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Issue 108 Item 6 Uncontrolled Type 1 Diabetes is a Fat Catabolic State

It is not a protein catabolic state as previously thought. Patients with uncontrolled type 1 diabetes have reduced total fat mass, but similar lean body soft tissue mass, at the time of diagnosis compared with healthy controls.

In the first year of insulin therapy, body weight increases by 6.5 percent, total fat mass increases by 13.3 percent and lean body mass increases by 4.9 percent, report investigators from the Department of Endocrinology at Hvidovre University Hospital in Copenhagen, Denmark.

The investigators assessed body composition in eight male and two female patients with newly onset type 1 diabetes. Patients were aged 31.5 ± 3.2 years with a body mass index of 20.8 ± 1.6 kg/m².

Dual-energy X-ray absorptiometry whole body scanning and total body water estimation by the isotope dilution technique were used to estimate body composition at diagnosis and after one, three, six and 12 months of insulin therapy.

At diagnosis, body composition data from the diabetes patients revealed a body weight 6.2 kilograms below the ideal and a total fat mass 25 percent below that of two reference populations – one from the Metropolitan Life Insurance Company and another group of healthy age- and sex-matched controls.

After insulin treatment, body weight increased 4.3 ± 2.9 kilograms distributed as a 13.3 percent increase in total fat mass and a 4.9 percent increase in lean body soft tissue mass.

These data suggest that, contrary to previous beliefs, uncontrolled diabetes is a fat catabolic state and not a protein catabolic state, the investigators conclude.
Diabet Med 2002; 19(5): 417-423.