Leeds Institute of Cardiovascular and Metabolic Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK.
Division of Endocrinology and Metabolism, Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hatyai, Songkhla, Thailand.
Diabetes Obes Metab. 2019 Dec;21(12):2609-2618. doi: 10.1111/dom.13848. Epub 2019 Aug 19.
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.
双糖尿病（DD）一词用于指超重、有 2 型糖尿病家族史和/或存在胰岛素抵抗临床特征的 1 型糖尿病（T1D）患者。有几项证据表明，表现出 DD 特征的个体发生未来糖尿病并发症的风险更高，这与平均血糖控制（以糖化血红蛋白（HbA1c）浓度衡量）无关。鉴于具有 DD 特征的个体的患病率增加，迫切需要制定实用的标准来识别和分层该群体，这将有助于随后实施更有效的个性化干预措施。在这篇综述中，我们讨论了临床识别具有 DD 特征的个体的潜在标准，强调了每种定义的优缺点。我们还涵盖了 DD 的潜在机制以及这些机制如何导致糖尿病并发症风险增加。特别强调估计葡萄糖处置率（eGDR）在 DD 诊断中的作用，该作用可以很容易地纳入临床实践并可预测不良临床结局。除了识别具有 DD 的个体外，eGDR 在监测对不同干预措施的反应方面也具有潜在的应用价值。T1D 比最初设想的更为复杂，具有 DD 特征的个体是并发症风险更高的亚组。DD 患者的诊断实用标准将有助于进行风险分层，允许针对该人群实施更个性化和有针对性的管理策略，以改善结局和生活质量。
