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Double Diabetes: An Independent Risk Factor for Macrovascular and Microvascular Complications

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Double Diabetes: An Independent Risk Factor for Macrovascular and Microvascular Complications

  • Posted: 26 Nov 2015
According to the findings of a study published ahead of print in Diabetes Research and Clinical Practice, around one-fourth of type-1 diabetes mellitus (T1DM) patients have co-existing metabolic syndrome (double diabetes). Furthermore, MS also seems to be an independent predictor of macrovascular and microvascular comorbidities in such subjects. Identification and appropriate treatment of such high-risk subjects is therefore crucial to prevent the development of MS in them. Long-term studies are however warranted to determine the effect of insulin resistance on patients with autoimmune diabetes, the researchers added.

Growing evidence suggests that the proportion of T1DM patients with features of MS known as “double diabetes” is increasing. However, there is lack of epidemiologic data on the prevalence of MS in T1DM subjects and its comorbidities. This cross-sectional analysis was therefore initiated to get a better estimate of the prevalence of MS in T1DM, and to assess its association with comorbidities.

Data of 31119 subjects with autoimmune diabetes mellitus (age ≥18 years) was analyzed for signs of MS and presence of late complications. Metabolic syndrome was defined as per the NCEP (National Cholesterol Education Program). Subjects with coexisting T1DM and MS (presence of obesity, hypertension, and dyslipidemia) were considered as having double diabetes. Associations between double diabetes and late complications were assessed using multiple linear or logistic regression analyses.

A quarter of the study population (25.5%; n=7926) presented with double diabetes. Subjects with double diabetes had a longer diabetes duration and a worse metabolic control, as measured by glycosylated hemoglobin (; mean HbA1c = 8.5 vs. 8%, p < 0.0001) vs. subjects with T1DM alone, when adjusted for age, sex and diabetes duration. Importantly, subjects with double diabetes had significantly more macrovascular comorbidities (coronary heart disease 8.0 vs. 3.0% w/o MS, stroke 3.6 vs. 1.6%, diabetic foot syndrome 5.5% vs. 2.1%). Similarly, a greater proportion of double diabetes subjects had microvascular diseases (retinopathy 32.4%vs. 21.7%, nephropathy 28.3% vs. 17.8%). Although the incidence of microvascular complications seemed to be dependent on the metabolic control (subjects with good metabolic control had lower rates of microvascular complications), the incidence of macrovascular complications was independent of glucose control.

The higher incidence of MS in T1DM subjects can perhaps be attributed to the drastic lifestyle changes that have occurred over a decade. As a result, lifestyle modification (physical exercise, healthy diet and weight reduction) may have a pivotal role even in the treatment strategies of T1DM subjects.

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