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Type 1 Diabetics Have More to Worry About Than Previously Thought

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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 or regulation

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 is.

"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.

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