Insulin sensitivity and arterial stiffness in youth with type 1 diabetes: the SEARCH CVD study

Abstract

Aims: Decreased insulin sensitivity is a cardiovascular risk factor (CVRF) in youth with type 1 diabetes (T1D). Whether baseline insulin sensitivity is independently associated with changes in early arterial stiffness (pulse wave velocity (PWV)) over time in youth with T1D is not known.

Methods: Two hundred ninety-eight youth with T1D in the SEARCH CVD study had PWV measured~five years apart. Insulin sensitivity and other CVRFs were measured at baseline. The association between baseline insulin sensitivity with PWV over time was explored using linear mixed models. Models were adjusted for baseline age, sex and race, with subsequent adjustment for CVRFs.

Results: There was a significant interaction (p=0.0326) between baseline insulin sensitivity and time on PWV, independent of CVRFs, indicating that higher insulin sensitivity levels were associated with lower rate of change in PWV over time. Other significant predictors of PWV change were baseline age [β=0.007 (p=0.03) increase in logPWV/year increase in age] and mean arterial blood pressure (MAP) [β=0.005 (p<0.01) increase in logPWV/mmHg increase in MAP] and smoking status (current vs. never smoker).

Conclusions: Lower insulin sensitivity at baseline appears to be an important risk factor for increased arterial stiffness over time in youth with T1D. This identifies a potentially modifiable therapeutic target.

Keywords: Cardiovascular disease; Insulin resistance; Pediatrics; Pulse wave velocity; Type 1 diabetes.

Figure 1

Predicted log PWV over time by baseline quartile of insulin sensitivity, where time is based on diabetes duration. Data is adjusted for age, sex, race, body mass index z score, mean arterial pressure, LDL-C, HDL-C and albumin to creatinine ratio.