The metabolic syndrome traits differentially and cumulatively influence micro- and macrovascular disease risk in patients with type 1 diabetes

Benjamin O; Alexander Henney; Conor Gillespie

doi:10.1530/endoabs.109.P97

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Endocrine Abstracts (2025) 109 P97 | DOI: 10.1530/endoabs.109.P97

SFEBES2025 Poster Presentations Metabolism, Obesity and Diabetes (68 abstracts)

The metabolic syndrome traits differentially and cumulatively influence micro- and macrovascular disease risk in patients with type 1 diabetes

Benjamin O’Connor ¹ , Alexander Henney ² & Conor Gillespie ³

Author affiliations

¹Watford General Hospital, West Hertfordshire NHS Trust, Watford, United Kingdom; ²Aintree Hospital, Liverpool University NHS Trust, Liverpool, United Kingdom; ³Addenbrooke’s Hospital, University of Cambridge NHS Trust, Cambridge, United Kingdom

Introduction: The impact of the metabolic syndrome (MetS) traits on micro- and macrovascular complications of type 1 diabetes (T1D) is poorly understood. Therefore, we aimed to use large cohort data to determine which MetS component was most associated with micro- and macrovascular disease in T1D patients, whilst assessing whether additional components incrementally increased risk.

Methods: We conducted a retrospective cohort study using anonymised data from TriNetX, a global federated database. The exposure arm was T1D patients (defined via International Classification of Diseases, 10th Revision coding), and ≥1 MetS components (obesity/central adiposity, hypertension, or dyslipidaemia), compared with a reference arm of T1D patients without any MetS components. We propensity score matched (1:1) for confounders with 5 years follow-up. Primary outcomes included microvascular (peripheral neuropathy, retinopathy, and nephropathy) and macrovascular (cardiovascular and cerebrovascular events) disease. Secondary analyses assessed the impact of additional MetS components on these outcomes.

Results: T1D plus hypertension was associated with the highest risk of micro- (n 17,800, (HR 1.60 [95% CI 1.42, 1.81])) outcomes, whereas T1D plus dyslipidaemia was associated with the highest risk of and macrovascular (n = 14,829 (HR 1.69 [95% CI 1.46, 1.95])) disease when assessing the MetS components differentially. T1D and all MetS components was associated with the highest overall risk of micro- (n = 12,269 (HR 1.78 [95% CI 1.55, 2.03])) and macrovascular (n = 9,642 (HR 3.51 [95% CI 3.08, 4.00])) disease.

Conclusion: We demonstrate a differential and cumulative association between the MetS and risk of microvascular and macrovascular disease in T1D patients. Hypertension complicating T1D was associated with the highest individual risk of micro- and macrovascular disease, although the greatest risk was seen in those with all MetS components. Early identification of MetS in T1D should be prioritised and include screening of high-risk patients and consideration of dual medical therapy.