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[IP] 'Double Diabetes' Ups Heart Disease Risk

Original article:


'Double Diabetes' Ups Heart Disease Risk

1 in 4 Adults with Type 1 Diabetes at Risk; Prevention Possible

      By Daniel DeNoon
      WebMD Medical News   Reviewed By Brunilda  Nazario, MD
      on Friday, April 25, 2003

April 25, 2003 -- Adults with type 1 diabetes often have type 2 diabetes as
well. This "double diabetes" greatly increases their risk of heart
disease -- but doing something about it is also risky, a new study suggests.

Type 1 diabetes was once thought to be a simple, albeit serious, condition.
The body fails to produce insulin, and blood sugar skyrockets. Type 2
diabetes is a complex disease that develops slowly -- but the key step is
insulin resistance. As insulin resistance builds, the body needs more and
more insulin to get the same sugar-lowering effect.

University of Pittsburgh researchers led by Trevor Orchard, MD, looked at
people with type 1 diabetes enrolled in the Pittsburgh Epidemiology of
Diabetes Complication Study. They studied 603 patients who did not have
heart disease at the beginning of the 10-year study. Those who developed
heart disease had one major thing in common: insulin resistance, the
hallmark of type 2 diabetes.

"The importance of the coincidence of type 1 diabetes and insulin resistance
indicating type 2 diabetes really hasn't been focused on," Orchard tells
WebMD. "There is a technical insulin resistance that occurs in type 1
diabetes because of high blood sugar, but this is separate."

Orchard's study suggests that one in five people with type 1 diabetes suffer
this double diabetes. Most of them inherit a tendency toward type 2 diabetes
from their parents. These patients are at greatly increased risk of heart
disease. But there's a twist to this finding.

People with double diabetes have lots of plaque in their arteries. But their
high blood sugar makes these plaques more fibrous. Ironically, this makes
them less likely to rupture and cause a heart attack. Despite their clogged
arteries, people with double diabetes don't suffer any more sudden heart
deaths than other people. However, their arteries are clogged. This leads to
clogged arteries in the lower limbs -- and often to amputation.

"I think if people have type 1 diabetes and a family history of type 2
diabetes or signs of metabolic syndrome -- large waist circumference -- they
should work with their doctors to improve insulin sensitivity," Orchard
advises. "At the moment, that would involve diet and exercise. In type 2

But that's not all. Once people with double diabetes get their blood sugar
under control, the plaques in their arteries become less stable for a while.

"There is a problem of risking heart failure," Orchard warns. "If we were
able to control blood sugar perfectly and get everybody with double diabetes
into the normal range, there would be dramatic improvement in heart disease.
But during the process of lowering blood sugar, you might have a period with
increased rates of acute heart disease. Two to three years down the line we
should see improvement. Eventually it would be a benefit, but in the short
term it might be risky. So the approach would be to make sure people had
good [treatment with statin drugs] to stabilize plaques while lowering blood

Orchard credits John D. Brunzell; MD, director of the Clinical Research
Center at the University of Washington, Seattle, with first finding signs of
type 2 diabetes in people with type 1 diabetes. Brunzell first noticed the
phenomenon when he saw people with type 1 diabetes gain weight as soon as
they got their blood sugar under tight control.

Brunzell agrees with Orchard that people with this condition urgently need
to control their weight gain as well as their blood sugar.

"If we tie this all together, it says that in the type 1 diabetic who gets
good glycemic control and gains weight, we should be concerned about the
weight gain," Brunzell tells WebMD. "We should also treat the things that go
along with it to prevent the development of unstable plaques. This is not
hypothesis. It is fact."

Orchard and colleagues report their findings in the May issue of the journal
Diabetes Care.


SOURCES: Diabetes Care, May 2003. Trevor Orchard, MD, professor, department
of epidemiology, University of Pittsburgh Graduate School of Public Health.
John D. Brunzell; MD, professor, division of metabolism, endocrinology &
nutrition and director, Clinical Research Center, University of Washington,

) 2003 WebMD Inc. All rights reserved.

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