Double diabetes: A distinct high‐risk group?

Abstract

The term double diabetes (DD) has been used to refer to individuals with type 1 diabetes (T1D) who are overweight, have a family history of type 2 diabetes and/or clinical features of insulin resistance. Several pieces of evidence indicate that individuals who display features of DD are at higher risk of developing future diabetes complications, independently of average glucose control, measured as glycated haemoglobin (HbA1c) concentration. Given the increased prevalence of individuals with features of DD, pragmatic criteria are urgently required to identify and stratify this group, which will help with subsequent implementation of more effective personalized interventions. In this review, we discuss the potential criteria for the clinical identification of individuals with DD, highlighting the strengths and weaknesses of each definition. We also cover potential mechanisms of DD and how these contribute to increased risk of diabetes complications. Special emphasis is placed on the role of estimated glucose disposal rate (eGDR) in the diagnosis of DD, which can be easily incorporated into clinical practice and is predictive of adverse clinical outcome. In addition to the identification of individuals with DD, eGDR has potential utility in monitoring response to different interventions. T1D is a more heterogeneous condition than initially envisaged, and those with features of DD represent a subgroup at higher risk of complications. Pragmatic criteria for the diagnosis of individuals with DD will help with risk stratification, allowing a more personalized and targeted management strategy to improve outcome and quality of life in this population.

Prevalence of Nonalcoholic Fatty Liver Disease (NAFLD) in Patients With Type 1 Diabetes Mellitus: A Systematic Review and Meta-Analysis

“…Patients will combine features of type 1 diabetes with those of type 2 diabetes, with increased prevalence of dyslipidemia and hypertension. This is labeled as “double diabetes,” and is associated with an increased cardiovascular risk ( 55 ). Moreover, patients with type 1 diabetes usually have a lifetime exposure to diabetes mellitus.…”

Estimated glucose disposal rate demographics and clinical characteristics of young adults with type 1 diabetes mellitus: A cross-sectional pilot study

“…Termed 'double diabetes', 1 a number of factors have been described as potentially causative in the insulin resistance seen including genetic, lifestyle and the injection of exogenous insulin. 2 Importantly, insulin resistance has been shown to increase vascular endothelial dysfunction 3 and induce a cytokine-mediated inflammatory response 2 which in turn has been proposed to increase cardiovascular risk and other diabetes complications in this group. 4 Within clinical practice, IR is broadly defined as daily insulin requirements exceeding one international unit (IU)/ kg/day.…”

Double Diabetes: A Growing Problem Requiring Solutions

“…Arguably, patients with double diabetes and family history of T2DM have a genetic predisposition to IR, but obviously with different time of onset during the natural history of T1DM [5,11]. IR may develop later in the course of T1DM, but it also can be present at T1DM diagnosis or potentially even contribute to earlier T1DM presentation, through the accelerator hypothesis postulating that obesity-induced IR could accelerate the autoimmune process of T1DM [5,11]. Nonetheless, the accelerator hypothesis is still questionable and remains controversial [12].…”

“…It is also unclear if there is a time frame after T1DM diagnosis for employing the proposed diagnostic criteria of double diabetes. It seems certain that the pathogenic mechanisms leading to double diabetes are related to both genetic predisposition and environmental factors [5]. Granted that the latter interact with T1DM duration and age, double diabetes probably represents a time-dependent condition [5].…”

“…It seems certain that the pathogenic mechanisms leading to double diabetes are related to both genetic predisposition and environmental factors [5]. Granted that the latter interact with T1DM duration and age, double diabetes probably represents a time-dependent condition [5]. In line with this assertion, the previously cited study examining 1337 Caucasian DCCT subjects showed that prevalence of MetS increased steadily from baseline to year 9 in both conventionally (from 15.5 to 27.2 %) and intensively treated subjects (from 13.7 to 45.4 %) [29].…”