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. 2020 Jun 15;20(1):87.
doi: 10.1186/s12902-020-00570-z.

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

Aldo Ferreira-Hermosillo  1 , Raúl Ibarra-Salce  2 , Joshua Rodríguez-Malacara  3 , Mario Antonio Molina-Ayala  2
Affiliations

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

Aldo Ferreira-Hermosillo et al. BMC Endocr Disord. .

Abstract

Background: The presence of insulin resistance (IR) and metabolic syndrome (MS) in patients with type 1 diabetes (T1D) has been called "double diabetes". This entity increases the risk for development of micro and macrovascular complications and cardiovascular mortality. The gold standard for IR quantification is the hyperinsulinemic euglycemic clamp (HEC) but it is invasive, time-consuming and not available in the majority of the clinical settings. Because of this, some formulas for IR quantification have been proposed. We aimed to compare the utility of those methods for MS detection in patients with T1D.

Methods: We conducted a cross-sectional study in 112 patients with T1D and determined the presence of MS using the Joint Statement Criteria. We calculated the estimated glucose disposal rate (eGDR), estimated insulin sensitivity index (eIS), natural logarithm of glucose disposal rate (lnGDR), triglyceride/high-density lipoprotein cholesterol ratio (TG/HDL-c), visceral adipose index (VAI) and waist-to-height ratio (WHtR), and compared among patients with and without MS using Student t-test or Mann-Whitney U test. Receiver Operating Characteristics curves for the different indexes were used to identify the best cut-off points for MS detection.

Results: Thirty three percent of the patients were considered to have MS. The patients with MS had lower eGDR (5.49 [4.37-6.80] vs. 8.93 [8.03-9.94] mg/kg/min), eIS (2.89 [1.54-3.54] vs. 3.51 [2.68-4.68]) and lnGDR (1.69 ± 0.27 vs. 1.95 ± 0.21 mg/kg/min), and higher WHtR (0.55 ± 0.05 vs. 0.50 ± 0.05), VAI (3.4 [1.92-5.70] vs. 1.39 [0.97-1.92]) and TG/HDL-c (3.78 [2.63-5.73] vs. 1.77 [1.18-2.75]) in comparison with patients without MS. The cut-off points of TG-HDL-c > 2.0, eGDR < 7.32 mg/kg/min, lnGDR < 1.8 mg/kg/min, VAI > 1.84, WHtR > 0.52 and eIS < 2.92 had a sensitivity of 86, 85, 82, 77 and 70% respectively, for MS detection. The TG/HDL-c, lnGDR and eIS sensitivity changed depending on sex meanwhile eGDR, WHtR and VAI did not need adjust by sex.

Conclusion: Our data show that an eGDR < 7.32 mg/kg/min have the highest sensitivity and specificity to detect the presence of MS in patients with T1D.

Keywords: Diabetes mellitus, type 1; Insulin resistance; Metabolic syndrome.

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Conflict of interest statement

AFH is an Associate Editor of this journal, and he had no role in the handling of the manuscript through publication. The other authors declare that they have no competing interests.

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