Estimated insulin sensitivity, cardiovascular risk, and hepatic steatosis after 12 years from the onset of T1D.

Abstract

To test the hypothesis that intensive insulin treatment and optimal glycaemic control are not fully protective against reduction of insulin sensitivity in children with type 1 diabetes. Cohort study of 78 normal-weight patients with prepubertal onset (T0 ) and follow-up waves at 1 (T1 ), 5 (T5 ), 10 (T10 ), and 12 (T12 ) years; matched for age and sex to 30 controls at T12 . Estimated insulin sensitivity (eIS) by three formulae; ultrasound evaluation of para and perirenal fat thickness; hepatic steatosis (HS); carotid intima media thickness (cIMT) at T12 . At T12, the 36 patients (46%) who had constantly or prevalently haemoglobin A1c (HbA1c)<58mmol/l during follow-up showed better eIS indexes (p=0.049 to <0.0001); lipid profile (p=0.042 to <0.0001), reduced fat mass (p=0.012) and required lower insulin dose (p=0.032) than the 42 patients (54%) with HbA1c≥58 at T12. Patients (N=25) with eISEDC <8.77mgkg-1 min-1 showed higher cIMT (p<0.0001). HS was found in 6 patients (∼8%). In patients and normal-weight controls, fat mass (p=0.03), age (p=0.03), cIMT (p=0.05) predicted HS; eIS indexes (p from 0.04 to <0.0001) predicted cIMT. Body mass index, perirenal fat, fat mass, and triglycerides to high density lipoprotein cholesterol ratio were associated with eIS indexes (p from 0.03 to <0.0001). Young T1D patients have reduced insulin sensitivity and higher cIMT. Adiposity, glucose, and lipid control over follow-up are likely to influence both. Enhanced adiposity seems of paramount relevance for the onset of HS in T1D patients alike in healthy youths.