Pozzilli Paolo, Guglielmi Chiara
Department of Endocrinology and Diabetes, University Campus Bio-Medico, Rome, Italy.
Endocr Dev. 2009;14:151-66. doi: 10.1159/000207484. Epub 2009 Feb 27.
The increase in the incidence of type 1 diabetes (T1D), especially in children <5 years of age reported over the past decade can be attributed to changes in environmental factors, either quantitative or qualitative, rather than to an effect of genetic factors operating in such a short period of time. The notable increase in the incidence of type 2 diabetes (T2D) in children and adolescents is very likely the consequence of the increase in obesity and sedentary life style occurring in developed countries. The increase in the number of children and adolescents with a mixture of the two types of diabetes has recently come to light (i.e. subjects who are obese and/or with signs of insulin resistance as well as positive for markers of autoimmunity to beta cells). Under the current classification, it is difficult to define the type of diabetes affecting these young subjects, being classified as T2D because they are obese and insulin resistant, but also as T1D because of the presence of auto-antibodies to beta cells. There is no doubt that these subjects show an overlapping diabetes phenotype typical of both T1D and T2D suggesting that the current classification of diabetes should be revised taking into account this new form of diabetes which has called double diabetes or hybrid diabetes.
1型糖尿病（T1D）发病率的增加，尤其是过去十年中报道的5岁以下儿童发病率的增加，可归因于环境因素在数量或质量上的变化，而非在如此短时间内起作用的遗传因素的影响。儿童和青少年2型糖尿病（T2D）发病率的显著增加很可能是发达国家肥胖率上升和久坐不动生活方式的结果。最近，患有两种糖尿病混合类型的儿童和青少年数量有所增加（即肥胖和/或有胰岛素抵抗迹象以及β细胞自身免疫标志物呈阳性的个体）。根据目前的分类，很难确定影响这些年轻患者的糖尿病类型，他们因肥胖和胰岛素抵抗而被归类为T2D，但又因存在β细胞自身抗体而被归类为T1D。毫无疑问，这些患者表现出T1D和T2D典型的重叠糖尿病表型，这表明应考虑到这种被称为双重糖尿病或混合糖尿病的新糖尿病形式，对目前的糖尿病分类进行修订。
