COMPARISON OF OBESITY RELATED CARDIOMETABOLIC RISKS IN DIABETES TYPE 1 AND 2

Diabetes mellitus (DM) regardless the type is a disease with very high cardiovascular complications rate (CVC). With the increase of obesity prevalence in the whole world, there is increase of DM type 1 number (DM1) with overweight as well. Taken DM1, obesity usually is not considered as a risk factor for CVC.

Aim. To study the prevalence of overweight and obesity, and influence on the risk of myocardial infarction development (MI), or stroke in DM1 and type 2 (DM2) patients with various metabolic phenotypes; and to evaluate gender specifics.

Material and methods. Patients with DM1 were included, totally 3190 persons, and DM2, totally 71602 persons. All DM patients were selected to 3 subgroups: group 1 — normal bodyweight, group 2 — overweight, and group 3 — obese. In each group the prevalence of MI and stroke was evaluated, and risk estimated.

Results. Among DM1 patients with overweight were 29,3% (men 29,0%, women 29,7%). Obesity was registered in 9,7% DM1. In difference with overweight, obesity was registered 2 times more commonly and significantly in men, than in women (6,8% vs. 13,4%; p<0,001). In DM1 patients there were no gender differences; in DM2 patients the prevalence of these complications was statistically more significant and higher in men than in women. Overweight and obesity do not increase risk of MI and stroke in DM2. In DM1 overweight increases 2,4 times the risk of stroke, but not MI; obesity does increase 5,2 times the risk of MI, but only in men. The risk of stroke in DM1 and obesity increases 2,8 times, but only in women. Presence of obesity metabolic phenotype in DM1 increases the risk of MI and stroke, nullifying gender differences.

Conclusion. Overweight and obesity do influence differently the CVC risk in DM1 and 2. Prevention and treatment of overweight and obesity, together with carbohydrate metabolism disorder, should be the fundamentals of cardiovascular risk decrease in DM1.

1. Li N, et al. BMI and Coronary Heart Disease Risk Among Low-Income and Underinsured Diabetic Patients. Diabetes Care. 2014; 37(12): 3204-12. doi: 10.2337/dc14-1091.

2. Li W, et al. Body Mass Index and Stroke Risk Among Patients With Type 2 Diabetes Mellitus. Stroke. 2015; 46: 164-9. doi:10.1161/STROKEAHA.114.006718.

3. Chumakova GA, Leonova NV, Nazarenko NV, et al. Association of acute cerebral circulation disorders with cardiovascular risk factors in patients with type 2 diabetes mellitus in the Altai Territory. Bulletin of Siberian Medicine. 2009; 3: 92-6. Russia (Чумакова Г. А., Леонова Н. В., Назаренко Н. В. и др. Ассоциация острого нарушения мозгового кровообращения с сердечнососудистыми факторами риска у больных сахарным диабетом типа 2 в Алтайском крае. Бюллетень сибирской медицины. 2009; 3: 92-6.)

4. Chumakova GA, Pushkareva SV, Leonova NV, et al. The risk of developing myocardial infarction among patients with type 2 diabetes mellitus according to the register of the Altai Territory. Modern problems of science and education. 2012; 3. Russia (Чумакова Г. А., Пушкарева С. В., Леонова Н. В. и др. Риск развития инфаркта миокарда среди пациентов с сахарным диабетом типа 2 по данным регистра Алтайского края. Современные проблемы науки и образования. 2012; 3).

5. Leonova NV, Chumakova GA, Nazarenko NV, et al. The dynamics of stroke in patients with type 2 diabetes according to the register of diabetes in the Altai Territory. Clinical neurology. 2014; 4: 10-4. Russia (Леонова Н. В., Чумакова Г.А, Назаренко Н. В. и др. Динамика развития инсульта у пациентов СД типа 2 по данным регистра сахарного диабета Алтайского края. Клиническая неврология. 2014; 4: 10-4).

6. Katz M, Giani E, Laffel L. Challenges and Opportunities in the Management of Cardiovascular Risk Factors in Youth with Type 1 Diabetes: Lifestyle and Beyond. Curr Diab. Rep. 2015; 15(12): 119. doi: 10.1007/s11892-015-0692-4.

7. Chillaron JJ, Goday A, Pedro-Botet J. Metabolic syndrome, type 1 diabetes mellitus and insulin resistance. Med Clin (Barc). 2008; 130(12): 466-70.

8. Da Costa VM, de Carvalho Padilha P, de Lima GC, et al. Overweight among children and adolescent with type I diabetes mellitus: prevalence and associated factors. Diabetol Metab Syndr. 2016; 8: 39. doi: 10.1186/s13098-016-0154-4.

9. Pinhas-Hamiel O, Levek-Motola N, Kaidar K, et al. Prevalence of overweight, obesity and metabolic syndrome components in children, adolescents and young adults with type 1 diabetes mellitus. Diabetes Metab Res Rev. 2015; 31(1): 76-84. doi: 10.1002/dmrr.2565.

10. Bastien M, Poirier P, Lemieux I, et al. Overview of epidemiology and contribution of obesity to cardiovascular disease. Prog Cardiovasc Dis. 2014; 56(4): 369-81. doi: 10.1016/j.pcad.2013.10.016.

11. Luczyński W, Szypowska A, Głowińska-Olszewska B, et al. Overweight, obesity and features of metabolic syndrome in children with diabetes treated with insulin pump therapy. Eur J Pediatr. 2011; 170: 891-8. doi: 10.1007/s00431-010-1372-7.)

12. Liu LL, Lawrence JM, Davis C, et al. Prevalence of overweight and obesity in youth with diabetes in USA: the SEARCH for Diabetes in Youth study. Pediatr Diabetes. 2010; 11(1): 4-11.

13. Purnell JQ, Zinman B, Brunzell JD. 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): 180-7.

14. Bastien M, Poirier P, Lemieux I, et al. Overview of epidemiology and contribution of obesity to cardiovascular disease. Prog Cardiovasc Dis. 2014; 56(4): 369-81. doi: 10.1016/j. pcad.2013.10.016.

15. Chumakova GA, Veselovskaya NG. Clinical significance of visceral obesity. Moscow. GEOTAR-Media. 2016. р. 160. Russia (Чумакова Г. А., Веселовская Н. Г. Клиническое значение висцерального ожирения. М.: ГЭОТАР-Медиа, 2016. 160 с.).

16. Roitberg GE, Dorosh ZV, Kurushkina OV. Metabolic syndrome and distribution of adipose tissue: points of contact and inconsistency of relationships. Preventive Medicine. 2010; 13: 22-5. Russia (Ройтберг Г. Е., Дорош Ж. В., Курушкина О. В. Метаболический синдром и распределение жировой ткани: точки соприкосновения и противоречивость взаимоотношений. Профилактическая медицина. 2010; 13: 22-5).