"Double Diabetes" a New Phenomenon

I was reading through some of my old emails today and I came across an article talking about a new phenomenon that is appearing in today's youth, where children have both symptoms of type I and II diabetes. Type 1 diabetes (T1D) is characterized as an autoimmune disease were the body's immune system begins destroying beta cells in the pancreas needed produce the insulin. Type 2 diabetes (T2D) involves the cells of the body become resistant to the insulin the pancreas is making, thus the pancreas increases the output of insulin to compensate for the resistant. Over time the pancreas can not keep up the rapid production and burns itself out. Factors such as lack of exercise, too much body fat, and poor diet increase the risk of developing T2D.

In this new form of diabetes called hybrid diabetes (11) or double diabetes (DD), overweight children with T1D are developing resistance to the insulin they are taking or T2D patients are developing an autoimmunity to beta cells. Petraikina et al. provides a good review over the world-wide progressing of overweight/obesity epidemic and the increasing cases of T1D/T2D. The article shows an increase in the number of obesity cases in Moscow raising from 6.24 per 1000 in 1996 to 10.3 per 1000 in 2005. Similar trends are seen in other European countries as the number of cases have increased dramatically in only the span of ten years. T1D and T2D cases are also raising at an alarming speed. The highest incidence rate of T1D occurring in Finland (40.9 per 100,000) with a majority of European countries experiencing a constant increase in the number of cases. Thailand, reported that 5% of children who were referred to a diabetes clinic were affected by T2D in 1996. By 1999, this percentage had risen to 17%. The article claims that these sudden increase can not be accounted for by genetic variance but is in fact more likely due to the environment interactions. 

The more interesting piece of the article is when they discuss DD and possible pathology. One of the theories is that an increased BMI in patients who might also be at risk for T1D can cause an imbalance of Th1/Th2 lymphocyte and a reduction of T-cell regulatory functions. The major contributor of down regulation is attributed to leptin, which is directly correlated to total body fat. Leptin is negatively correlated with the frequency of regulatory T cells in peripheral blood, and has been shown to promote early inflammation of the pancreatic islets with an increased production of interferon gamma in NOD (non-obese diabetic) mice. Leptin levels can also be increased as macrophages infiltrate the adipose tissue they can secrete cytokines such as tumor necrosis factor alpha (TNF-a) and interleukin 1 (IL-1) beta which cause the adipocytes to produce leptin. Due to youths with DD having both the symptoms of T1D and T2D it is theorized that they could be at a high risk of complications associated with both types of diabetes. Treatment options for DD might better be focused on the intervention capable of interfering with some of the mechanisms involved in the disease process due to the DD be-cell functions seems to decline slower than in classical T1D. Unfortunately, there is limited information about the effectiveness of any treatment approach on pediatric patients and most standard treatments are based off of adult treatments.

 Elena Petraikina, et al. "Double Or Hybrid Diabetes Associated With An Increase In Type 1 And Type 2 Diabetes In Children And Youths." Pediatric Diabetes 8.(2007): 88-95. Academic Search Complete. Web. 2 May 2013.