Abstract
ObjectiveTo assess the presence of insulin resistance (IR) in patients with type 1 diabetes (T1DM) according to the estimated glucose disposal rate formula (eGDR) and the insulin sensitivity score (ISS) and to estimate the correlation between these two measures and identify the clinical and laboratory markers related to IR.Research design and methodsCross-sectional study of adults with T1DM (n = 135). The results of the formulas that estimate IR were separated into quartiles and correlated with demographic data, clinical characteristics and laboratory parameters. We analyzed the total and regional adiposity by dual-energy X-ray absorptiometry and skin fold thickness measurements.ResultsTwo thirds of the patients were overweight or obese. A moderate correlation was found between eGDR and ISS (r = 0.612). The results of both formulas were positively correlated with BMI (r = −0.373 eGDR and r = −0.721 ISS), thoracic-abdominal fat (r = −0.484 eGDR and r = −0.758 ISS), waist/height ratio (r = −0.537 eGDR and r = −0.779 ISS), subscapular skinfold (mm) (r = −0.356 eGDR and r = −0.569 ISS), total dose insulin IU/lean mass (kg) (r = −0.279 eGDR and r = −0.398 ISS), age (years) (r = −0.495 eGDR and r = −0.190 ISS) and diabetes duration (years) (r = −0.428 eGDR and r = −0.187 ISS).A moderate agreement (Kappa 0.226) was observed between the 1st quartile of results determined by the formulas in 10.4% of the patients, but the 4th quartile presented a strong correlation (Kappa 0.679). The individuals with IR that were classified in the 1st quartile by the ISS formula had a higher chance of presenting with acanthosis nigricans (OR = 5.58, 95% CI =1.46-21.3).ConclusionsThe correlations found in this study indicate the possibility of using clinical and laboratory data to estimate IR in patients with TDM1. The detection of IR in T1DM patients may allow early intervention and possibly impact on future diabetes complications.
Highlights
An extensive amount of literature that explores insulin resistance (IR) and adiposity in populations of non-diabetic and type 2 diabetic patients suggests that regional adiposity may be an important determining factor of IR [1,2,3,4,5,6]
A moderate correlation was found between estimated glucose disposal rate formula (eGDR) and insulin sensitivity score (ISS) (r = 0.612). The results of both formulas were positively correlated with body mass index (BMI) (r = −0.373 eGDR and r = −0.721 ISS), thoracic-abdominal fat (r = −0.484 eGDR and r = −0.758 ISS), waist/height ratio (r = −0.537 eGDR and r = −0.779 ISS), subscapular skinfold (r = −0.356 eGDR and r = −0.569 ISS), total dose insulin IU/lean mass (r = −0.279 eGDR and r = −0.398 ISS), age (r = −0.495 eGDR and r = −0.190 ISS) and diabetes duration (r = −0.428 eGDR and r = −0.187 ISS)
The individuals with IR that were classified in the 1st quartile by the ISS formula had a higher chance of presenting with acanthosis nigricans (OR = 5.58, 95% CI =1.46-21.3)
Summary
An extensive amount of literature that explores insulin resistance (IR) and adiposity in populations of non-diabetic and type 2 diabetic patients suggests that regional adiposity may be an important determining factor of IR [1,2,3,4,5,6]. IR is traditionally related to type 2 diabetes (T2DM), but its association with T1DM is well documented [7,8,9,10,11]. In individuals at risk for T1DM, increased IR concomitant to the decrease in beta-cell mass can alter the balance between insulin sensitivity (IS) and secretion which precipitates hyperglycemia [12]. This imbalance could result in a more aggressive form of the autoimmune disorder, mediated by immunoinflammatory factors common to both processes, that mediates both IR and the destruction of beta cells, such as TNF-α and IL-6 [13]. IR is an independent risk factor for the development of micro and macrovascular diseases in both T2DM and T1DM patients [7,21]
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