Metabolic syndrome in patients with diabetes mellitus type 1, prevalence, impact on morbidity and mortality

Authors: Jitka Brožová;  Daniela Čechurová;  Silvie Lacigová
Authors‘ workplace: Diabetologické centrum I. interní kliniky LF UK a FN Plzeň
Published in: Vnitř Lék 2016; 62(Suppl 4): 8-14
Category: Original Contributions

Předneseno na 52. diabetologických dnech v Luhačovicích dne 15. 4. 2016


Aim of this retrospective observational study was to determine the prevalence of metabolic syndrome (MS) in patients with diabetes mellitus type 1 (DM1Z) at baseline (in 2003) and find the parameters that determine the difference between group with (MS+) and without MS (MS-). Did the presence of MS affect morbidity and mortality in the subsequent 10 years?

278 patients were enrolled to the study with age average 39 ± 13 years with medical history of diabetes 15.9 ± 9 years. The IDF criteria were used for MS diagnosis. Anthropometric and biochemical parameters, prevalence and incidence of microangiopathic and macroangiopathic complications were checkedat baseline and after 10 years.

MS was diagnosed in 16.2 % (45) patients. MS+ group was older (p < 0.001), with a longer duration of DM (p < 0.05), which is manifested in the elderly patients (p < 0.01), with higher weight (p < 0.001), less compensation (p < 0.05), a higher value of blood pressure (p < 0.001) and reduced glomerular filtration rate (p < 0.001). MS correlated from microvascular complications with proteinuria (p < 0.001), with peripheral and cardiovascular autonomic neuropathy (p < 0.001) and with retinopathy (p < 0.01). Patients with MS had often chronic ischemic heart disease (p < 0.01), with absence of other macroangiopatic complications. After 10 years the number of patients with newly diagnosed retinopathy (p < 0.05), with chronic ischemic heart disease (p < 0.01) and with other macroangiopathy (p < 0.05) increased in MS+ group. The number of other microvascular complication sincreased, but similarly in both groups. On the other hand, in MS+ group both systolic (p < 0.01), diastolic pressure (p < 0.05) significantly decreased and values of glycosylated hemoglobin (p < 0.05) improved compared to group MS- within 10 years. 18 patients died, with higher incidence in MS+ group (p < 0.05; 13.3 % vs 5.2 %). Cardiovascular autonomic neuropathy was observed as the most serious risk factor for mortality (p < 0.05), also age was almost significant (p = 0.08).

The prevalence of MS is increasing even patients with DM1T are affected. The study shows the negative impact of MS on diabetic complications and mortality and demonstrates that early diagnosis and treatment of individual components of MS as very important.

Key words:
cardiovascular diseases – diabetes mellitus type 1 – insulin distance – metabolic syndrome – microvascular complications – mortality


1. Soedamah-Muthu SS, Fuller JH, Mulnier HE et al. All-cause mortality rates in patients with type 1 diabetes mellitus compared with a non-diabetic population from the UK general practice research database, 1992–1999. Diabetologia 2006; 49(4): 660–666.

2. Alberti KG, Eckel RH, Grundy SM et al. Harmonizing the metabolic syndrome: a joint interim statement of the International Diabetes Federation Task Force on Epidemiology and Prevention; National Heart, Lung, and Blood Institute; American Heart Association; World Heart Federation; International Atherosclerosis Society; and International Association for the Study of Obesity. Circulation 2009; 120(16): 1640–1645. Dostupné z DOI: <>.

3. Billow A, Anjana RM, Ngai M et al. Prevalence and clinical profile of metabolic syndrome among type 1 diabetes mellitus patients in southern India. J Diabetes Complications2015; 29(5): 659–664. Dostupné z DOI: <>.

4. Chillarón JJ, FloresLe-Roux JA, Benaiges D et al. Type 1 diabetes, metabolic syndrome and cardiovascular risk. Metabolism 2014; 63(2): 181–187. Dostupné z DOI: <>.

5. Thorn LM, Forsblom C, Fagerudd J et al. Metabolic syndrome in type 1 diabetes: association with diabetic nephropathy and glycemic control (the Finn Diane study). Diabetes Care 2005; 28(8): 2019–2024.

6. Ghosh S, Collier A, Hair M et al. Metabolic syndrome in type 1diabetes. Int J Diabetes Mellit 2010; 2(1): 38–42. Dostupné z DOI: <>

7. 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(3): 707–712.

8. Purnell JQ, Zinman B, Brunzell JD. [DCCT/EDIC Research Group]. The effect of excess weight gain with intensive diabetes mellitus treatment on cardiovascular disease risk factors and atherosclerosis in type 1 diabetes mellitus: results from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study (DCCT/EDIC) study. Circulation 2013; 127(2): 180–187. Dostupné z DOI: <>.

9. Williams K, Erbey J, Becker D et al. Can clinical factor sestimate insulin resistance in type 1 diabetes? Diabetes 2000; 49(4): 626–632.

10. McGill M, Molyneaux L, Twigg SM et al. The metabolic syndrome in type 1 diabetes: does it exist and does it matter? J Diabetes Complications 2008; 22(1): 18–23. Dostupné z DOI: <>.

11. Momesso DP, Bussade I, Lima GA et al. Body composition, metabolic syndrome and insulin resistance in type 1 diabetes mellitus. Arq Bras Endocrinol Metabol 2011; 55(3): 189–193.

12. Miller RG, Secrest AM, Sharma RK et al. Improvements in the life expectancy of type 1 diabetes: the Pittsburgh Epidemiology of Diabetes Complications study cohort. Diabetes 2012; 61(11): 2987–2992. Dostupné z DOI: <–1625>.

13. Morimoto A, Onda Y, Nishimura R et al. Cause-specific mortality trends in a nationwide population-based cohort of childhood-onset type 1 diabetes in Japan during 35 years of follow-up: the DERI Mortality Study. Diabetologia 2013; 56(10): 2171–2175. Dostupné z DOI: <–013–3001–2>.

14. Lacigova S, Brozova J, Cechurova D et al. The influence of cardiovascular autonomic neuropathy on mortality in type 1 diabetic patients; 10-year follow-up. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2016; 160(1): 111–117. Dostupné z DOI: <>.

15. Retnakaran R, Zinman B. Type 1 diabetes, hyperglycaemia, and the heart. Lancet 2008; 371(9626): 1790–1799. Dostupné z DOI: <–6736(08)60767–9>.

16. Pop-Busui R, Hotaling J, Braffett BH. [DCCT/EDIC Research Group]. Cardiovascular autonomic neuropathy, erectile dysfunction and lower urinary tract symptoms in men with type 1 diabetes: findings from the DCCT/EDIC. J Urol 2015; 193: 2045–2051. Dostupné z DOI: <>.

17. Lachin JM, White NH, Hainsworth DP et al. [Diabetes Control and Complications Trial (DCCT)/Epidemiology of Diabetes Interventions and Complications (EDIC) Research Group]. Effect of intensive diabetes therapy on the progression of diabetic retinopathy in patients with type 1 diabetes: 18 years of follow-up in the DCCT/EDIC. Diabetes 2015; 64(2): 631–642. Dostupné z DOI: <–0930>.

18. Lagani V, Chiarugi F, Thomson S et al. Development and validation of risk assessment models for diabetes-related complications based on the DCCT/EDIC data. J Diabetes Complications 2015; 29(4): 479–487. Dostupné z DOI: <>.

19. Orchard TJ, Costacou T, Kretowski A et al. Type 1 diabetes and coronary artery disease. Diabetes Care 2006; 29(11): 2528–2538.

20. Orchard TJ, Olson JC, Erbey JR et al. Insulin resistance-related factors, but not glycemia, predict coronary artery disease in type 1 diabetes: 10-year follow-up data from the Pittsburgh Epidemiology of Diabetes Complications Study. Diabetes Care 2003; 26(5): 1374–1379.

21. Škrha J. Epidemiologická studie o diabetes mellitus v České republice, porovnání výsledků z roku 2002 a 2006. DMEV 2010; 13(2): 55–62.

22. Cardiovascular disease and risk management. Standards of Medical Care in Diabetes – 2015. Diabetes Care 2015; 38(Suppl 1): S49-S57. Dostupné z DOI: <>.

23. Schoenaker DA, Toeller M, Chaturvedi N et al. [EURODIAB Prospective Complications Study Group]. Dietary saturated fat and fibre and risk of cardiovascular disease and all-cause mortality among type 1 diabetic patients: the EURODIAB Prospective Complications Study. Diabetologia 2012; 55(8): 2132–2141. Dostupné z DOI: <–012–2550–0>.

24. Plodkowski RA, Andal JC. Adult Patients with type 1 diabetes and the metabolic syndrome. Medscape Diabetes & Endocrinology 2003. Dostupné z WWW:

25. Lacigová S, Rušavý Z, Kyselová P et al. Short-term and long-term effect of metformin in type 1 diabetics. Vnitř Lék 2001; 47(2): 81–86.

26. Lacigová S, Rušavý Z, Jankovec Z et al. Metformin in the treatment of type 1 diabetics – a placebo controlled study. Čas Lék Čes 2001; 140(10): 302–306.

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