Double Diabetes: Modern Challenge
https://doi.org/10.31550/1727-2378-2024-23-4-7-14
Abstract
Aim. To describe the main aspects of the double diabetes concept, the challenges of diagnosing and treating this condition, as well as potential solutions to these challenges.
Key points. Our contemporary cohort of patients with type 1 diabetes mellitus shows a concerning increase in the prevalence of obesity, metabolic syndrome, and insulin resistance — characteristics that are traditionally associated with type 2 diabetes. This combination of factors has been termed double diabetes. These patients demonstrate poorer glycemic control and have an increased risk of microvascular and macrovascular complications, as well as mortality. The diagnosis of double diabetes poses a significant challenge due to the lack of well-defined diagnostic criteria. However, the estimated glucose disposal rate has emerged as a promising and reliable indicator, demonstrating a correlation with cardiovascular complications and mortality in these patients. A pressing issue revolves around the possibility of incorporating additional glucose-lowering medications in conjunction with insulin therapy for these individuals. Current researches provide controversial results.
Conclusion. The concept of double diabetes highlights the contemporary challenges facing type1 diabetic patients and endocrinologists while also revealing new opportunities for future research aimed at improving outcomes for these individuals.
About the Authors
A. S. Ametov
Russian Medical Academy of Continuous Professional Education; Botkin Hospital
Russian Federation
Russian Federation
Ametov, A.S.
2/1 Barrikadnaya Str., build. 1, Moscow, 125993
5 2nd Botkinsky pr-d, Moscow, 125284
E. Yu. Pashkova
Russian Medical Academy of Continuous Professional Education; Botkin Hospital
Russian Federation
Russian Federation
Pashkova, E.Yu.
2/1 Barrikadnaya Str., build. 1, Moscow, 125993
5 2nd Botkinsky pr-d, Moscow, 125284
V. R. Gadzhiev
Russian Medical Academy of Continuous Professional Education
Russian Federation
Russian Federation
Gadzhiev, V.R.
2/1 Barrikadnaya Str., build. 1, Moscow, 125993
References
1. Magliano D.J., Boyko E.J., Balkau B., Barengo N. et al. IDF diabetes atlas. 10th ed. 2021: 54, 55.
2. Teupe B., Bergis K. Epidemiological evidence for “double diabetes.” Lancet. 1991;337(8737):361–2. DOI: 10.1016/0140-6736(91)90988-2
3. Conway B., Miller R.G., Costacou T., Fried L. et al. Temporal patterns in overweight and obesity in type 1 diabetes. Diabet. Med. 2010;27(4):398–404. DOI: 10.1111/J.1464-5491.2010.02956.X
4. Fang M., Jeon Y., Echouffo-Tcheugui J.B., Selvin E. Prevalence and management of obesity in U.S. adults with type 1 diabetes. Ann. Intern. Med. 2023;176(3):427–9. DOI: 10.7326/M22-3078
5. Faradji-Hazán R.N., Valenzuela-Lara M., Díaz-Barriga Menchaca A.P., Almeda-Valdes P. et al. Type 1 diabetes care in Mexico: an analysis of the RENACED-DT1 National Registry. Rev. Invest. Clin. 2021;73(4): 222–30. DOI: 10.24875/RIC.20000498
6. Edqvist J., Rawshani A., Adiels M., Björck L. et al. BMI, mortality, and cardiovascular outcomes in type 1 diabetes: findings against an obesity paradox. Diabetes Care. 2019;42(7):1297–304. DOI: 10.2337/dc18-1446
7. Lavens A., Nobels F., De Block C., Oriot P. et al. Effect of an integrated, multidisciplinary nationwide approach to type 1 diabetes care on metabolic outcomes: an observational real-world study. Diabetes Technol. Ther. 2021;23(8):565–76. DOI: 10.1089/dia.2021.0003
8. Fellinger P., Fuchs D., Wolf P., Heinze G. et al. Overweight and obesity in type 1 diabetes equal those of the general population. Wien. Klin. Wochenschr. 2019;131(3–4):55–60. DOI: 10.1007/S00508-018-1434-9
9. Thorn L.M., Forsblom C., Wadén J., Söderlund J. et al. Effect of parental type 2 diabetes on offspring with type 1 diabetes. Diabetes Care. 2009;32(1):63–8. DOI: 10.2337/DC08-0472
10. Purnell J.Q., Hokanson J.E., Marcovina S.M., Steffes M.W. et al. Effect of excessive weight gain with intensive therapy of type 1 diabetes on lipid levels and blood pressure: results from the DCCT. Diabetes Control and Complications Trial. JAMA. 1998;280(2):140–6. DOI: 10.1001/JAMA.280.2.140
11. Roglic G., Colhoun H.M., Stevens L.K., Lemkes H.H. et al. Parental history of hypertension and parental history of diabetes and microvascular complications in insulin-dependent diabetes mellitus: the EURODIAB IDDM Complications Study. Diabet. Med. 1998;15(5):418–26. DOI: 10.1002/(SICI)1096-9136(199805)15:5<418::AID-DIA604>3.0.CO;2-P
12. Erbey J.R., Kuller L.H., Becker D.J., Orchard T.J. The association between a family history of type 2 diabetes and coronary artery disease in a type 1 diabetes population. Diabetes Care. 1998;21(4):610–14. DOI: 10.2337/DIACARE.21.4.610
13. Purnell J.Q., Braffett B.H., Zinman B., Gubitosi-Klug R.A. et al. Impact of excessive weight gain on cardiovascular outcomes in type 1 diabetes: results from the Diabetes Control and Complications Trial / Epidemiology of Diabetes Interventions and Complications (DCCT/ EDIC) Study. Diabetes Care. 2017;40(12):1756–62. DOI: 10.2337/DC16-2523
14. Nyström T., Andersson Franko M., Ludvigsson J., Lind M. et al. Overweight or obesity, weight variability and the risk of retinopathy in type 1 diabetes. Diabetes Obes. Metab. 2024. Online ahead of print. DOI: 10.1111/dom.15545
15. Ranasinghe P., Mathangasinghe Y., Jayawardena R., Hills A.P. et al. Prevalence and trends of metabolic syndrome among adults in the asia-pacific region: a systematic review. BMC Public Health. 2017;17(1):101. DOI: 10.1186/S12889-017-4041-1
16. do Vale Moreira N.C., Hussain A., Bhowmik B., Mdala I. et al. Prevalence of metabolic syndrome by different definitions, and its association with type 2 diabetes, pre-diabetes, and cardiovascular disease risk in Brazil. Diabetes Metab. Syndr. 2020;14(5):1217–24. DOI: 10.1016/j.dsx.2020.05.043
17. Merger S.R., Kerner W., Stadler M., Zeyfang A. et al. Prevalence and comorbidities of double diabetes. Diabetes Res. Clin. Pract. 2016;119:48–56. DOI: 10.1016/J.DIABRES.2016.06.003
18. Gingras V., Leroux C., Fortin A., Legault L. et al. Predictors of cardiovascular risk among patients with type 1 diabetes: a critical analysis of the metabolic syndrome and its components. Diabetes Metab. 2017;43(3):217–22. DOI: 10.1016/j.diabet.2016.10.007
19. Thorn L.M., Forsblom C., Fagerudd J., Thomas M.C. et al. Metabolic syndrome in type 1 diabetes: association with diabetic nephropathy and glycemic control (the FinnDiane study). Diabetes Care. 2005;28(8):2019–24. DOI: 10.2337/DIACARE.28.8.2019
20. Belete R., Ataro Z., Abdu A., Sheleme M. Global prevalence of metabolic syndrome among patients with type I diabetes mellitus: a systematic review and meta-analysis. Diabetol. Metab. Syndr 2021;13(1):25. DOI: 10.1186/S13098-021-00641-8
21. Donga E., Dekkers O.M., Corssmit E.P.M., Romijn J.A. Insulin resistance in patients with type 1 diabetes assessed by glucose clamp studies: systematic review and meta-analysis. Eur. J. Endocrinol. 2015;173(1):101–9. DOI: 10.1530/EJE-14-0911
22. Schauer I.E., Snell-Bergeon J.K., Bergman B.C., Maahs D.M. et al. Insulin resistance, defective insulin-mediated fatty acid suppression, and coronary artery calcification in subjects with and without type 1 diabetes: the CACTI study. Diabetes. 2011;60(1):306–14. DOI: 10.2337/DB10-0328
23. Williams K.V., Erbey J.R., Becker D., Arslanian S. et al. Can clinical factors estimate insulin resistance in type 1 diabetes? Diabetes. 2000;49(4):626–32. DOI: 10.2337/diabetes.49.4.626
24. Zheng X., Huang B., Luo S., Yang D. et al. A new model to estimate insulin resistance via clinical parameters in adults with type 1 diabetes. Diabetes Metab. Res. Rev. 2017;33(4):e2880. DOI: 10.1002/dmrr.2880
25. Duca L.M., Maahs D.M., Schauer I.E., Bergman B.C. et al. Development and validation of a method to estimate insulin sensitivity in patients with and without type 1 diabetes. J. Clin. Endocrinol. Metab. 2016;101(2):686–95. DOI: 10.1210/jc.2015-3272
26. Uruska A., Zozulinska-Ziolkiewicz D., Niedzwiecki P., Pietrzak M. et al. TG/HDL-C ratio and visceral adiposity index may be useful in assessment of insulin resistance in adults with type 1 diabetes in clinical practice. J. Clin. Lipidol. 2018;12(3):734–40. DOI: 10.1016/j.jacl.2018.01.005
27. Nyström T., Holzmann M.J., Eliasson B., Svensson A.M. et al. Estimated glucose disposal rate predicts mortality in adults with type 1 diabetes. Diabetes Obes. Metab. 2018;20(3):556–63. DOI: 10.1111/dom.13110
28. Ferreira-Hermosillo A., Ibarra-Salce R., Rodríguez-Malacara J., Molina- Ayala M.A. Comparison of indirect markers of insulin resistance in adult patients with double diabetes. BMC Endocr. Disord. 2020;20(1):87. DOI: 10.1186/s12902-020-00570-z
29. Pambianco G., Costacou T., Orchard T.J. The prediction of major outcomes of type 1 diabetes: a 12-year prospective evaluation of three separate definitions of the metabolic syndrome and their components and estimated glucose disposal rate: the Pittsburgh Epidemiology of Diabetes Complications Study experience. Diabetes Care. 2007;30(5):1248–54. DOI: 10.2337/dc06-2053
30. Chillarón J.J., Goday A., Flores-Le-Roux J.A., Benaiges D. et al. Estimated glucose disposal rate in assessment of the metabolic syndrome and microvascular complications in patients with type 1 diabetes. J. Clin. Endocrinol. Metab. 2009;94(9):3530–4. DOI: 10.1210/jc.2009-0960
31. Helliwell R., Warnes H., Kietsiriroje N., Campbell M. et al. Body mass index, estimated glucose disposal rate and vascular complications in type 1 diabetes: beyond glycated haemoglobin. Diabet. Med. 2021;38(5):e14529. DOI: 10.1111/dme.14529
32. Lu Z., Xiong Y., Feng X., Yang K. et al. Insulin resistance estimated by estimated glucose disposal rate predicts outcomes in acute ischemic stroke patients. Cardiovasc. Diabetol. 2023;22(1):225. DOI: 10.1186/s12933-023-01925-1
33. Kilpatrick E.S., Rigby A.S., Atkin S.L. Insulin resistance, the metabolic syndrome, and complication risk in type 1 diabetes: “double diabetes” in the Diabetes Control and Complications Trial. Diabetes Care. 2007;30(3):707–12. DOI: 10.2337/dc06-1982
34. Mertens J., Block C.D., Dirinck E., Francque S. The role of estimated glucose disposal rate as a predictor of insulin resistance, NAFLD and major adverse cardiovascular events in type 1 diabetes mellitus. Endocrine Abstracts. 2021;73AEP11. DOI: 10.1530/endoabs.73.AEP11
35. Petrie J.R., Chaturvedi N., Ford I., Brouwers M.C.G.J. et al. Cardiovascular and metabolic effects of metformin in patients with type 1 diabetes (REMOVAL): a double-blind, randomised, placebocontrolled trial. Lancet Diabetes Endocrinol. 2017;5(8):597–609. DOI: 10.1016/S2213-8587(17)30194-8
36. Liu C., Wu D., Zheng X., Li P. et al. Efficacy and safety of metformin for patients with type 1 diabetes mellitus: a meta-analysis. Diabetes Technol. Ther. 2015;17(2):142–8. DOI: 10.1089/dia.2014.0190
37. Tandon S., Ayis S., Hopkins D., Harding S. et al. The impact of pharmacological and lifestyle interventions on body weight in people with type 1 diabetes: a systematic review and meta-analysis. Diabetes Obes. Metab. 2021;23(2):350–62. DOI: 10.1111/DOM.14221
38. Taylor S.I., Blau J.E., Rother K.I., Beitelshees A.L. SGLT2 inhibitors as adjunctive therapy for type 1 diabetes: balancing benefits and risks. Lancet Diabetes Endocrinol. 2019;7(12):949–58. DOI: 10.1016/ S2213-8587(19)30154-8
39. Evans M., Hicks D., Patel D., Patel V. et al. Optimising the benefits of SGLT2 inhibitors for type 1 diabetes. Diabetes Ther. 2020;11(1): 37–52. DOI: 10.1007/S13300-019-00728-6
40. Mathieu C., Dandona P., Birkenfeld A.L., Hansen T.K. et al. Benefit/risk profile of dapagliflozin 5 mg in the DEPICT‐1 and ‐2 trials in individuals with type 1 diabetes and body mass index ≥ 27 kg/m2. Diabetes Obes. Metab. 2020;22(11):2151–60. DOI: 10.1111/DOM.14144
41. Rosenstock J., Marquard J., Laffel L.M., Neubacher D. et al. Empagliflozin as adjunctive to insulin therapy in type 1 diabetes: the EASE Trials. Diabetes Care. 2018;41(12):2560–9. DOI: 10.2337/DC18-1749
42. Park J., Ntelis S., Yunasan E., Downton K.D. et al. Glucagon-like peptide 1 analogues as adjunctive therapy for patients with type 1 diabetes: an updated systematic review and meta-analysis. J. Clin. Endocrinol. Metab. 2023;109(1):279–92. DOI: 10.1210/clinem/dgad471
43. Yang Z., Yu M., Mei M., Chen C. et al. The association between GLP-1 receptor agonist and diabetic ketoacidosis in the FDA adverse event reporting system. Nutr. Metab. Cardiovasc. Dis. 2022;32(2):504–10. DOI: 10.1016/J.NUMECD.2021.10.003
44. Anson M., Zhao S.S., Austin P., Ibarburu G.H. et al. SGLT2i and GLP-1 RA therapy in type 1 diabetes and reno-vascular outcomes: a real-world study. Diabetologia. 2023;66(10):1869–81. DOI: 10.1007/s00125-023-05975-8
45. Garg S.K., Moser E.G., Bode B.W., Klaff L.J. et al. Effect of sitagliptin on post-prandial glucagon and GLP-1 levels in patients with type 1 diabetes: investigator-initiated, double-blind, randomized, placebocontrolled trial. Endocr. Pract. 2013;19(1):19–28. DOI: 10.4158/EP12100.OR
46. Wang Q., Long M., Qu H., Shen R. et al. DPP-4 inhibitors as treatments for type 1 diabetes mellitus: a systematic review and meta-analysis. J. Diabetes Res. 2018;2018:5308582. DOI: 10.1155/2018/5308582
47. Guo H., Fang C., Huang Y., Pei Y. et al. The efficacy and safety of DPP4 inhibitors in patients with type 1 diabetes: a systematic review and meta-analysis. Diabetes Res. Clin. Pract. 2016;121:184–91. DOI: 10.1016/J.DIABRES.2016.08.022
48. Ametov A.S., Turkina S.V. Pleiotropic effects of taurine in treatment of a patient with diabetes mellitus. Endocrinology: News, Opinions, Training. 2022;11(4):78–88. (in Russian). DOI: 10.33029/2304-9529-2022-11-4-78-88
49. Doskina E.V. Justifications for taurine application in case of diabetes mellitus and its complications (Russian clinical experience). Endocrinology: News, Opinions, Training. 2013;3:39–45. (in Russian)
Review
For citations:
Ametov A.S., Pashkova E.Yu., Gadzhiev V.R. Double Diabetes: Modern Challenge. Title. 2024;23(4):7-14. (In Russ.) https://doi.org/10.31550/1727-2378-2024-23-4-7-14
Views:
22
Email this article 