Metabolic syndrome in type 1 diabetes: exploring the prevalence of ‘double diabetes’ and the risk of diabetes complications in the Australian National Diabetes Information Audit and Benchmarking (ANDIAB) Initiative — ASN Events
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Metabolic syndrome in type 1 diabetes: exploring the prevalence of ‘double diabetes’ and the risk of diabetes complications in the Australian National Diabetes Information Audit and Benchmarking (ANDIAB) Initiative (#47)

Angela S Lee 1 2 , Stephen M Twigg 2 3 , Jeff R Flack 1 4
  1. Department of Diabetes and Endocrinology, Bankstown-Lidcombe Hospital, Sydney, NSW, Australia
  2. Sydney Medical School, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
  3. Department of Endocrinology, Diabetes Centre, Royal Prince Alfred Hospital, Sydney, NSW, Australia
  4. University of New South Wales, Sydney, NSW, Australia

Background: Whilst traditionally associated with type 2 diabetes, the metabolic syndrome (MetS) and insulin resistance have become increasingly recognised in some patients with type 1 diabetes (T1D), giving rise to the term ‘double diabetes’.

Aim: To assess the prevalence of MetS in adults with T1D and its association with diabetes complications, utilising the Australian National Diabetes Information Audit and Benchmarking (ANDIAB) data.

Methods: ANDIAB was a well-established quality program conducted by the National Association of Diabetes Centres (NADC) annually, thence biennially, from 1998-2011 (8 surveys) with protocols for data verification. It provides cross-sectional de-identified data describing the clinical status of patients attending specialist diabetes services across Australia. We determined the prevalence of MetS in this population, and compared clinical characteristics of patients with and without MetS.

Results: There were 2120 adults with T1D with complete data collected for the components of MetS (WHO criteria). Overall MetS prevalence was 30% and was similar between men and women (31% and 29% respectively, p=0.12). Patients with MetS, compared to those without, were older (mean age 49vs42years, p<0.001), had a longer diabetes duration (mean 22vs17years, p<0.001), and higher HbA1c (mean 8.4vs8.0%, p<0.001). Those with MetS, had higher prevalence of all four categories of risk factors: hypertension (89%vs29%), hyperlipidaemia (50%vs9%), obesity (50%vs7%) and microalbuminuria (50%vs4%), all p<0.001. They also had a significantly higher prevalence of diabetes complications(Table 1). Of 624 (29%) with metformin use data available (2009-2011 only), metformin use in MetS patients was higher (16%vs4%, p<0.001).

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Conclusions:  We believe this is the largest Australian cohort reported to date to explore metabolic syndrome prevalence in T1D. The ‘double diabetes’ state is common and identifies patients at increased risk of the spectrum of diabetes complications. Potential clinical implications are that therapies targeting insulin sensitivity in this high-risk group may reduce diabetes complications and should be explored.

Acknowledgement: With thanks to and on behalf of the NADC.