si ipotizza che un evento precipitante di natura ambientale (virale, tossica, dietetica ecc..) o mutazionale sia necessario per iniziare il processo autoimmune. Particolare interesse sta suscitando il possibile ruolo del precoce allattamento con latte vaccino, in quanto l’ albumina bovina condividerebbe una regione di omologia con una proteina della superficie delle cellule beta.
Presenza di autoanticorpi o di linfociti T autoreattivi. Una volta persa la tolleranza immunitaria verso i componenti delle cellule beta, il sistema immune produce autoanticorpi e linfociti T autoreattivi diretti contro antigeni insulari (insulina, glutammico-decarbossilasi, zinc transporter ZnT8 ecc…). Tali anticorpi sono presenti in circolo e possono essere dimostrati con metodi immunochimici, permettendo l’identificazione di quei soggetti che pur non avendo ancora il DM, hanno però un processo autoimmune in atto.
Presenza di anomalie metaboliche iniziali. Con il progredire della distruzione autoimmune e la conseguente riduzione del numero di cellule beta funzionanti compaiono le prime anomalie metaboliche: mancanza della pulsatilità della secrezione insulinica e perdita del picco precoce di secrezione insulinica in seguito a carico endovenoso di glucosio.
Esordio clinico della malattia. Quando 80/ 90% delle cellule beta è distrutto si assiste all’esordio clinico delle DM.
SINTOMATOLOGIA
La sintomatologia del diabete di tipo 1 si manifesta con:
– stanchezza
– aumento della sete (polidipsia)
– aumento della diuresi (poliuria)
– perdita di peso nonostante iperfagia (incremento dell’appetito)
– malessere
– dolori addominali
Nei casi più gravi può essere presente anche:
– confusione mentale e perdita della coscienza
complicanze possono manifestarsi a livello:
– neurologico
– renale
– oculare
– cardio-cerebrovascolare
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