OBJECTIVE -The aim of this study was to estimate the prevalence of the metabolic syndrome in Finnish type 1 diabetic patients and to assess whether it is associated with diabetic nephropathy or poor glycemic control.RESEARCH DESIGN AND METHODS -In all, 2,415 type 1 diabetic patients (51% men, mean age 37 years, duration of diabetes 22 years) participating in the nationwide, multicenter Finnish Diabetic Nephropathy (FinnDiane) study were included. Metabolic syndrome was defined according to the National Cholesterol Education Program diagnostic criteria. Patients were classified as having normal albumin excretion rate (AER) (n ϭ 1,261), microalbuminuria (n ϭ 326), macroalbuminuria (n ϭ 383), or end-stage renal disease (ESRD) (n ϭ 164). Glycemic control was classified as good (HbA 1c Ͻ7.5%), intermediate (7.5-9.0%), or poor (Ͼ9.0%). Creatinine clearance was estimated with the Cockcroft-Gault formula.RESULTS -The overall prevalence of metabolic syndrome was 38% in men and 40% in women. The prevalence was 28% in those with normal AER, 44% in microalbuminuric patients, 62% in macroalbuminuric patients, and 68% in patients with ESRD (P Ͻ 0.001). Patients with metabolic syndrome had a 3.75-fold odds ratio for diabetic nephropathy (95% CI 2.89 -4.85), and all of the separate components of the syndrome were independently associated with diabetic nephropathy. The prevalence of metabolic syndrome was 31% in patients with good glycemic control, 36% in patients with intermediate glycemic control, and 51% in patients with poor glycemic control (P Ͻ 0.001). Similarly, metabolic syndrome increased with worsening creatinine clearance.CONCLUSIONS -The metabolic syndrome is a frequent finding in type 1 diabetes and increases with advanced diabetic nephropathy and worse glycemic control.

Aims/hypothesis. The incidence of Type 1 diabetes has increased 2.5 times during the time period from 1966 to 2000 in Finland -a general trend seen in almost all developed countries that can only be explained by environmental factors. The aim of this study was to test the possible effect of a changing environment on distribution of genotypes associated with disease susceptibility. Methods. HLA DRB1-DQA1-DQB1 genes and two diabetes-associated polymorphisms at IDDM2 and IDDM12 were analyzed. The frequencies of genotypes were compared between cases diagnosed with childhood-onset Type 1 diabetes during the period of 1939-1965 (n=367) and those diagnosed between 1990 and 2001 (n=736). Chi-square statistics or the Fisher's Exact test were used for the comparison of frequencies of analyzed haplotypes and genotypes in the two groups.

OBJECTIVE -To elucidate whether serum adiponectin is associated with renal function, low-grade inflammatory markers, metabolic control, and insulin resistance in type 1 diabetic patients with and without nephropathy. RESEARCH DESIGN AND METHODS-A total of 189 type 1 diabetic patients from the Finnish Diabetic Nephropathy Study were divided into three groups based on their urinary albumin excretion rate (AER): patients with normal AER (n ϭ 66) had no antihypertensive medication, while patients with microalbuminuria (n ϭ 63) or macroalbuminuria (n ϭ 60) were all treated with an ACE inhibitor. Renal function was estimated with the Cockcroft-Gault formula. Adiponectin was measured by an in-house time-resolved immunofluorometric assay.RESULTS -Adiponectin concentrations were higher in women than in men, but since there was no significant difference in sex distribution between the groups, data were pooled. Adiponectin concentrations were higher in patients with macroalbuminuria (19.8 Ϯ 12.0 mg/l) than in patients with microalbuminuria (13.1 Ϯ 4.8 mg/l) or normoalbuminuria (11.8 Ϯ 4.2 mg/l). In a univariate analysis, adiponectin was positively associated with creatinine (r ϭ 0.41; P Ͻ 0.0001), AER (r ϭ 0.33; P Ͻ 0.0001), interleukin-6 (r ϭ 0.22; P ϭ 0.002), systolic blood pressure (r ϭ 0.22; P ϭ 0.004), HbA 1c (r ϭ 0.17; P ϭ 0.02), total cholesterol (r ϭ 0.16; P ϭ 0.03), and HDL cholesterol (r ϭ 0.16; P ϭ 0.03) and negatively with estimated glomerular filtration rate (GFR; r ϭ Ϫ0.52; P Ͻ 0.0001) and waist-to-hip ratio (WHR; r ϭ Ϫ0.16; P ϭ 0.03). In a multiple linear regression analysis including the above variables, estimated GFR, AER, and WHR were independently associated with adiponectin levels (r 2 ϭ 0.32).CONCLUSIONS -Serum adiponectin concentrations are increased in type 1 diabetic patients with nephropathy, and levels are further associated with renal insufficiency. Diabetes Care 28:1410 -1414, 2005D iabetic nephropathy is associated with insulin resistance and low-grade inflammation in type 1 diabetes (1,2). Circulatory levels of adiponectin, a hormone that is secreted exclusively from the adipocytes (3), correlate negatively with insulin resistance (4 -6), serum triglycerides, fasting serum insulin, and fasting plasma glucose concentrations (5-7). Low plasma adiponectin concentrations are found in obesity (8,9), type 2 diabetes (7,8), and in patients with coronary artery disease (7,10). Women have higher adiponectin concentrations than men (6,7), a difference that may be explained by the effect of testosterone (11). Weight reduction increases adiponectin in both diabetic and nondiabetic subjects (7). Interestingly, the thiazolidinediones (peroxisome proliferatoractivated receptor ␥ agonists) have emerged as an effective treatment for insulin-resistant states (12), and one of the mechanisms may be their ability to stimulate adiponectin synthesis (13,14).The fact that adiponectin may have an anti-inflammatory effect is supported by the reciprocal association between adiponectin and C-reactive protein (CRP) in pat...