Type 1 Diabetes, Metabolic Syndrome and Cardiovascular Risk

Metabolism. 2014 Feb;63(2):181-7. doi: 10.1016/j.metabol.2013.10.002. Epub 2013 Oct 24.

Abstract

Patients with type 1 diabetes mellitus (T1DM) traditionally had a low body mass index and microangiopathic complications were common, while macroangiopathy and the metabolic syndrome were exceptional. The Diabetes Control and Complications Trial, published in 1993, demonstrated that therapy aimed at maintaining HbA1c levels as close to normal as feasible reduced the incidence of microangiopathy. Since then, the use of intensive insulin therapy to optimize metabolic control became generalized. Improved glycemic control resulted in a lower incidence of microangiopathy; however, its side effects included a higher rate of severe hypoglycemia and increased weight gain. Approximately 50% of patients with T1DM are currently obese or overweight, and between 8% and 40% meet the metabolic syndrome criteria. The components of the metabolic syndrome and insulin resistance have been linked to chronic T1DM complications, and cardiovascular disease is now the leading cause of death in these patients. Therefore, new therapeutic strategies are required in T1DM subjects, not only to intensively lower glycemia, but to control all associated metabolic syndrome traits.

Keywords: ADA; American Diabetes Association; Apo; Cardiovascular risk; Chronic complications; DCCT; Diabetes Control and Complications Trial; EASD; EDIC; Epidemiology of Diabetes Interventions and Complications trial; European Association for the Study of Diabetes; HDL; HOMA-IR; LDL; Metabolic syndrome; T1DM; T2DM; Type 1 diabetes; apolipoprotein; eGDR; estimated glucose disposal rate; high-density lipoproteins; homeostasis model assessment-insulin resistance; low-density lipoproteins; type 1 diabetes mellitus; type 2 diabetes mellitus.

Publication types

  • Review

MeSH terms

  • Biomarkers / blood
  • Blood Glucose / metabolism
  • Cardiovascular Diseases / blood
  • Cardiovascular Diseases / epidemiology*
  • Cardiovascular Diseases / etiology
  • Cardiovascular Diseases / prevention & control*
  • Diabetes Complications / blood
  • Diabetes Complications / epidemiology*
  • Diabetes Complications / prevention & control*
  • Diabetes Mellitus, Type 1 / complications*
  • Diabetes Mellitus, Type 1 / drug therapy
  • Glycated Hemoglobin A / metabolism
  • Humans
  • Hypoglycemia / chemically induced
  • Hypoglycemia / prevention & control
  • Hypoglycemic Agents / administration & dosage*
  • Hypoglycemic Agents / adverse effects
  • Insulin / administration & dosage*
  • Insulin / adverse effects
  • Insulin Resistance
  • Metabolic Syndrome / complications*
  • Obesity / etiology
  • Risk Assessment
  • Risk Factors
  • Weight Gain

Substances

  • Biomarkers
  • Blood Glucose
  • Glycated Hemoglobin A
  • Hypoglycemic Agents
  • Insulin
  • hemoglobin A1c protein, human