Could Help Diabetics
Avoid Heart Damage
Adam
Marcus
HealthSCOUT
Although it might sound hard to
believe, many diabetics may soon be grateful for an IRS audit.
University of
Pittsburgh researchers have devised a checklist of risk factors that
accurately reflects a patient's risk of having Insulin Resistance
Syndrome (IRS), a condition that could predispose some diabetics to
heart disease later in life. A report on the new screening tool
appears in the April issue of Diabetes.
Roughly 1 million
Americans suffer from Type I diabetes, which occurs when the pancreas
doesn't produce enough insulin, the hormone that controls how cells
extract sugar from blood. Another 15 million have Type II, or insulin
resistant, diabetes, in which their muscle, liver and fat cells become
insensitive to the hormone.
Researchers are now
coming to understand that some patients with Type I diabetes are also
at risk for the second form, which generally sets in during middle
age.
Studies, too, have
suggested that insulin resistance undermines the health of blood
vessels, predisposing patients to arterial disease that eventually
becomes the leading cause of death among diabetics.
Knowing a patient is
likely to have insulin resistance allows them to carefully monitor
their blood sugar and keep their condition in check through exercise,
diet and, if necessary, medication.
The question,
however, is how to diagnose people leaning toward insulin resistance
before it becomes a full-blown problem.
The current gold
standard for gauging insulin resistance is the euglycemic
hyperinsulinemic clamp, a three-hour marathon measurement whose
ultimate goal is the "glucose disposal rate" -- essentially the pace
at which the body processes a given amount of blood sugar. But the
clamp is available only as a research procedure, not an office tool.
New test simpler,
quicker
The latest screening method, on the other hand, could give
doctors an accurate rundown of a diabetic's risk of insulin resistance
in a quick office visit.
The IRS score
factors in the patients' blood pressure, their waist-to-hip hip ratio
-- a gauge of abdominal fat that's known to predict insulin resistance
-- and their blood counts of triglyceride and HDL cholesterol (the
"good" cholesterol). It also ranks patients for their family history
of type II diabetes and their vigilance at watching their blood sugar.
In the latest work,
Dr. Trevor Orchard and his colleagues tested the predictive powers of
their IRS score in 24 Type I diabetics.
Subjects who scored
high on the IRS also had the most difficulty processing glucose. And
those who scored highest in three categories -- blood pressure,
abdominal fat and family history of Type II diabetes -- had
particularly troubling clamp readings.
"This subgroup
probably needs specific management aimed at lowering their insulin
resistance and controlling their blood sugar," Orchard says.
What To Do
But Dr. Marian Parrott, a spokeswoman for the American Diabetes
Association, says the finding probably has more academic than
practical interest. People with diabetes shouldn't be overweight, and
they shouldn't have high blood pressure, so a tool to identify those
factors merely underscores sound medical care.
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