Recent Developments

There is a complex relationship between cardiovascular risk factors and the risk of developing diabetes. Recent data from the Insulin Resistance Atherosclerosis Study2 suggest that the presence of cardiovascular risk factors including hypertriglyceri-daemia and low HDL-cholesterol predict development of type 2 diabetes (Figure 30.1). The greater the number of risk factors, the greater the risk. It is uncertain whether specific interventions to improve these risk factors will prevent diabetes developing but, given the relationship between triglycerides and insulin resistance, this approach should be pursued.

Increased tissue levels of triglyceride are associated with insulin resistance and other features of metabolic syndrome. Magnetic resonance spectroscopy studies demonstrate hepatic lipid accumulation in vivo in obese patients with type 2 diabetes,3 and the presence of elevated serum hepatic transaminase levels in the West of Scotland Coronary Prevention Study (WOSCOPS) predicted development of type 2 diabetes.4 Also, triglyceride accumulation in skeletal muscle impairs the efficiency of substrate utilization and contributes to peripheral insulin resistance.

Interaction between components of the diet and genes involved in the pathogenesis of metabolic syndrome is an area of research interest. For example, polyunsaturated fatty acids and a common polymorphism of the PPAR-7 gene interact to regulate peripheral levels of triglyceride. Further study in this area may identify more effective dietary manipulations and therapies tailored to individual genotype.5

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