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.

中文翻译：

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双重糖尿病：一个需要解决的日益严重的问题

越来越多的具有胰岛素抵抗 (IR) 临床特征的 1 型糖尿病 (T1DM) 患者导致描述了一个独特的 T1DM 亚组，目前的指南仍未识别，称为双重糖尿病，假设与较差的代谢表型和增加微血管和大血管并发症的风险。估计多达一半的 T1DM 患者存在双重糖尿病，其主要目标是及时实施适当的治疗干预措施，以降低与这种情况相关的慢性并发症和其他不良代谢特征的风险增加。提出的诊断标准主要分为三组：2 型糖尿病 (T2DM) 家族史、肥胖/代谢综合征和 IR。估计的葡萄糖处理率可能证明是双重糖尿病最可靠的标志物。除了一般措施（饮食、体力活动、抗高血压和降脂药物等）和开发具有更多肝脏作用的新胰岛素制剂外，双重糖尿病患者可能会从为 T2DM 开发的药物中获得更多益处。事实上，这些潜在的有前景的药物包括胰高血糖素样肽 1 受体激动剂、钠-葡萄糖 contrasporter-2 抑制剂，以及它们的组合。我们现在正在等待评估这些药物在双重糖尿病中的代谢和血管益处的长期试验。双重糖尿病患者可能会从为 T2DM 开发的药物中获得更多益处。事实上，这些潜在的有前景的药物包括胰高血糖素样肽 1 受体激动剂、钠-葡萄糖 contrasporter-2 抑制剂，以及它们的组合。我们现在正在等待评估这些药物在双重糖尿病中的代谢和血管益处的长期试验。双重糖尿病患者可能会从为 T2DM 开发的药物中获得更多益处。事实上，这些潜在的有前景的药物包括胰高血糖素样肽 1 受体激动剂、钠-葡萄糖 contrasporter-2 抑制剂，以及它们的组合。我们现在正在等待评估这些药物在双重糖尿病中的代谢和血管益处的长期试验。