title: Double-diabetes in a real-world sample of 2711 individuals: associated with insulin treatment or part of the heterogeneity of type 1 diabetes?
abstract: 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.
authors.affiliation: Departamento de Ciências da Vida, Universidade do Estado da Bahia (UNEB), Rua Silveira Martins, 2555, Cabula, Salvador, Bahia CEP: 41.150-000 Brazil ; Centro de Diabetes e Endocrinologia do Estado da Bahia (CEDEBA), Salvador, Brazil.
authors.forename: Fernando M A
authors.identifier: 0000-0002-5566-8070
authors.initials: FM
authors.lastname: Giuffrida
authors.affiliation: Centro de Diabetes e Endocrinologia do Estado da Bahia (CEDEBA), Salvador, Brazil.
authors.forename: Caroline
authors.initials: C
authors.lastname: Bulcão
authors.affiliation: Universidade Estadual do Rio de Janeiro, Rio De Janeiro, Brazil.
authors.forename: Roberta A
authors.initials: RA
authors.lastname: Cobas
authors.affiliation: Associação de Diabéticos de Bauru, Bauru, Brazil.
authors.forename: Carlos Antonio
authors.initials: CA
authors.lastname: Negrato
authors.affiliation: Universidade Estadual do Rio de Janeiro, Rio De Janeiro, Brazil.
authors.forename: Marilia B
authors.initials: MB
authors.lastname: Gomes
authors.affiliation: Centro de Diabetes, Universidade Federal de São Paulo, São Paulo, Brazil.
authors.forename: Sergio Atala
authors.initials: SA
authors.lastname: Dib
keywords: Cardiovascular risk factors; Double diabetes; Type 1 diabetes