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.

OBJECTIVE: To investigate risk factors for the development of chronic kidney disease and death two years postliver transplantation. METHOD: Associations between clinical and laboratory parameters and the development of chronic kidney disease and survival two years post-liver transplant were analyzed in a cohort of 148 adult patients with hepatic cirrhosis consecutively submitted to liver transplantation in a referral Brazilian center. RESULTS: Median age at liver transplantation was 56 (range, 20-73) years, and 105 (70.9%) patients were males. The prevalence of chronic kidney disease at two years post-liver transplantation was: stage 1 or no chronic kidney disease, 27.5%; stage 2, 33.8%; stage 3, 34.6%; stages 4-5, 4.7%. Four variables were independently associated with the stage of chronic kidney disease two years after liver transplantation: (i) age (at liver transplantation), (ii) male gender, (iii) median tacrolimus levels in the first three months post-liver transplantation, and (iv) median of serum creatinine in the first six months post-liver transplantation. Two variables showed independent association with death in two years post-liver transplantation: (i) stay in Intensive Care Unit for three or more days after the liver transplantation surgery and (ii) median of serum creatinine levels in the first six months postliver transplantation equal or higher than 1.3 mg/dL. CONCLUSIONS: Administration of the lowest effective dose of tacrolimus and adoption of strategies to spare renal function are important measures to reduce the risk of late chronic kidney disease and death post-liver transplantation especially in high risk patients.