RESUMO
Double diabetes (DD) refers to patients with type 1 diabetes who have developed insulin resistance. The objective of this review is to update relevant information on the prescription of physical activity, pharmacological adjustments and consumption of carbohydrates in DD. A systematic search for scientific articles was carried out in the following databases: PubMed, Cochrane, EBSCO, WoS, ScienceDirect and Medline. The evidence analyzed shows that both physical activity (PA) and physical exercise (PE) are essential to achieve metabolic control in people with DD. Physiological considerations such as: insulin adjustments, insulin injection sites, time to perform PA and PE, absolute and relative contraindications are essential to avoid complications, especially hypoglycemia.
RESUMO
BACKGROUND: Double diabetes (DD) describes both individuals with obesity upon diagnosis of type 1 diabetes and those who have gained weight during follow-up, although cardiovascular risk factors (CVRF) are not well understood in this group. We aim to evaluate the frequency of DD in a real-world type 1 diabetes sample and the interaction of insulin treatment with CVRF. METHODS: Multicentre cross-sectional study of 2711 individuals with clinical diagnosis of type 1 diabetes from secondary diabetes centres in 20 Brazilian cities. RESULTS: Patients with diabetes duration <5 and ≥5 years had similar frequency of overweight (20.4 vs. 25 %) and obesity, (9.8 vs. 6.1 %), p 0.28 for trend. Insulin dose (U/kg/day) was lower in obese individuals compared to normal BMI, with mean (95 % CI) 0.72 (0.62-0.83) vs. 0.88 (0.84-0.92) U/kg/day for diabetes duration <5 years and 0.84 (0.77-0.92) vs. 0.99 (0.97-1.01) U/kg/day for duration ≥5 years. Obese individuals had lower HDL (47.5 vs. 54.4 mg/dL) and higher non-HDL-cholesterol (134.5 vs. 115.2 mg/dL) than lean ones only among those with more than 5 years of diabetes. CONCLUSIONS: Lower insulin doses in obese individuals point to a role of clinical heterogeneity in insulin deficiency rather than normal progression of type 1 diabetes. Early obesity in type 1 diabetes is associated to lower HDL-cholesterol and higher number of CVRF. These data suggest a broad landscape of pathophysiological phenomena in double diabetes, rather than simple progression of a homogeneous clinical entity.
RESUMO
Durante las últimas décadas, el aporte de la epidemiología a través de la estandarización de los métodos y las definiciones y la colaboración internacional ha permitido una mejor estimación de la incidencia y prevalencia de la diabetes mellitus (DM) en la infancia y la adolescencia, así como la detección de probables factores de riesgo para los distintos tipos de la enfermedad, lo que orientaría al desarrollo de medidas preventivas y terapéuticas y la mayor comprensión de la magnitud del problema. Se ha observado un aumento global y amplias diferencias entre distintas regiones en la incidencia de la diabetes tipo 1 (DM1), al igual que un incremento en la frecuencia de la diabetes tipo 2 (DM2) en ciertas etnias asociado a un aumento de la obesidad. Se ha descripto la existencia de la llamada DM "doble" o "híbrida", caracterizada por la asociación de un fenotipo de DM2 (obesidad, acantosis nigricans) con manifestaciones de autoinmunidad anti células beta.
During the last decades, the contribution of epidemiology through the standardization of methods and definitions and international collaboration allowed a better estimation of the incidence and prevalence of DM in children and adolescents, as well as the detection of likely risk factors for the different types of the disease, which would allow the development of preventive and therapeutic measures and a better understanding of the magnitude of the problem. A global increase and wide differences in the incidence of type 1 diabetes have been observed among regions, as well as an increase in the frequency of type 2 diabetes in some ethnic groups, associated to a growing prevalence of obesity. The existence of what has been named "double" or "hybrid" DM has also been described, characterized by a phenotype of DM2 (obesity and acantosis nigricans) associated with manifestations of autoimmunity.