Type 1 diabetes and insulin resistance: estimated glucose disposal rate and its correlation with chronic complications
DOI:
https://doi.org/10.47196/diab.v51i2.53Keywords:
type 1 diabetes mellitus, insulin resistance, diabetes complicationsAbstract
Introduction: insulin resistance (IR) in type 1 diabetes (T1D) is associated with a higher risk of complications in these patients. The gold standard for measuring insulin sensitivity is the
hyperinsulinemic-euglycemic clamp although not used in clinical practice. The estimated glucose disposal rate (eGDR) has been validated to estimate insulin sensitivity.
Objectives: the objective was to correlate IR in T1D (eGDR), with macro and microvascular complications in patients assisted in a Diabetology Service.
Materials and methods: we performed a crosssectional study. The eGDR was calculated using HbA1c, waist circumference, and hypertensive status.
Results: 446 patients with prior clinical diagnosis of T1D were included. A 57% of patients were male; mean age 38 years and an average of 15 year evolution of diabetes. The patients in the lowest eGDR tertile (>IR) were older, with longer time of evolution, larger BMI, higher insulin doses, higher levels of triglycerides and LDL, and poorer metabolic control. They were more sedentary and had more use of statins, aspirin, ACE inhibitor or ARBs, and metformin. They showed higher prevalence of microvascular complications and higher cardiovascular disease (p<0.05). In the multivariate analysis, the lowest tertile patients
had the highest risk of nephropathy (OR 3.37 [95% CI 1.92-5.90]) and any complication of diabetes (OR 2.44 [95% CI 1.41-4.24]).
Conclusions: a lower eGDR was associated with higher presence of complications and comorbidities. This clinical tool could become useful to identify patients with higher risk of complications, in order to implement more aggressive strategies to control risk factors.
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