Clinical and metabolic characteristics of children with hybrid diabetes mellitus (HD) compared to children with type 2 diabetes mellitus (T2DM): A preliminary comparative study Hybrid Diabetes in Children

Main Article Content

Vincenzo De Sanctis
Ashraf Soliman
Fawzia Alyafei
Nada Alaaraj
Shayma Ahmed
Ahmed Elawwa
Noor Hamed


Hybrid diabetes (HD), type 2 diabetes mellitus, metabolic syndrome (MetS), follow-up, treatment, children


Background: The term double diabetes or “Hybrid Diabetes (HD)” describes diabetes with combined features of type 1 and type 2 diabetes (T2DM). Patients and Methods: We report the clinical and biochemical characteristics of 7 children with HD and the course of their disease including the response to treatment. The data were compared to 59 children with a diagnosis of T2DM. Variables examined included age, height, weight, body mass index (BMI), triglycerides (Tg), high-density lipoprotein (HDL), and blood pressure. The Weiss criteria were used to diagnose metabolic syndrome (MetS). The atherogenic index of plasma (AIP) was calculated from the standard lipid profile. Four autoantibodies against pancreatic β-cell were measured in all patients. Results: Significant clinical and biochemical differences were detected among children with HD versus T2DM. The mean BMI of children with T2DM was significantly higher than for the HD group. At presentation, the mean C peptide level was significantly lower in HD versus T2DM group and 28% presented with diabetic ketoacidosis (DKA). The percentage of those with full criteria of MetS was significantly higher in T2DM versus HD group as well as the percentage of children with high atherogenic index. After a mean duration of 2.3 months from diagnosis, 4/7 of HD patients stopped insulin therapy and 3 patients had a marked reduction in the insulin requirement. During the follow-up (after 15 ±5 months), 5/7 HD patients required an increase in their insulin dose, one was controlled on a markedly low dose of basal insulin and the last patient did not require any insulin therapy for 40 months. Conclusion: Appropriate assessment of HD is necessary for early and correct diagnosis. Increasing awareness of HD among the general population and primary care practitioners is necessary for successfully and properly treating this complex disease.


Download data is not yet available.
Abstract 564 | PDF Downloads 264


1. Mottalib A, Kasetty M, Mar JY, Elseaidy T, Ashrafzadeh S, Hamdy O. Weight management in patients with Type 1 diabetes and obesity. Cur Diab Rep. 2017; 17:92. doi: 10.1007/s11892-017-0918-8.

2. Knerr I, Wolf J, Reinehr T, et al ; DPV Scientific Initiative of Germany and Austria. The 'accelerator hypothesis': relationship between weight, height, body mass index and age at diagnosis in a large cohort of 9,248 German and Austrian children with type 1 diabetes mellitus. Diabetologia. 2005; 48:2501-4.

3. Wilkin TJ. The accelerator hypothesis: a review of the evidence for insulin resistance as the basis for type I as well as type II diabetes. Int J Obes (Lond).2009; 33:716–26.

4. Merger S R, Kerner W, Stadler M, et al; DPV Initiative; German BMBF Competence Network Diabetes mellitus. Prevalence and comorbidities of double diabetes. Diabetes Res Clin Pract. 2016; 119:48-56.

5. Weiss R, Bremer AA, Lustig RH. What is metabolic syndrome, and why are children getting it? Ann N Y Acad Sci. 2013; 1281:123-40.

6.Mishra B K, Shukla P, Aslam M, Siddiqui AA, Madhu SV. Prevalence of double diabetes in youth onset diabetes patients from east Delhi and neighboring NCR region. Diabetes Metab Syndr. 2018;12: 839–842.

7. Kaufman F. 'Double diabetes' in young people and how to treat it. Diabetes Voice 2006; 51:19-22

8. Pozzilli P, Guglielmi C, Caprio S, Buzzetti R. Obesity, autoimmunity, and double diabetes in youth. Diabetes Care. 2011;34 (Suppl 2): S166-70.

9. Pozzilli P, Guglielmi C. Double Diabetes -A mixture of Type 1 and Type 2 Diabetes in youth. Endocr Dev.2009; 14: 151–66.

10. Khawandanah J. Double or hybrid diabetes: A systematic review on disease prevalence, characteristics and risk factors. Nutr Diabetes. 2019; 9:33. doi: 10.1038/s41387-019-0101-1.

11. Weiss R, Bremer AA, Lustig RH. What is metabolic syndrome, and why are children getting it? Ann N Y Acad Sci. 2013; 1281:123-140.

12. Sørgjerd EP. Type 1 Diabetes-related Autoantibodies in Different Forms of Diabetes. Curr Diabetes Rev. 2019; 15:199-204.

13. Purushothaman R, Ramchandani N, Kazachkova I, Ten S. Prevalence and clinical features of type 1.5 diabetes mellitus in children. J Pediatr Endocrinol Metab. 2007; 20:981-7.

14. Atkinson MA, Eisenbarth GS, Michels AW. Type 1 diabetes. Lancet. Elsevier Ltd; 2014;383: 69-82.

15. Braham R, Alzaid A, Robert AA, et al. Double diabetes in Saudi Arabia: A new entity or an underestimated condition. World J Diabetes. 2016; 7:621-6.

16. Weng J, Li Y, Xu W, et al. Effect of intensive insulin therapy on beta-cell function and glycaemic control in patients with newly diagnosed type 2 diabetes: a multicentre randomised parallel-group trial. Lancet. 2008; 371:1753–60.

17. Larsen CM, Faulenbach M, Vaag A, et al. Interleukin-1-receptor antagonist in type 2 diabetes mellitus. N Engl J Med. 2007; 356:1517–26

18. Bunck MC, Diamant M, Cornér A, et al. One-year treatment with exenatide improves beta-cell function, compared with insulin glargine, in metformin-treated type 2 diabetic patients: a randomized, controlled trial. Diabetes Care 2009; 32:762–8.

19.Törn C, Landin-Olsson M, Lernmark A, et al. Prognostic factors for the course of beta cell function in autoimmune diabetes. J Clin Endocrinol Metab. 2000; 85:4619-23.

20. Kietsiriroje N, Pearson S, Campbell M, Ariëns RAS, Ajjan RA. Double diabetes: A distinct high-risk group? Diabetes Obes Metab. 2019; 21:2609-2618.

21. Khawandanah J. Double or hybrid diabetes: A systematic review on disease prevalence, characteristics, and risk factors. Nutr. Diabetes. 2019;9(1):33. doi: 10.1038/s41387-019-0101-1.

22. Bo MS, Cheah WL, Lwin S, Moe Nwe T, Win TT, Aung M. Understanding the Relationship between Atherogenic Index of Plasma and Cardiovascular Disease Risk Factors among Staff of an University in Malaysia. J Nutr Metab. 2018; 2018:7027624. doi: 10.1155/ 2018/7027624.

Most read articles by the same author(s)

1 2 3 4 5 6 7 8 9 10 > >>