Insulin resistance and associated factors in patients with Type 1 Diabetes

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.

Comparison of indirect markers of insulin resistance in adult patients with Double Diabetes

“…Indeed, it seems that patients with T1D have a decreased insulin sensitivity in liver tissue (defined in the HEC as a decreased insulin-stimulated suppression of endogenous glucose production), and an increased IR in muscle (observed in the HEC as a lower whole-body glucose disposal even in the presence of lower intrahepatic fat content) and in adipose tissue (observed due impaired insulin-mediated suppression of lipolysis with subsequent increase of free fatty acids and glycerol levels) [6,32], in comparison with healthy controls. On the other hand, it has been proposed that IR is related with glucometabolic control, diabetes duration (more than 10 years) and ethnicity [33,34]. However, those variables were not different among patients with T1D and "double diabetes" in our study.…”

Postexercise Glycemic Control in Type 1 Diabetes Is Associated With Residual β-Cell Function

“…Authors from previous secondary analysis of glycemic control during and after exercise have postulated that insulin resistance may play a role in the interindividual variability ( 28 ). As a longer duration of diabetes is associated with increased insulin resistance ( 29 ), and the Cpep high group had a lower mean duration, this study cannot rule out the role that insulin resistance plays in postexercise glycemic control. However, it is important to note that the mean ± SD BMI (25.22 ± 3.73 kg/m 2 ), total daily insulin dose (41.77 ± 23.40 units), and dose per kilogram (0.55 ± 0.24 units/kg/day) were comparable across groups and were not high enough to indicate insulin resistance.…”

Insulin Resistance in Type 1 Diabetes Mellitus and Its Association with Patient’s Micro- and Macrovascular Complications, Sex Hormones, and Other Clinical Data

“…eGDR was significantly lower in smokers, male patients aged 50 years or more, and in long-standing T1D. Older age and long evolution of diabetes are factors known to be associated with IR as shown in numerous studies [31,40,41]. A possible explanation for these associations, according to Teixeira et al, is hypertension, a component of the eGDR formula that is more prevalent in patients with T1D after several years of the disease.…”