Measuring insulin resistance in type 1 diabetes and examining its association with complications
Prediction of CVD using eGDR
Other derived measures related to insulin resistance: does the metabolic syndrome identify CVD risk in type 1 diabetes?
Intensive insulin therapy, weight/weight gain and their relationship to insulin resistance and CV risk in type 1 diabetes
Quartiles of weight gain
HbA1c (%) [mmol/mol]
Insulin dose (units kg−1 day−1)
Achieved BMIa (kg/m2)
Systolic BP (mmHg)
Lipid metabolism in type 1 diabetes
Summary and conclusions
Summary of what is known and what remains unknown (and thus requires further research) in ‘double diabetes’
Unknown: areas for future research
Is the effect of FHT2 on complications in T1DM mediated by genetic or familial factors (or both)?
Is peripheral insulin resistance in T1DM related to increased ectopic fat stores (e.g. skeletal muscle) as a result of abnormal fat partitioning owing to non-physiological subcutaneous insulin administration?
There are no prospective studies of baseline clamp insulin resistance in a T1DM cohort with follow-up for incident CV events.
Newer risk models in contemporary populations of T1DM patients are urgently needed.
DCCT participants in the intensive insulin therapy group in the highest quartile for weight gain developed a higher BP and a more atherogenic lipid profile .
Numbers of CV events in the DCCT/EDIC study are too small to demonstrate any excess risk in those patients who gained the most weight. Further prospective cohort studies are required. It remains possible (and clinically relevant) that a beneficial CV effect of intensive glycaemic control might, in some patients, be outweighed by the adverse effects of weight gain.
What is the effect of weight gain on hepatic fat stores (and ectopic fat stores) in T1DM? Any increase in perivascular or epicardial fat could have implications for CV risk.
Do newer insulins that target liver rather than systemic tissues lead to more liver fat but less weight gain overall and less cardiac and intramyocellular fat accumulation? How do newer vs current insulins affect the function of HDL particles?
FHT2, family history of type 2 diabetes; T1DM, type 1 diabetes