As the world population eats more crap and exercises less, the numbers of people afflicted with diabetes rises to match it: There were approximately 171 million diabetics in 2000, and researchers estimate 366 million people will have it by 2030. Diabetes diagnoses traditionally get split into type 1, which requires insulin injections to treat, and type 2, which can be managed with diet and exercise. But an article in NewScientist covers a disturbing trend in which newly diagnosed diabetics exhibit symptoms of both type 1 and type 2 diabetics.
More and more children exhibit some symptoms of both types, which some researchers informally call "type 1.5.," while increasing numbers of adults are developing full-blown symptoms of both — a condition known as "double diabetes." These diagnoses present new treatment challenges for physicians and call the very classification of the disease into question.
Some argue that the traditional type 1 and type 2 classifications are completely artificial, and that diabetes is instead a spectrum disorder that operates and displays symptoms on more of a sliding scale. Most people with mixed symptoms begin with type 1 and then develop symptoms of type 2. Double diabetes is significantly more difficult to treat and manage and presents major health risks later in life.
"There are going to be complications associated with both type 1 and type 2," says Paolo Pozzilli, a diabetes specialist at Queen Mary, University of London. This means damage to the small blood vessels in the retina and kidney, which is typical of type 1, plus the cardiovascular disease and raised blood lipids typical of type 2.
Many skeptics cling to the old-school definitions of diabetes, but increasing incidences of intertwined symptoms mean doctors will have to tailor-make their treatment plans for individual diabetes sufferer, which makes for customized plans and improved chances for success.
Rather than shoehorning people into one category or the other, doctors are increasingly prepared to treat them as individuals, says Gale. "There is a growing awareness that patients should be assessed as accurately as possible and treated in the light of their capacity to secrete insulin and their level of resistance to its action," he says. The cloud of double diabetes, it seems, could have a silver lining after all.
Diabetes: One disease or two? (NewScientist, subscription required)
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