I’ve argued for some time that, from the patient’s perspective, having type 1 diabetes is one of the most demanding long-term conditions. For many patients, their mantra may be “Forget empowerment – why can’t my doctor sort out my diabetes?”.
Well, imagine you have type 1 diabetes and find out that your gene pool is even worse than you thought! Your grandparents (and maybe even a parent) are apple shaped and have type 2 diabetes. You wake up one morning, leap out of bed and step nimbly on to the bathroom scales only to find that your belly is obscuring the view. This, and any other associated feature of the metabolic syndrome, puts you at a much higher risk of macrovascular disease than the person with type 1 diabetes with a normal BMI (or waist circumference).
The paper by Merger and colleagues (summarised alongside) highlights the growing coexistence of the two most common types of diabetes and the impact this has on complication prevalence. Metabolic syndrome in type 1 diabetes is associated with increased prevalence of macro- and microvascular complications, even in those with good glycaemic control. People with “double diabetes” are a special risk population and lifestyle modifications, such as physical exercise, healthy diet and weight reduction, are essential therapeutic strategies in order to improve quality of life and survival.
This often overlooked association deserves more attention, with a particular focus on vascular risk modification. We are likely to see many more people with double diabetes over the next decade or so.
To read the article summaries, please download the PDF
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