Insulin resistance and risk of vascular events, interventions and mortality in type 1 diabetes
Helmink, Marga A G; de Vries, Marieke; Visseren, Frank L J; de Ranitz, Wendela L; de Valk, Harold W; Westerink, Jan
(2021) European Journal of Endocrinology, volume 185, issue 6, pp. 831 - 840
(Article)
Abstract
Objective: To identify determinants associated with insulin resistance and to assess the association between insulin resistance and cardiovascular events, vascular interventions and mortality in people with type 1 diabetes at high risk of cardiovascular disease. Design: Prospective cohort study. Methods: One hundred and ninety-five people with type 1 diabetes from
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the Secondary Manifestations of ARTerial disease (SMART) cohort were included. Insulin resistance was quantified by the estimated glucose disposal rate (eGDR) with higher eGDR levels indicating higher insulin sensitivity (i.e. lower eGDR levels indicating higher insulin resistance). Linear regression models were used to evaluate determinants associated with eGDR. The effect of eGDR on cardiovascular events, cardiovascular events or vascular interventions (combined endpoint) and on all-cause mortality was analysed using Cox proportional hazards models adjusted for confounders. Results: In 195 individuals (median follow-up 12.9 years, IQR 6.7-17.0), a total of 25 cardiovascular events, 26 vascular interventions and 27 deaths were observed. High eGDR as a marker for preserved insulin sensitivity was independently associated with a lower risk of cardiovascular events (HR: 0.75; 95% CI: 0.61-0.91), a lower risk of cardiovascular events and vascular interventions (HR: 0.74; 95% CI: 0.63-0.87) and a lower risk of all-cause mortality (HR: 0.81; 95% CI: 0.67-0.98). Conclusions: Insulin resistance as measured by eGDR is an additional risk factor for cardiovascular disease in individuals with type 1 diabetes. Modification of insulin resistance by lifestyle interventions or pharmacological treatment could be a viable therapeutic target to lower the risk of cardiovascular disease.
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Keywords: Adult, Amputation/statistics & numerical data, Aortic Aneurysm, Abdominal/mortality, Aortic Rupture/mortality, Cardiovascular Diseases/epidemiology, Cause of Death, Cohort Studies, Diabetes Mellitus, Type 1/epidemiology, Female, Heart Failure/mortality, Humans, Insulin Resistance, Linear Models, Male, Middle Aged, Mortality, Myocardial Infarction/epidemiology, Myocardial Revascularization/statistics & numerical data, Proportional Hazards Models, Prospective Studies, Stroke/epidemiology, Subarachnoid Hemorrhage/epidemiology, Vascular Surgical Procedures/statistics & numerical data, Young Adult, Endocrinology, Diabetes and Metabolism, Endocrinology, Journal Article
ISSN: 0804-4643
Publisher: BioScientifica Ltd.
Note: Publisher Copyright: © 2021 European Society of Endocrinology.
(Peer reviewed)