Even though, as described above, type 1 and type 2 diabetes represent two different disease entities, the clinical and etiological distinction between them is becoming more difficult as there is increasing evidence of a significant overlap between the two disease states. Clinical studies have reported that even within the same family both type 1 and type 2 diabetes may co-occur and patients with such double genetic predisposition have intermediate phenotype (259). As an example of common genetic predisposition, a variable number of tandem repeats polymorphism in the insulin gene promoter region has been associated with both type 1 and type 2 diabetes (259).
The "accelerator hypothesis" suggests that both type 1 and type 2 diabetes are the same disorder of insulin resistance set against different genetic background (260). According to this hypothesis, type 1 and type 2 diabetes are one and the same entity, distinguished only by the rate of P cell loss. Instead of overlap between the two types of diabetes, the hypothesis envisages overlay between the two types, with one disease representing a subset of the other.
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