Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Dec 15, 2016; 7(20): 621-626
Published online Dec 15, 2016. doi: 10.4239/wjd.v7.i20.621
Double diabetes in Saudi Arabia: A new entity or an underestimated condition
Rim Braham, Aus Alzaid, Asirvatham Alwin Robert, Muhammad Mujammami, Rania Ahmad Ahmad, Monther Zitouni, Samia Hasan Sobki, Mohamed Abdulaziz Al Dawish
Rim Braham, Aus Alzaid, Asirvatham Alwin Robert, Rania Ahmad Ahmad, Mohamed Abdulaziz Al Dawish, Department of Endocrinology and Diabetes, Prince Sultan Military Medical City, Riyadh 11159, Saudi Arabia
Muhammad Mujammami, Endocrinology and Diabetes Unit, Department of Medicine, King Khalid University Hospital, King Saud University, Riyadh 11461, Saudi Arabia
Monther Zitouni, Samia Hasan Sobki, Department of Pathology, Prince Sultan Military Medical City, Riyadh 11159, Saudi Arabia
Author contributions: All authors contributed to this work.
Institutional review board statement: The study protocol was approved by the Research and Ethics committee of Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
Informed consent statement: During the informed consent process, study participants are assured that data collected will be used only for stated purposes and will not be disclosed or released to others without the consent of the participants.
Conflict-of-interest statement: Authors have no conflict of interests and the work was not supported or funded by any drug company.
Data sharing statement: No data sharing as this manuscript and the data were not published elsewhere.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dr. Rim Braham, Department of Endocrinology and Diabetes, Prince Sultan Military Medical City, P.O. Box 7897, Riyadh 11159, Saudi Arabia. braham_rim@yahoo.fr
Telephone: +966-1-4777714-43116
Received: June 2, 2016
Peer-review started: June 6, 2016
First decision: July 5, 2016
Revised: September 15, 2016
Accepted: October 17, 2016
Article in press: October 18, 2016
Published online: December 15, 2016
Processing time: 189 Days and 12.7 Hours
Abstract
AIM

To determine the clinical and biological characteristics of double diabetes (DD) among young people in Saudi Arabia.

METHODS

This was a retrospective descriptive chart review study including 312 young newly diagnosed diabetic patients (aged 12-20 years), whom were admitted over a five year period (January 2009 to December 2013). Family history of diabetes mellitus (DM) (first degree), physical body mass index (BMI), acanthosis nigricans, history of auto-immune disease and laboratory information for glycosylated hemoglobin, basal C peptide level and diabetes autoantibody response (anti-GAD, anti-IA2 and anti-ICA) were collected from medical report. A mean follow-up of 3 years for these patients was performed.

RESULTS

Patients were categorized into 4 groups, based on the autoantibody response (Ab+ or Ab-) and C-peptide secretion (β+ for fasting level 0.4-2.1 ng/mL and β- if < 0.4 ng/mL). Group1 (type 1a): Ab+ β- (21%), group 2 (type 1b): Ab- β- (9%), group 3 (DD): Ab+ β+ (31%) and group 4 (classic type 2 DM): Ab- β+ (39%). The mean age of the DD patients in our study was 15.1 ± 6.4 years. A total of 41% of the study population presented with diabetic ketoacidosis and 61% of the study population presented with positive family history of DM. The mean BMI was 26.8 kg/m2 with 64% of overweight or obese patients. Ninety two percent of the patients were started on insulin at the time of diagnosis. During a mean follow-up of 3 years, only 32% of the patients with DD required insulin and 78% were on metformin alone or with insulin.

CONCLUSION

Our findings enable us to arrive at the conclusion that almost one-third of the young Saudi diabetic patients reveal atypical forms of DM (double diabetes) expressing features resulting from both T1D and T2D.

Keywords: Double diabetes; Therapeutic approaches; Hybrid diabetes; Autoantibody response; Saudi Arabia

Core tip: Almost one-third of the young Saudi diabetic patients reveal atypical forms of double diabetes (DD) expressing features resulting from both type 1 diabetes and type 2 diabetes. Therefore, identification of DD patients becomes important as this will give direction for the selection of the most apt diagnostic and therapeutic lines of treatment.