Autoimmune T1D is associated with a range of acute and long-term complications1-8
Patients with autoimmune T1D can experience many diabetic complications, both chronic and acute. Hyperglycaemia-induced oxidative stress is a key pathlological factor in both microvascular and macrovascular complications of T1D.1
Long-term complications
Diabetic retinopathy is a common complication seen in people with T1D (up to 50% are at risk of this complication), causing irreversible damage and blindness in severe cases. Retinal damage can be caused by microvascular changes as a result of hyperglycaemia.1
Diabetic foot problems pose a major burden to patients with diabetes, including foot ulceration, infection, peripheral neuropathy, peripheral artery disease, neuro-osteoarthropathy, gangrene and amputation.2
Foot ulceration is one of the most serious complications, impacting quality of life and incurring financial cost to both the patient and healthcare system.2
A major cause of morbidity and premature mortality in T1D is cardiovascular disease due to accelerated atherosclerosis.3
Cardiac autonomic neuropathy significantly impairs myocardial function and blood flow, and exacerbates cardiac abnormalities. Coronary calcification is related to coronary artery disease. Hypoglycaemic episodes are considered to adversely influence cardiac performance.4
Cardiovascular disease (CVD) mortality in adult patients (aged 45-64) with T1D has been reported to increase by ~50% with every 1% increase in glycated haemoglobin (HbA1c).4
Characterised by loss of glomerular filtration rate, albuminuria and glomeruli damage. Diabetic nephropathy occurs in approximately 30–40% of patients with T1D.1
Hyperglycaemia causes damage to peripheral sensory, motor and autonomic neurones. Characteristics of peripheral neuropathy include axonal thickening, axonal and microfilament loss, neuronal demyelination and neuronal death.1
Oral problems are often experienced by patients with T1D and include dental caries, gingivitis, peridontal abnormalities and infections.5
Impotence, sexual dysfunction and urogenital dysfunction are complications experienced by patients with diabetes.5
As well as cardiovascular complications, psychosexual factors, endocrine complications and endothelial dysfunction also contribute to the pathogenesis of sexual dysfunction.6
Acute complications
DKA is a life-threatening situation where lack of insulin and hyperglycaemia lead to acidosis, ketonaemia and electrolyte imbalance.7
DKA is a serious complication and the primary reason for hospitalisation in children with autoimmune T1D. It is responsible for 70% of diabetes-related deaths in children under 10 years, often due to cerebral oedema.9-12
Management of symptomatic autoimmune T1D (Stage 3) carries a substantial physical and mental burden for patients13
Every year, the average symptomatic autoimmune T1D (Stage 3) patient may experience:14,15
Blood glucose monitoring, calculation of insulin dosing, and insulin administration are a source of constant burden for patients with symptomatic autoimmune T1D (Stage 3)13,16
Despite advances in insulin delivery systems and glucose monitoring, the burden of disease management is still substantial and glycaemic control remains a challenge13,16
Annual diabetes health checks may also involve:17
- Foot checks
- Eye examination
- Blood pressure assessment
- Urine samples
- Blood tests
Beyond the burden of insulin treatment, life with Stage 3 autoimmune T1D can negatively impact personal and family wellbeing:18,19
Success at school and work:
67% patients reported T1D had a negative impact on success at work or school‡18
Relationships:
43% patients reported T1D had a negative impact on family relationships‡18
Mental health:
>3X higher rate of depression in adults with T1D vs general public§20 ~1 in 3 parents experience distress at time of child’s diagnosis, with ~1 in 5 reporting distress 1–4 years later21
Sleep quality:
Adults and children experience poor sleep quality related to glycaemic variability22 Maintaining glucose levels within range at night can lead to disrupted sleep for caregivers23
Age of Stage 3 T1D onset is an important determinant of survival24
Life years lost in relation to age at onset of Stage 3 T1D‖24
Adapted from Rawshani A, et al. 2018.24,25
Diagnosis of Stage 3 T1D before 10 years of age resulted in reduced life expectancy of 16 years (95% CI 15.7, 16.4).||24,25
Diagnosis of Stage 3 T1D after 20 years of age resulted in reduced life expectancy of ~10 years.||24,25
Despite improvements in insulin technology, metabolic control in young people remains a challenge26,27
Mean HbA1c by age for two cohorts of the T1D Exchange registry⁋26,27
Adapted from Miller KM et al. 2015 and Foster NC et al. 2019.26,27
In the 2016–2018 cohort, only 17% of youths (N=10,778) and 21% of adults (N=11,919) reached ADA targets (HbA1c <58 mmol/mol and <53 mmol/mol, respectively).27,29
In England and Wales, ~60% of patients with autoimmune T1D fail to achieve HbA1c ≤7.5%.#30
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Get in touchINDICATION: TZIELD is indicated to delay the onset of Stage 3 T1D in adult and paediatric patients 8 years of age and older with Stage 2 T1D.31
*If using injectable insulin instead of a pump. Calculation based on the minimum requirement of one basal insulin injection and three mealtime insulin injections per day = four injections per day. 4x365 = 1,460+ injections per year.14
†If using an insulin pump. Calculated based on recommendation that insulin pumps should be changed every 48–72 hours (2–3 days). Therefore, pump change required 122–183 times per year (365/3 = 121.7 and 365/2 = 182.5).15
‡From an online survey exploring the unmet needs of people with diabetes (3,350 patients with T1D), 67% of patients with T1D reported T1D having a negative impact on success at school or work; 43% reported T1D having a negative impact on family relationships.18
§From a systematic review of 20 studies (two studies in autoimmune T1D, five in T1D and Type 2 diabetes [T2D]; 13 in T2D) measuring the prevalence of depression in adults with diabetes across Europe and North America between 2006 and 2011.20
||Data from the Swedish National Diabetes Registry. 27,195 adults with T1D and 135,178 matched controls from the general population were compared to examine how age at diagnosis of T1D relates to excess mortality and cardiovascular risk.24 Loss of life year was estimated using separate Cox regressions fitted to persons with T1D and their matched control within each age group. Conditional mean survival was estimated from the upper limit of each age interval. Life years lost due to T1D is calculated as the difference in the expected median survival between people with T1D and their matched control.24
⁋Data from the T1D Exchange clinic registry (2010–2012 and 2016–2018) — a large-scale multisite registry of adults and youths (age 1–93 years) with autoimmune T1D (duration <1–80 years) in the US, followed annually to assess longitudinal changes in T1D management and clinical outcomes.26,27 Data for patients ≥80 years old have been pooled.27
#Based on data from ~243,000 patients in England (231,385) and Wales (11,620) with autoimmune T1D from the UK National Diabetes Audit. Zeros are reported, and all patient numbers are rounded to the nearest 5, unless the number is 1 to 7, in which case it is rounded to '5'. 60.4% failed to achieve HbA1c ≤58 mmol/mol (7.5%).30
CI, confidence interval; CVD, cardiovascular disease; DKA, diabetic ketoacidosis; HbA1c, glycated haemoglobin; T1D, Type 1 diabetes; T2D, Type 2 diabetes.
MAT-XU-2500759 (v3.0) | September 2026