Metabolic syndrome in people with type 1 diabetes

This multicentre, cross-sectional analysis from Australia assessed the prevalence of metabolic syndrome, and its association with diabetes complications, in people with type 1 diabetes. Metabolic syndrome was identified using World Health Organization criteria (two or more of the following: hypertension, dyslipidaemia, obesity and microalbuminuria).

A total of 2120 people had the required data recorded and were included in the analysis. Metabolic syndrome was present in 30% of the cohort, with no difference between men and women. Those with metabolic syndrome were older and had a longer diabetes duration, higher HbA_1c and a worse cardiometabolic profile than those without the condition.

The most common was component of metabolic syndrome was hypertension, occurring in 89% of those with the condition versus 29% of those without. Dyslipidaemia, obesity and microalbuminuria occurred in around half of those with metabolic syndrome, versus a minority of those without. Metabolic syndrome prevalence increased with age, primarily driven by increasing hypertension rates.

Diabetes complications were significantly more common in people with metabolic syndrome, with odds ratios (adjusted for age, HbA_1c and diabetes duration) ranging from 1.5 to 3.5 for all microvascular, macrovascular and foot-related complications assessed.

Notably, those with metabolic syndrome who were aged <40 years were at particularly increased risk of complications, with odds ratios of 2.7, 5.9 and 4.3 for microvascular, macrovascular and foot complications, respectively, compared with those of the same age group without metabolic syndrome.

The authors conclude that metabolic syndrome is a clinically useful risk marker in people with type 1 diabetes, particularly those who are younger. The presence of this “double diabetes” may identify people who would benefit from more intensive management, including the use of non-insulin antidiabetes drugs such as metformin.

Lee AS, Twigg SM, Flack JR (2020) Metabolic syndrome in type 1 diabetes and its association with diabetes complications. Diabet Med 1 Aug [epub ahead of print]. https://doi.org/10.1111/dme.14376

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