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Type I diabetes (TID) is a heterogeneous disorder characterized by destruction of pancreatic beta cells, culminating in loss of insulin secretion. Data from large epidemiologic studies worldwide indicate that during the last decades the incidence of TID has increased significantly, reaching percentages of 2-5% annually. This increase suggests that there is a significant environmental contribution impacting the development of the disease, since genetic factors alone can hardly explain the rapid increase. Studies regarding TID epidemiology in diverse populations aim to identify the disease causal factors and new targets for intervention. Viruses are one of the environmental factors implicated in the development of TID in susceptible individuals. Recent studies suggest an association of TID with HINI influenza. We would like to comment on this association and report our experience. Prospective studies are necessary to assess whether HINI infection is involved in TID pathogenesis and provide directions on how to deal with viral infections in diabetes-susceptible individuals. HINI virus seems in some way to be involved in the pathogenesis of TID. The complex interaction between genetic and environmental factors leading to TID is not elucidated and studies regarding TID epidemiology in diverse populations are aimed at identifying causal factors of the disease. Various risk factors for development of TID such as age, sex, race, genotype and geographic location must be considered (2). A seasonal pattern in the onset of TID, with increased cases during late autumn, winter, and early spring, has been noted and ascribed to the seasonal variation in infections implicated in TID precipitation (3, 4). Many different types of virus, including rubella virus, cytomegalovirus, mumps virus and enterovirus have been implicated in the development of TID through their interaction with the innate immune system and/or by indirect

SUMMARYThe management of insulin therapy in diabetic patients who have comorbidities that involve nutritional aspects, is a major challenge for diabetes care teams. In diabetic patients with compromised nutritional status, artificial nutrition, both enteral or parenteral, may help in the treatment of chronic and acute diseases, leading to better and faster recover of the health status but, if not adequately associated with insulin therapy, it may negatively affect blood glucose levels and lead to poorer metabolic control. In particular, evidence-based recommendations for the treatment of diabetic patients during enteral nutrition therapy are not currently available and, therefore, medical practices are often based on case reports, rather than outcomes of research. We report our experience with a diabetic patient receiving nocturnal enteral feeding due to comorbidities and malnutrition, who was followed up at our centre and precociously treated with continuous subcutaneous insulin infusion after the onset of type 1 diabetes. There is great need for adequately powered randomized controlled trials to provide scientific evidence for the insulin treatment of diabetic patients undergoing enteral feeding. Arq Bras Endocrinol Metab. 2013;57(5):388-92 SUMÁRIO O manejo da terapia com insulina em pacientes diabéticos que têm comorbidades que envolvam aspectos nutricionais é um grande desafio para os especialistas em diabetes. Em pacientes diabéticos com estado nutricional comprometido, a nutrição artificial, tanto enteral quanto parenteral, pode ajudar no tratamento de doenças crônicas e agudas, levando à recuperação melhor e mais rápida do estado de saúde. Entretanto, se não adequadamente associada à terapia com insulina, a nutrição artificial pode afetar negativamente os níveis de glucose e levar a um pior controle glicêmico. Particularmente, não há recomendações baseadas em evidências para o tratamento de pacientes diabéticos durante a terapia nutricional enteral e, portanto, as práticas médicas são geralmente baseadas em relatos de caso, em vez de desfechos de estudos. Relatamos nossa experiência com uma paciente diabética que recebeu nutrição enteral noturna em função de comorbidades e desnutrição, acompanhada no nosso centro e tratada precocemente com infusão subcutânea contínua de insulina depois do estabelecimento do diabetes tipo 1. Existe grande necessidade de estudos randomizados controlados para se obter evidências científicas sobre o tratamento insulínico de pacientes diabéticos que sejam submetidos à nutrição enteral. Arq Bras Endocrinol Metab. 2013;57(5):388-92