Skip Navigation
Skip to contents

Diabetes Metab J : Diabetes & Metabolism Journal

Search
OPEN ACCESS

Articles

Page Path
HOME > Diabetes Metab J > Volume 46(3); 2022 > Article
Letter
Association between Metabolic Syndrome and Microvascular Complications in Chinese Adults with Type 1 Diabetes Mellitus (Diabetes Metab J 2022;46:93-103)
Gyuri Kimorcid
Diabetes & Metabolism Journal 2022;46(3):512-514.
DOI: https://doi.org/10.4093/dmj.2022.0134
Published online: May 25, 2022
  • 2,811 Views
  • 119 Download
  • 2 Web of Science
  • 2 Crossref
  • 2 Scopus

Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea

Corresponding author: Gyuri Kim orcid Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, Korea E-mail: gyuri5.kim@samsung.com

Copyright © 2022 Korean Diabetes Association

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

See the article "Association between Metabolic Syndrome and Microvascular Complications in Chinese Adults with Type 1 Diabetes Mellitus" on page 93.
Metabolic syndrome is a cluster of metabolic abnormalities including central obesity, impaired glucose tolerance, dyslipidemia, and hypertension [1]. Numerous previous studies have highlighted its importance due to the associated risk with type 2 diabetes mellitus, cardiovascular disease, and mortality, in relation to insulin resistance. The prevalence and incidence of metabolic syndrome have increased worldwide and it may have a significant impact on public health. Although several studies revealed that metabolic syndrome in patients with type 1 diabetes mellitus (T1DM) is also common and increased in Western populations, the prevalence of metabolic syndrome and its relationship with diabetes-related complications in patients with T1DM in Asian countries are not well established.
In this article, entitled “Association between metabolic syndrome and microvascular complications in Chinese adults with type 1 diabetes mellitus,” Huang et al. [2] explored the prevalence of metabolic syndrome among adult patients with T1DM in China and evaluated its association with risk factors and microvascular complications. The prevalence of metabolic syndrome in the study population was 15.1%. Huang et al. [2] showed that female sex (odds ratio [OR], 2.86; 95% confidence interval [CI], 1.63 to 5.02; P=0.047), longer diabetes duration (OR, 1.04; 95% CI, 1.00 to 1.08; P<0.001), higher body mass index (OR, 1.14; 95% CI, 1.03 to 1.25; P=0.009), glycosylated hemoglobin (HbA1c) (OR, 1.23; 95% CI, 1.11 to 1.36; P< 0.001), and nutrition therapy (OR, 0.46; 95% CI, 0.26 to 0.78; P=0.005) were significantly associated with the prevalence of metabolic syndrome in patients with T1DM. After adjusting for sex, age, diabetes duration, HbA1c, and other lifestyle and socioeconomic factors, metabolic syndrome was independently associated with the presence of diabetic kidney disease (DKD) (OR, 2.14; 95% CI, 1.12 to 4.11; P=0.022) and diabetic retinopathy (DR) (OR, 3.72; 95% CI, 1.59 to 8.72; P=0.002). These findings are consistent with previous reports that have shown an association between metabolic syndrome and albuminuria, DKD, and DR in patients with T1DM [3]. However, there are several issues to be discussed.
First, as noted by the authors, insulin dose and medications for hypertension and dyslipidemia are important variables to define and characterize patients with metabolic syndrome and T1DM, but these data were missing from the study. Intensive insulin therapy at high dosages can cause weight gain and increased insulin dose can be a clinical indicator of insulin resistance [4]. There was a relationship between intensive insulin treatment and a higher subsequent prevalence of metabolic syndrome [5]. In addition, the presence of insulin resistance in patients with T1DM may lead to quantitative lipid abnormalities. However, although most patients with T1DM showed abnormal lipid levels and atherogenic changes in lipoprotein composition, T1DM patients with optimal HbA1c had similar or even lower atherogenic lipid profiles due to peripheral hyperinsulinemia than nondiabetic controls, showing that glycemic control is an important mediator of lipid abnormalities [6]. Also, HbA1c was independently correlated with total cholesterol, low-density lipoprotein cholesterol (LDL-C), and non-high-density lipoprotein cholesterol levels, indicating that abnormalities in lipid profiles were mostly observed in T1DM patients with poor glycemic control [7]. In the study by Huang et al. [2], the mean HbA1c was 9.2% in subjects with metabolic syndrome, indicating that glycemic control was not optimized. More than half of the study population was treated with therapies other than insulin pump or basal-bolus insulin therapy, which may be inadequate to achieve intensive insulin therapy. Therefore, although there was a significant association between metabolic syndrome and DKD or DR in patients with T1DM after adjustment for HbA1c, further adjustment for body mass index or subgroup analyses based on categories of optimal and poor or suboptimal glycemic control could provide more information. Moreover, specific medications for hypertension such as angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, and sodium glucose co-transporter 2 inhibitors have shown beneficial effects on renal outcomes, including albuminuria [8,9]. Also, adjunctive metformin use in T1DM may confer additional benefits on diabetes management, leading to enhanced insulin sensitivity and reduced total daily insulin dose, body weight, triglycerides, and LDL-C; thus, metformin could be considered in T1DM patients with metabolic syndrome [10]. Therefore, information about the use of these medications in the current study population would be helpful.
In addition, the results of this study raised important issues that need to be taken into account with regard to the management of T1DM. The ORs of those who received diabetes education and those who followed a diabetic diet were not significantly different between those with and without metabolic syndrome, but T1DM patients who received nutrient therapy education exhibited a reduced OR for metabolic syndrome. Also, the study highlighted the presence of metabolic syndrome in patients with T1DM to identify the risk of microvascular complications. Therefore, more intensive diabetes education programs on insulin therapy and therapeutic strategies such as physical exercise, weight control, and healthy diet are essential for T1DM patients with metabolic syndrome to improve metabolic syndrome status and ultimately reduce diabetes-related complications.
Lastly, this was a cross-sectional study, and further longitudinal studies regarding changes in metabolic syndrome status from the time of diagnosis of T1DM and the incidence of diabetes-related microvascular and macrovascular complications are warranted.

CONFLICTS OF INTEREST

No potential conflict of interest relevant to this article was reported.

  • 1. Eckel RH, Grundy SM, Zimmet PZ. The metabolic syndrome. Lancet 2005;365:1415-28.ArticlePubMed
  • 2. Huang Q, Yang D, Deng H, Liang H, Zheng X, Yan J, et al. Association between metabolic syndrome and microvascular complications in Chinese Adults with type 1 diabetes mellitus. Diabetes Metab J 2022;46:93-103.ArticlePubMedPMCPDF
  • 3. Metascreen Writing Committee, Bonadonna R, Cucinotta D, Fedele D, Riccardi G, Tiengo A. The metabolic syndrome is a risk indicator of microvascular and macrovascular complications in diabetes: results from Metascreen, a multicenter diabetes clinic-based survey. Diabetes Care 2006;29:2701-7.PubMed
  • 4. The Diabetes Control And Complications Trial Research Group. Influence of intensive diabetes treatment on body weight and composition of adults with type 1 diabetes in the Diabetes Control and Complications Trial. Diabetes Care 2001;24:1711-21.ArticlePubMedPDF
  • 5. Kilpatrick ES, Rigby AS, Atkin SL. Insulin resistance, the metabolic syndrome, and complication risk in type 1 diabetes: “double diabetes” in the Diabetes Control and Complications Trial. Diabetes Care 2007;30:707-12.PubMed
  • 6. Guy J, Ogden L, Wadwa RP, Hamman RF, Mayer-Davis EJ, Liese AD, et al. Lipid and lipoprotein profiles in youth with and without type 1 diabetes: the SEARCH for Diabetes in Youth case-control study. Diabetes Care 2009;32:416-20.PubMedPMC
  • 7. Marcovecchio ML, Dalton RN, Prevost AT, Acerini CL, Barrett TG, Cooper JD, et al. Prevalence of abnormal lipid profiles and the relationship with the development of microalbuminuria in adolescents with type 1 diabetes. Diabetes Care 2009;32:658-63.ArticlePubMedPMCPDF
  • 8. Jafar TH, Schmid CH, Landa M, Giatras I, Toto R, Remuzzi G, et al. Angiotensin-converting enzyme inhibitors and progression of nondiabetic renal disease. A meta-analysis of patient-level data. Ann Intern Med 2001;135:73-87.ArticlePubMed
  • 9. Li N, Lv D, Zhu X, Wei P, Gui Y, Liu S, et al. Effects of SGLT2 inhibitors on renal outcomes in patients with chronic kidney disease: a meta-analysis. Front Med (Lausanne) 2021;8:728089.ArticlePubMedPMC
  • 10. Cree-Green M, Bergman BC, Cengiz E, Fox LA, Hannon TS, Miller K, et al. Metformin improves peripheral insulin sensitivity in youth with type 1 diabetes. J Clin Endocrinol Metab 2019;104:3265-78.ArticlePubMedPMCPDF

Figure & Data

References

    Citations

    Citations to this article as recorded by  
    • Receiver Operator Characteristic (ROC) Analysis of Lipids, Proteins, DNA Oxidative Damage, and Antioxidant Defense in Plasma and Erythrocytes of Young Reproductive-Age Men with Early Stages of Type 1 Diabetes Mellitus (T1DM) Nephropathy in the Irkutsk Reg
      Marina Darenskaya, Elena Chugunova, Sergey Kolesnikov, Natalya Semenova, Isay Michalevich, Olga Nikitina, Anastasya Lesnaya, Lyubov Kolesnikova
      Metabolites.2022; 12(12): 1282.     CrossRef
    • Recent advances and potentiality of postbiotics in the food industry: Composition, inactivation methods, current applications in metabolic syndrome, and future trends
      Yujie Zhong, Tao Wang, Ruilin Luo, Jiayu Liu, Ruyi Jin, Xiaoli Peng
      Critical Reviews in Food Science and Nutrition.2022; : 1.     CrossRef

    • PubReader PubReader
    • ePub LinkePub Link
    • Cite
      CITE
      export Copy
      Close
      Download Citation
      Download a citation file in RIS format that can be imported by all major citation management software, including EndNote, ProCite, RefWorks, and Reference Manager.

      Format:
      • RIS — For EndNote, ProCite, RefWorks, and most other reference management software
      • BibTeX — For JabRef, BibDesk, and other BibTeX-specific software
      Include:
      • Citation for the content below
      Association between Metabolic Syndrome and Microvascular Complications in Chinese Adults with Type 1 Diabetes Mellitus (Diabetes Metab J 2022;46:93-103)
      Diabetes Metab J. 2022;46(3):512-514.   Published online May 25, 2022
      Close
    • XML DownloadXML Download
    Related articles

    Diabetes Metab J : Diabetes & Metabolism Journal