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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