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Obesity, CVD also of concern in type 1 diabetes


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3 minutes

Yehuda Handelsman, MD
Yehuda Handelsman, MD

A Saturday afternoon symposium includes a timely debate about the use of type 2 diabetes medications that have proven cardiovascular (CV) benefits in type 1 diabetes patients to prevent atherosclerotic cardiovascular disease (CVD). The two-hour symposium, Obesity and Cardiovascular Disease in Type 1 Diabetes, begins at 4:00 p.m. ET.

The symposium will be similar to a session last year that explored how different drug classes helped prevent and treat CVD in type 2 diabetes patients, said Yehuda Handelsman, MD, Medical Director and Principal Investigator, The Metabolic Institute of America.

In a presentation before the debate, Dr. Handelsman will try to remove some of the confusion involved in managing CVD and CV risk in type 1 diabetes patients. While a lot of emphasis has been placed on CVD in type 2 diabetes, Dr. Handelsman and others believe that many type 1 diabetes patients also have a high risk for CVD. But clinical studies about the relationship between type 1 diabetes and CVD are lacking and there are no guidelines for clinicians to address CVD in type 1 diabetes patients.

“The obesity epidemic did not overlook people with type 1 diabetes,” Dr. Handelsman said. “People with type 1 diabetes have almost as much obesity as the rest of the population. With obesity, just like the rest of the population, they develop insulin resistance, visceral fat, hence metabolic syndrome, dyslipidemia, and other conditions that put them at a higher risk for cardiovascular disease. And being that this group has had diabetes for a longer time, that puts them at even further risk.”

Tina Costacou, PhD
Tina Costacou, PhD

Tina Costacou, PhD, Assistant Professor of Epidemiology, University of Pittsburgh Graduate School of Public Health, will discuss trends in obesity and other CV risk factors in type 1 diabetes patients. Obesity is increasing in type 1 diabetes patients, Dr. Costacou said, and obesity and its sequelae contribute to the development of vascular complications.

Health care providers treating type 1 diabetes patients need to know that obesity, even if it’s a result of insulin therapy, leads to adverse health outcomes. And for researchers, this knowledge may open up new avenues for study, such as finding the optimal way to reduce weight gain in patients intensively treated for type 1 diabetes, Dr. Costacou said.

“The adverse effects of obesity in the type 1 diabetes population are not well studied, although the evidence that exists suggests that it contributes to adverse health outcomes, just like in the general population and in type 2 diabetes,” she added. “However, how to counteract obesity in patients with type 1 diabetes is not as straightforward since intensive insulin therapy itself promotes weight gain.”

Sophia Zoungas, MBBS (Hons), PhD, FRACP
Sophia Zoungas, MBBS (Hons), PhD, FRACP

The session will conclude with a debate between Sophia Zoungas, MBBS (Hons), PhD, FRACP, Head of the School of Public Health and Preventive Medicine, Monash University, and Vivian A. Fonseca, MD, Professor of Medicine, Tullis–Tulane Alumni Chair in Diabetes, Chief of the Section of Endocrinology, and Assistant Dean for Clinical Research, Tulane University School of Medicine. Dr. Zoungas will argue in favor of using type 2 diabetes medications that have proven CV benefits in type 1 diabetes patients to prevent atherosclerotic cardiovascular disease and Dr. Fonseca will argue the opposite.

Early evidence is emerging for some medication classes, but there have been no definitive cardiovascular outcome trials (CVOTs) so far, and there are concerns about safety.

“The question remains do we wait for the large, definitive CVOTs, which may or may not come, or can we start using these agents at the very least in those with heart failure or chronic kidney disease where the underlying pathophysiology may be similar to those groups that have already been studied and the prognosis is poor?” Dr. Zoungas said.


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