Surrogate markers of metabolic syndrome and insulin resistance in children and young adults with type 1 diabetes: a systematic review & meta-analysis (MetS and IR in T1DM)

Abstract

Objective: Metabolic syndrome (MetS) and insulin resistance (IR) are associated with diabetes. Insulin therapy in type 1 diabetes (T1DM) may complicate the diagnosis of both these conditions. Therefore, investigation of the diagnostic efficacy of MetS and IR components is important in paediatric population with type 1 diabetes mellitus (T1DM). Methods: SCOPUS, Web of Science, and PubMed were searched for studies that have MetS and IR in paediatric populations with T1DM. We assessed the strength of association for MetS and IR components. A random effect model was used for the meta-analysis and the effect size was reported in terms of Hedge’s g. Results: A total 30 studies were identified relevant to our systematic search. Insulin dosage and HbA1c, markers for glycemic condition showed very small effect on MetS with T1DM. In the lipid profile, triglyceride (TG) and low-density lipoprotein (LDL) showed better effect size than high-density lipoprotein (HDL). In case of IR, heterogeneous nature of studies made it difficult to carry out a meta-analysis. A descriptive review of existing and novel markers is thus provided. Conclusion: In children with T1DM, lack of association between markers of glycemic condition suggested that MetS may develop independent of glycemic level. Other than TG and HDL, LDL may be used in the diagnosis of MetS. A universally accepted diagnosis protocol would enhance accuracy and comparability across research and clinical settings, as observed in the descriptive review.