Type 1 Diabetics Have More to Worry About Than Previously Thought
WebMD News Archive
Mar. 23, 2000 (Eugene, Ore.) -- A substantial number of people with type 1
diabetes also have a condition called insulin resistance, which dramatically
increases their risk of developing heart disease. Fortunately, physicians can
evaluate who is most likely to have insulin resistance by doing some routine
tests, according to a new study published in the April issue of the journal
Diabetes, a journal of the American Diabetes Association.
There are two major types of diabetes -- type 1 and type 2. Type 2 diabetes
generally occurs in older and/or obese patients; it is diagnosed when the body
can no longer properly control blood sugar levels because it can't
respond appropriately to insulin, a hormone required for the control of
sugar in the body. This process is generally referred to as insulin resistance
On the other hand, type 1 diabetes was thought to be a much simpler concept.
It occurs when the body simply doesn't make enough insulin. Insulin
resistance was not thought to be a part of type 1 diabetes, but perhaps it
"Insulin resistance does play a role in type 1 diabetes," says
Katherine Williams, MD, MPH. "In the past, the focus in this disease has
been on the pancreas not producing insulin. There hasn't been much emphasis on
an additional problem: that some people are also not responding to
insulin." Williams is an instructor in medicine at the University of
Pittsburgh School of Medicine, and the clinical investigator on the study.
"We have identified a subgroup of patients with type 1 diabetes who
[also] have insulin resistance and therefore are at increased risk of
cardiovascular disease. They probably need special treatment such as increased
exercise, weight loss, and possibly [medication]," says Trevor Orchard,
MBBCh, MMS, senior author of the article.
Additional research is needed to confirm the study's results, Orchard says.
"Meanwhile, we think the major risk factors identified here -- waist-hip
ratio, [high blood pressure], and a family history of type 2 diabetes -- are
important predictors of the risk of heart disease in type 1 diabetics."
Orchard is professor of medicine, epidemiology, and pediatrics at the
University of Pittsburgh School of Public Health.
The research team looked at various factors that might predict the
likelihood of insulin resistance in adults with type 1 diabetes, including high
blood pressure, waist-hip ratio, triglyceride and HDL (or 'good') cholesterol
levels, family history of type 2 diabetes, and level of blood sugar
They found a high waist-hip ratio was the strongest predictor of insulin
resistance. That means being overweight -- and especially carrying that weight
around the belly -- puts type 1 diabetics at increased risk for heart
"If you are in that situation, get your weight down," advises Ronald
Goldberg, MD. "Getting weight down to normal levels is much more important
than we ever thought." Goldberg is professor of medicine and associate
director of the Diabetes Research Institute at the University of Miami School