Abstract
The growing proportion of type 1 diabetes mellitus (T1DM) patients with clinical features
of insulin resistance (IR) has led to the description of a distinctive T1DM subgroup,
still unrecognised by current guidelines, called double diabetes, assumingly associated
with poorer metabolic phenotype and increased risk of micro- and macrovascular complications.
The main goal of identifying double diabetes, estimated to be present in up to half
of T1DM patients, is timely implementation of appropriate therapeutic interventions
to reduce the increased risk of chronic complications and other adverse metabolic
traits associated with this condition. Proposed diagnostic criteria are largely divided
into three different groups: family history of type 2 diabetes mellitus (T2DM), obesity/metabolic
syndrome, and IR. Estimated glucose disposal rate may prove the most reliable marker
of double diabetes. In addition to general measures (diet, physical activity, antihypertensive,
and lipid-lowering medications, etc.) and development of new insulin preparations
with more hepatic action, double diabetes patients may derive more benefit from agents
developed for T2DM. Indeed, such potentially promising agents include glucagon-like
peptide-1 receptor agonists, sodium-glucose contrasporter-2 inhibitors, and their
combination. We are now awaiting long-term trials assessing metabolic and vascular
benefits of these medications in double diabetes.
Key words adjunctive therapy - cardiovascular risk - double diabetes - insulin resistance -
metabolic syndrome - type 1 diabetes mellitus.
