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Comparative Study
. 2024 May 3;23(1):152.
doi: 10.1186/s12933-024-02234-x.

Insulin sensitivity estimates and their longitudinal association with coronary artery disease in type 1 diabetes. Does it matter?

Stefan Mutter  1   2   3 , Erika B Parente  1   2   3 , Andrzej S Januszewski  4   5 , Johan R Simonsen  1   2   3 , Valma Harjutsalo  1   2   3 , Per-Henrik Groop  6   7   8   9   10 , Alicia J Jenkins #  5   11 , Lena M Thorn #  1   3   12 ; FinnDiane Study Group
Affiliations
Comparative Study

Insulin sensitivity estimates and their longitudinal association with coronary artery disease in type 1 diabetes. Does it matter?

Stefan Mutter et al. Cardiovasc Diabetol. .

Abstract

Background: Insulin resistance and chronic kidney disease are both associated with increased coronary artery disease risk. Many formulae estimating glucose disposal rate in type 1 diabetes infer insulin sensitivity from clinical data. We compare associations and performance relative to traditional risk factors and kidney disease severity between three formulae estimating the glucose disposal rate and coronary artery disease in people with type 1 diabetes.

Methods: The baseline glucose disposal rate was estimated by three (Williams, Duca, and Januszewski) formulae in FinnDiane Study participants and related to subsequent incidence of coronary artery disease, by baseline kidney status.

Results: In 3517 adults with type 1 diabetes, during median (IQR) 19.3 (14.6, 21.4) years, 539 (15.3%) experienced a coronary artery disease event, with higher rates with worsening baseline kidney status. Correlations between the three formulae estimating the glucose disposal rate were weak, but the lowest quartile of each formula was associated with higher incidence of coronary artery disease. Importantly, only the glucose disposal rate estimation by Williams showed a linear association with coronary artery disease risk in all analyses. Of the three formulae, Williams was the strongest predictor of coronary artery disease. Only age and diabetes duration were stronger predictors. The strength of associations between estimated glucose disposal rate and CAD incidence varied by formula and kidney status.

Conclusions: In type 1 diabetes, estimated glucose disposal rates are associated with subsequent coronary artery disease, modulated by kidney disease severity. Future research is merited regarding the clinical usefulness of estimating the glucose disposal rate as a coronary artery disease risk factor and potential therapeutic target.

Keywords: Cardiovascular diseases; Coronary artery disease; Insulin resistance; Kidney disease; Type 1 diabetes mellitus.

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Conflict of interest statement

S.M. reports receiving lecture honoraria from Encore Medical Education. E.B.P. reports receiving lecture honorariums from Sanofi and Astra Zeneca. P.H.G. reports receiving lecture honorariums from Astellas, AstraZeneca, Bayer, Boehringer Ingelheim, Eli Lilly, Elo Water, Medscape, MSD, Mundipharma, Novo Nordisk, PeerVoice, Sanofi, Sciarc, and being an advisory board member of AbbVie, Astellas, AstraZeneca, Bayer, Boehringer Ingelheim, Eli Lilly, Medscape, MSD, Mundipharma, Nestlé, Novo Nordisk, and Sanofi. All other authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Cohort-wide hazard ratios for incident coronary artery disease by estimated glucose disposal rate formulae. Williams (A), Duca (B), Januszewski (C). D Compares all three formulae and shows the hazard ratio per score percentile
Fig. 2
Fig. 2
C-indexes for cardiovascular risk factors including estimated glucose disposal rate scores. For all individuals and separately for individuals in Kidney Disease Improving Global Outcomes risk categories low, moderate and high combined with very high
See this image and copyright information in PMC

References

    1. Donga E, Dekkers OM, Corssmit EP, Romijn JA. Insulin resistance in patients with type 1 diabetes assessed by glucose clamp studies: systematic review and meta-analysis. Eur J Endocrinol. 2015;173:101–109. doi: 10.1530/EJE-14-0911. - DOI - PubMed
    1. Thorn LM, Forsblom C, Fagerudd J, Thomas MC, Pettersson-Fernholm K, Saraheimo M, Waden J, Ronnback M, Rosengard-Barlund M, Bjorkesten CG, Taskinen MR, Groop PH, FinnDiane Study G Metabolic syndrome in type 1 diabetes: association with diabetic nephropathy and glycemic control (the FinnDiane study) Diabetes Care. 2005;28:2019–2024. doi: 10.2337/diacare.28.8.2019. - DOI - PubMed
    1. Ekstrand AV, Groop PH, Gronhagen-Riska C. Insulin resistance precedes microalbuminuria in patients with insulin-dependent diabetes mellitus. Nephrol Dial Transplant. 1998;13:3079–3083. doi: 10.1093/ndt/13.12.3079. - DOI - PubMed
    1. Linn W, Persson M, Rathsman B, Ludvigsson J, Lind M, Andersson Franko M, Nystrom T. Estimated glucose disposal rate is associated with retinopathy and kidney disease in young people with type 1 diabetes: a nationwide observational study. Cardiovasc Diabetol. 2023;22:61. doi: 10.1186/s12933-023-01791-x. - DOI - PMC - PubMed
    1. Martin FI, Hopper JL. The relationship of acute insulin sensitivity to the progression of vascular disease in long-term type 1 (insulin-dependent) diabetes mellitus. Diabetologia. 1987;30:149–153. doi: 10.1007/BF00274219. - DOI - PubMed

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