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Type 1 diabetes, metabolic syndrome and cardiovascular risk

Juan J Chillarón1, Juana A Flores Le-Roux1, David Benaiges1

  • 1Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona; Institut Municipal d´Investigacions Mèdiques; Departament de Medicina, Universitat Autònoma de Barcelona.

Metabolism: Clinical and Experimental
|November 27, 2013
PubMed

Insights

Intensive glycemic control in type 1 diabetes mellitus (T1DM) reduced microangiopathy but increased obesity and metabolic syndrome. New strategies are needed to manage these associated conditions for better cardiovascular outcomes in T1DM patients.

Area of Science:

  • Endocrinology
  • Metabolic Diseases
  • Diabetes Management

Background:

  • Type 1 diabetes mellitus (T1DM) historically presented with low BMI and microangiopathy.
  • Intensive glycemic control, established by the Diabetes Control and Complications Trial, reduced microangiopathy but led to increased weight gain and hypoglycemia.
  • Currently, a significant proportion of T1DM patients are overweight or obese and exhibit features of metabolic syndrome.

Purpose of the Study:

  • To address the rising prevalence of obesity and metabolic syndrome in T1DM.
  • To investigate the link between metabolic syndrome components, insulin resistance, and chronic T1DM complications.
  • To highlight the need for novel therapeutic approaches beyond glycemic control in T1DM.

Main Methods:

  • Review of historical T1DM patient profiles and complications.
  • Analysis of the impact of intensive insulin therapy on glycemic control, weight, and hypoglycemia.
  • Examination of current T1DM population data regarding obesity and metabolic syndrome prevalence.

Main Results:

  • Intensive glycemic control in T1DM has paradoxically increased the incidence of overweight/obesity and metabolic syndrome.
  • Metabolic syndrome and insulin resistance are associated with increased chronic complications and cardiovascular disease in T1DM.
  • Cardiovascular disease is now the primary cause of mortality in T1DM patients.

Conclusions:

  • Current T1DM management strategies require re-evaluation to incorporate metabolic syndrome management.
  • Therapeutic approaches must target both glycemia and associated metabolic traits to reduce cardiovascular risk.
  • New treatment paradigms are essential for improving long-term outcomes in type 1 diabetes mellitus.

Keywords:
ADAAmerican Diabetes AssociationApoCardiovascular riskChronic complicationsDCCTDiabetes Control and Complications TrialEASDEDICEpidemiology of Diabetes Interventions and Complications trialEuropean Association for the Study of DiabetesHDLHOMA-IRLDLMetabolic syndromeT1DMT2DMType 1 diabetesapolipoproteineGDRestimated glucose disposal ratehigh-density lipoproteinshomeostasis model assessment-insulin resistancelow-density lipoproteinstype 1 diabetes mellitustype 2 diabetes mellitus

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