Prevalence of Insulin Resistance and Metabolic Syndrome in Pediatric Patients with Type 1 Diabetes Mellitus and Its Association with Macrovascular Complications

Abstract

Background Insulin resistance (IR) is an independent risk factor for the development of micro and macrovascular diseases in both type 2 diabetes (T2DM) and type 1 diabetes (T1DM) patients. Objective To assess the frequency of insulin resistance and metabolic syndrome among pediatric patients with T1DM and highlight the factors associated with both. Subjects and Methods Analytical cross-sectional study, including eighty (80) patients with T1DM divided into two equal groups according to body mass index(BMI) (Group1= 40 patients with normal BMI, Group 2= 40 obese or overweight patients). Both groups were subjected to: Detailed history, through clinical examination with special emphasis on assessment of Insulin Resistance and Metabolic Syndrome. Carotid intima media thickness (CMIT) was assessed as a marker of macrovascular complication. Results In group 2, (93%) of participants showed manifestations of metabolic syndrome Also, the same group showed significantly higher HbA1c (P < 0.05) and waist/ hip ratio (P < 0.05). Estimated glucose disposal rate formula (eGDR) (5.49 ± 3.53) were significantly lower in group 2 compared with group 1 (10.51 ± 2.20) (P < 0.05).The best cut-off value of eGDR for prediction of IR among patients with T1DM was < 7.15 mg/kg/min. CIMT was significantly higher in group 2 (0.93 ± 0.13) compared to group 1 (0.66 ± 0.09) (P < 0.05). Furthermore, there was a strong negative correlation between eGDR and CIMT. Conclusion Overweight and obese youth with T1DM had significantly higher prevalence of components of metabolic syndrome including insulin resistance. A specific novel finding of this study is the relationship between eGDR and macrovascular complications.