The Prediction of Major Outcomes of Type 1 Diabetes: a 12-Year Prospective Evaluation of Three Separate Definitions of the Metabolic Syndrome and Their Components and Estimated Glucose Disposal Rate
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OBJECTIVE—The metabolic syndrome has been shown to confer an increased risk of cardiovascular disease in both the general and type 2 diabetic populations, but few studies have assessed the metabolic syndrome in type 1 diabetic patients. In a type 1 diabetic cohort, we assessed the prevalence and value of the metabolic syndrome in improving the prediction of major complication outcomes compared with its components and a surrogate measure of insulin resistance, estimated glucose disposal rate (eGDR). RESEARCH DESIGN AND METHODS—A total of 514 (78%) subjects participating in the Pittsburgh Epidemiology of Diabetes Complications Study with complete 12-year follow-up clinical data were classified by baseline metabolic syndrome status according to three definitions: those of the National Cholesterol Education Program Adult Treatment Panel III (modified by the American Heart Association), the International Diabetes Federation (IDF), and the World Health Organization (WHO). The complication outcomes included coronary artery disease, renal failure, diabetes-related death, and the aggregate of these three major outcomes of diabetes (MOD). RESULTS—Metabolic syndrome prevalence ranged from 8% (IDF) to 21% (WHO). All definitions showed reasonable specificity (≥83%) for each outcome, while the WHO definition had the highest sensitivity for all outcomes except renal failure, for which eGDR was most sensitive. However, the components of each definition predicted better than the overall syndrome. Microalbuminuria was clearly the strongest predictor of all individual measures, yielding hazard ratios of 9 and 6 for mortality and MOD, respectively. CONCLUSIONS—Though the three metabolic syndrome classifications predict major complication outcomes in type 1 diabetes, their individual components predict better. Of the variables studied, including HbA1, microalbuminuria appears to be the best single predictor of MOD.
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Albuminuria is a continuous variable for cardiovascular risk.
“reinforcing the notion that albuminuria is a continuous variable for cardiovascular risk (466-468).”
From Guidelines and Recommendations for Laboratory Analysis in the Diagnosis and Management of Diabetes Mellitus (2023) · cites this paper as [466]
The Results section concludes that microalbuminuria predicts cardiovascular risk in people with type 1 diabetes. The WHO definition section uses an albumin-excretion cutoff, however, and the paper does not establish that cardiovascular risk varies continuously with albuminuria levels or extend its finding beyond this population. Page numbers are unavailable in our copy. (LLM, conf=0.85)
Experimental — accuracy not yet measuredRecent data suggest that cardiovascular risk extends below the lower limit of 20 mg/min, reinforcing that albuminuria is a continuous variable for cardiovascular risk.
“Recent data, however, suggest that risk extends below the lower limit of 20 mg/min (328-330), reinforcing the notion that this factor is a continuous variable for cardiovascular risk (331)(332)(333).”
From Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus (2011) · cites this paper as [333]
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- Authors
- Pambianco, G., Costacou, T., & Orchard, T. J.
- Affiliations
- University of Pittsburgh (US)
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2007-05-01
- Volume
- 30
- Issue
- 5
- Pages
- 1248-1254
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W2097169420
- Semantic Scholar
- 85205b40b335d5348deaacc5eb106b43b6106e51
- Cited by
- 198
- References
- 45
- Citations by year
- 2026: 3 · 2025: 8 · 2024: 12 · 2023: 9 · 2022: 8 · 2021: 16 · 2020: 8 · 2019: 6 · 2018: 8 · 2017: 8 · 2016: 2 · 2015: 9 · 2014: 3 · 2013: 10 · 2012: 15
- FWCI
- 14.37
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health (DK34818)
- National Institute of Diabetes and Digestive and Kidney Diseases (DK-34818)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Keywords
- type 1 diabetes, metabolic syndrome, metabolic syndrome definitions, estimated glucose disposal rate, insulin resistance, microalbuminuria, cardiovascular disease, renal failure, diabetes mortality, HbA1c, Pittsburgh Epidemiology of Diabetes Complications Study
- MeSH terms
- Adolescent, Adult, Child, Death Certificates, Diabetes Mellitus, Type 1, Diet, Female, Glucose, Humans, Male, Pennsylvania, Prospective Studies, Surveys and Questionnaires, Risk Factors, Treatment Outcome, Glucose Intolerance, Metabolic Syndrome, Diabetes Complications, Body Size
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