Cardiovascular Risk Factors Characteristic for the Metabolic Syndrome in Adult Patients with Type 1 Diabetes

Left Ventricular Structure, Tissue Composition, and Aortic Distensibility in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Intervention and Complications

Alterations in myocardial structure, function, tissue composition (e.g., fibrosis) may be associated with metabolic syndrome (MetS). This study aimed to determine the relation of MetS and its individual components to markers of cardiovascular disease in patients with type 1 Diabetes Mellitus (T1DM). A total of 978 subjects of the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications T1DM cohort (age: 49 ± 7 years, 47% female, DM duration 28 ± 5 years) underwent cardiovascular magnetic resonance. In a subset of 200 patients, myocardial tissue composition was measured with cardiovascular magnetic resonance T1 mapping after contrast administration. MetS was defined as T1DM plus 2 other abnormalities based on the American Heart Association/National Cholesterol Education Program criteria. MetS was present in 34.1% of subjects. After adjustment for age, height, scanner, study cohort, gender, smoking, mean glycated hemoglobin levels, history of macroalbuminuria and end-stage renal disease, left ventricle mass was greater by 12.3 g, end-diastolic volume was higher by 5.4 ml, and mass to end-diastolic volume ratio was higher by 5% in patients with MetS versus those without MetS (p <0.001 for all). Myocardial T1 times were lower by 29 ms in patients with MetS than those without (p <0.001). Elevated waist circumference showed the strongest associations with left ventricle mass (+10.1 g), end-diastolic volume (+6.7 ml), and lower myocardial T1 times (+31 ms) in patients with MetS compared with those without (p <0.01). In conclusion, in a large cohort of patients with T1DM, 34.1% of subjects met MetS criteria. MetS was associated with adverse myocardial structural remodeling and change in myocardial tissue composition.

Global prevalence of metabolic syndrome among patients with type I diabetes mellitus: a systematic review and meta-analysis

BACKGROUND

The presence of metabolic syndrome among diabetes patients is frequent and is associated with an increased incidence of chronic complications and mortality. Despite several studies have been conducted, there is no overall estimation on the prevalence of metabolic syndrome among type 1 diabetic patients. Therefore, this study aimed to estimate the pooled prevalence of metabolic syndrome among patients with type 1 diabetes mellitus.

METHODS

Medline via PubMed, CINAHL, ScienceDirect, Ovid, Google Scholar, ResearchGate and African Journals Online were searched by limiting publication period from January 2005 to October 2020. Data were extracted with a standardized format prepared in Microsoft Excel and exported to Stata 16.0 for analyses. The I² statistic was used to check heterogeneity across the included studies. DerSimonian and Laird random-effects model was applied to estimate pooled prevalence and 95% confidence interval across studies. Funnel plot symmetry, Begg's test and Egger's regression test were used to determine the presence of publication bias. Subgroup and sensitivity analysis as well as meta-regression were conducted to explore the potential sources of heterogeneity. The study protocol is registered on PROSPERO with reference number: CRD42020213435.

RESULTS

In this meta-analysis, a total of 27 studies with 45,811 study participants were included. The pooled prevalence of metabolic syndrome was 23.7% with substantial heterogeneity (I² = 98.2%; P < 0.001). Geographical-based subgroup analysis revealed that the highest prevalence was observed in Australia (27.3%). As per meta-analysis of 17 studies, the pooled prevalence of metabolic syndrome in female type 1 diabetes patients (25.9%) was slightly higher than male T1DM patients (22.5%).

CONCLUSION

Nearly a quarter of the type 1 diabetes mellitus patients were affected by metabolic syndrome. Therefore, more attention should be paid to the prevention and control of the epidemic and for the reduction of the morbidity and mortality associated with metabolic syndrome among type 1 diabetes mellitus patients.

Relação entre o perfil antropométrico e bioquímico em crianças e adolescentes com diabetes melito tipo 1

OBJETIVO: Avaliar a relação entre o perfil antropométrico e bioquímico de crianças e adolescentes com diabetes melito tipo 1 (DM1). MÉTODOS: Estudo transversal com 11 crianças e 43 adolescentes com DM1. Coletaram-se dados socioeconômicos e demográficos (idade, sexo, escolaridade, renda), clínicos (insulinoterapia), antropométricos (peso, estatura, dobras cutâneas, circunferência da cintura - CC) e bioquímicos (hemoglobina glicada - HbA, glicemias casual - GLC, pós-prandial - GLPP, e perfil lipídico). Foram utilizados o teste t de Student (p<0,05) e a correlação de Pearson (p<0,05). RESULTADOS: A renda média per capita foi de 0,58±0,39 salário-mínimo e predominou o esquema de três aplicações de insulina/dia em 72,2% da amostra. A maioria apresentou estatura (92,6%) e IMC (87%) adequados para a idade. Aqueles com índice da HbA (inHbA) adequado apresentaram menores GLC (p=0,002) e GLPP (p<0,001). O inHbA correlacionou-se positivamente com CC (p=0,013), GLC (p=0,014), GLPP (p<0,001), TG e VLDL (p<0,001). CONCLUSÕES: O pior controle glicêmico relaciona-se a maiores níveis de lipídeos séricos e CC mais elevada.

Epicardial adipose tissue thickness in type 1 diabetic patients

Insulin resistance is getting important in the course of type 1 diabetes mellitus. Visceral fat depot is associated with insulin resistance and assessment of epicardial fat thickness is a way of measuring visceral fat. The aim of the study was to measure epicardial adipose tissue (EAT) thickness and to determine its relationship with waist-hip-ratio (WHR) and estimated glucose disposal rate (eGDR) in adult type 1 diabetic patients. Thirty-six type 1 diabetic patients (aged 31±8 years; Female/Male: 22/14) and 43 age, gender and BMI matched healthy controls were included. Fasting blood glucose (FBG), hemoglobin A1c, and lipid profiles were measured. Waist-hip-ratio (WHR) was calculated. Daily insulin dose/kg of patients were recorded and eGDR of all subjects was calculated. Epicardial adipose tissue (EAT) thickness was evaluated by echocardiography. EAT thickness of the type 1 diabetic patients was significantly higher than controls (3.30±1.06 vs. 2.30±0.34 mm, P<0.0001). EAT thickness was correlated with age (P=0.05; r=0.35), WHR (P=0.003; r=0.67), daily insulin dose/kg (r=0.45, P=0.005), and eGDR (r=-0.55, P=0.0004). Multivariate analysis revealed WHR and eGDR to be related to EAT among age, WHR, daily insulin dose/kg, eGDR, FBG, and hemoglobin A1c (r2 of the model=0.64). Epicardial adipose tissue thickness is increased in type 1 diabetic patients compared to controls and is related to WHR and eGDR in this group of patients. This measurement may point to the presence of insulin resistance in type 1 diabetic patients.

New clinical data with metformin therapy in patients with diabetes mellitus

A metforminterápia ma széles körben használatos a 2-es típusú cukorbetegek kezelésében. Az utóbbi években olyan tanulmányok jelentek meg, amelyek a metformin további előnyeire, újabb potenciális alkalmazási lehetőségeire hívják fel a figyelmet. Így adatok szólnak az 1-es típusú diabetesben történő alkalmazás előnyeiről (inzulinkezelés mellett, elsősorban akkor, ha felnőttkorban a 2-es típusú diabetes fenotípusjegyei megjelennek). Epidemiológiai megfigyelések igazolják, hogy metformin használata mellett a daganatos betegségek kockázata csökken. Szórványos adatok hívják fel a figyelmet arra, hogy szívelégtelenségben is előnye lehet a metformin adásának. A 2-es típusú cukorbetegek inzulinterápiájának megkezdésekor érdemes a korábbi metformint megtartani, mert remélhető, hogy adásával csökkenhet a szükséges inzulin dózisa, javulhat az anyagcserekontroll, mérséklődik az inzulinterápia kapcsán jelentkező testsúlygyarapodás, és csökkenhet a macrovascularis szövődmények kialakulásának kockázata. A 2-es típusú diabetes kórfejlődésének korai szakában metforminnal biztosított jó anyagcserehelyzet késői, kedvező utóhatásai is detektálhatók a cukorbetegség hosszú kórlefolyása során. Bár az új klinikai megfigyelések biztatóak, s további vizsgálatokra adnak ösztönzést, a klinikai gyakorlatban jelenleg csak az alkalmazási előiratnak megfelelő módon használhatjuk a metformint a 2-es típusú diabetesben szenvedők kezelése során. Orv. Hetil., 2010, 49, 2025–2030.

From the metabolic syndrome to the concept of global cardiometabolic risk

Although the clustering of cardiovascular risk factors is unquestionable, the clinical significance of the metabolic syndrome as a distinct entity has been debated in the past years. Recently, the term ‘metabolic syndrome’ has been replaced by ‘global cardiometabolic risk’ which implies cardiovascular risk factors beyond the metabolic syndrome. The metabolic syndrome can be frequently detected among people in western and developing countries affecting 25-30% of adult population, and its prevalence rate is increasing. Prospective studies show that the metabolic syndrome is a significant predictor of incident diabetes but has a weaker association with cardiovascular morbidity and mortality. At the same time the metabolic syndrome is inferior to established predicting models for either type 2 diabetes or cardiovascular disease.The underlying pathomechanism of the metabolic syndrome is still poorly understood. The role of insulin resistance – although not as a single factor – is still considered as a key component. In the last decade the importance of abdominal obesity has received increased attention but some studies, mainly in the Asian population, showed that central obesity is not an essential component of the syndrome. Regardless of the theoretical debates the practical implications are indisputable. The frequent clustering of hypertension, dyslipidaemia and glucose intolerance, that often accompanies central obesity, can not be ignored. Following the detection of one risk factor, the presence of other, traditional and non-traditional factors should be searched for, as the beneficial effect of intensive, target oriented, continuous treatment of metabolic and cardiovascular risk factors has been proven in both the short and long term.