Síndrome metabólica, resistência à ação da insulina e doença cardiovascular no diabete melito tipo 1

Rodrigues, Ticiana da Costa; Canani, Luís Henrique Santos; Gross, Jorge Luiz

doi:10.1590/s0066-782x2010000100020

Cited by 22 publications

(15 citation statements)

References 72 publications

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“…Some theories propose the participation of inflammatory cytokines secreted by the adipose tissue, known to generate atherothrombosis in type 2 diabetes [24-26]. Other studies have associated the increasing insulin concentrations to the stimulation of 11 β- hydroxysteroid dehydrogenase, which modifies the differentiation from fibroblasts to adipocytes and transformation from cortisone to the highly active cortisol [27]. …”

Section: Discussionmentioning

confidence: 99%

Utility of the waist-to-height ratio, waist circumference and body mass index in the screening of metabolic syndrome in adult patients with type 1 diabetes mellitus

Ferreira‐Hermosillo

Ramírez‐Rentería

Mendoza‐Zubieta

et al. 2014

Diabetol Metab Syndr

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BackgroundThe incidence of macrovascular complications and morbidities associated to metabolic syndrome are increasing in patients with type 1 diabetes mellitus (T1DM). The combination of T1DM with features of insulin resistance similar to that of type 2 diabetes (T2DM), sometimes called “double diabetes”, has been associated with central obesity. Since the most methods to accurately detect body fat and insulin resistance are not readily available, we propose that certain indirect indexes for detecting obesity as waist-to-height ratio, waist circumference and body mass index, may be useful when screening for metabolic syndrome in patients with T1DM.MethodsWe performed a transversal evaluation (clinical and biochemical) in all the patients of the T1DM Clinic (n = 120). We determined the presence of metabolic syndrome according to the Joint Statement Criteria by the American Heart Association/ National Heart Lung and Blood Institute and the International Diabetes Federation and the utility of certain anthropometric indexes for predicting double diabetes was evaluated.ResultsThirty seven percent of the patients were considered to have metabolic syndrome using these criteria (n = 30). These patients were significantly older (p = 0.002), have a higher glycated hemoglobin (p = 0.036), cholesterol (p < 0.012) and triglyceride concentration (p < 0.01) as well as body mass index (p = 0.004), waist circumference (p = 0.01) and waist-to-height ratio (p < 0.01) than the group without metabolic syndrome. Also their c-HDL is lower (p < 0.01). A value of 0.52 for waist-to-height ratio correctly classified the largest number of patients (68% of correctly classified) well as the waist circumference (66% of correctly classified) with an adequate specificity and sensibility. Meanwhile the most precise body mass index value only classified correctly to 61% of patients.ConclusionOur data show that waist circumference and waist-to-height ratio indexes are useful to predict the presence of metabolic syndrome in adult patients with type 1 diabetes mellitus.

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Section: Discussionmentioning

confidence: 99%

Utility of the waist-to-height ratio, waist circumference and body mass index in the screening of metabolic syndrome in adult patients with type 1 diabetes mellitus

Ferreira‐Hermosillo

Ramírez‐Rentería

Mendoza‐Zubieta

et al. 2014

Diabetol Metab Syndr

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“…Furthermore, we confirmed that low eGDR is associated with an increased risk of diabetes vascular complications. Although the concept of IR among individuals with type 1 diabetes is not new (3–5), few studies have explored this phenomenon in nonwhite populations or assessed interethnic differences (6,16). To our knowledge, this is the first study of adults with type 1 diabetes that was adequately powered to analyze eGDR, demographic and metabolic confounders, and diabetes complications among three major ethnic groups.…”

Section: Discussionmentioning

confidence: 99%

“…The presence of insulin resistance (IR), a key feature of type 2 diabetes mellitus, has been demonstrated in epidemiologic and metabolic studies of type 1 diabetes and is associated with greater vascular risk in these patients (1–5). IR and type 2 diabetes are more common among certain racial or ethnic groups.…”

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confidence: 99%

Use of the Estimated Glucose Disposal Rate as a Measure of Insulin Resistance in an Urban Multiethnic Population With Type 1 Diabetes

et al. 2013

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OBJECTIVEInsulin resistance has been described in type 1 diabetes mellitus, is related to risk of vascular complications, and may be more common in certain ethnic groups. Estimated glucose disposal rate (eGDR) is a validated clinical tool for estimating insulin sensitivity in type 1 diabetes. Because previous reports of eGDR in adults with type 1 diabetes have included few ethnic minorities, this study explored interethnic differences in eGDR and the relationship of eGDR with diabetic vascular complications.RESEARCH DESIGN AND METHODSWe conducted a cross-sectional study using a sample that included 207 white, black, or Hispanic adults with prior clinical diagnosis of type 1 diabetes who were receiving care at an urban academic medical center. eGDR (milligrams per kilogram per minute) was calculated using HbA1c, waist circumference, and hypertensive status. Race/ethnicity was self-reported. Multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% CIs of association of eGDR with diabetes complications (cardiovascular disease, retinopathy, albuminuria, and chronic kidney disease above stage 3).RESULTSForty-two percent of the participants were women, and mean age was 45 ± 15 years; 34% were white, 32% were Hispanic, and 34% were black. Ethnicity was significantly associated with eGDR; blacks had significantly lower eGDR (5.66 ± 2.34) than Hispanics (6.70 ± 2.29) and whites (7.20 ± 2.03) (P < 0.001). Patients with the lowest eGDR compared with the highest had a significantly greater risk of any diabetes complication (OR 3.1 [95% CI 1.2–8.1]) compared with the least insulin-resistant patients.CONCLUSIONSIn an urban clinic population of patients with type 1 diabetes, blacks were significantly less insulin sensitive than whites or Hispanics, and lower eGDR was associated with diabetes complications. Further study is needed to determine whether using eGDR to target interventions can improve outcomes.

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“…Insulin resistance (IR) is defined as a defect in insulin action with consequent compensatory hyperinsulinemia to maintain normal glucose levels 1 . Insulin resistance occurs in many tissues including liver, muscle and adipose tissue 2 .…”

Section: Introductionmentioning

confidence: 99%

“…Insulin resistance occurs in many tissues including liver, muscle and adipose tissue 2 . An important contributor to IR is the presence of elevated serum levels of free fatty acids from the increased mobilization of triglycerides from adipose tissue 1 . Evidences suggest that aging is closely associated with insulin resistance and this is an important risk factor for diabetes, cardiovascular disease and other age-related diseases 3,4 .…”

Section: Introductionmentioning

confidence: 99%

Indicadores antropométricos na identificação de resistência à insulina em homens idosos

Anunciação

Ribeiro

2015

Mundo Saúde

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Insulin resistance (IR) increases with advancing age, yet the underlying mechanism is not well established. Anthropometric and body composition indicators are alternative tools for assessing insulin resistance in a fast, non-invasive and inexpensive way. This study aimed to evaluate the association between anthropometric indicators and insulin resistance in older men. This cross-sectional study included 62 men aged between 60 and 92 years. We evaluated waist circumference (WC), sagittal abdominal diameter (SAD), body mass index (BMI), sagittal index (SI), conicity index (CI), body fat percentage (BF%), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR) and waist-to-thigh ratio (WTR). IR was determined by homeostasis model assessment (HOMA-IR). Statistical analysis consisted of correlation coefficient. All anthropometric indicators correlated with HOMA-IR, highlighting the SAD (r = 0.680), BF% (r = 0.651) and WC (r = 0.591), which showed the highest correlations with the index. All measurements showed significant differences and progressive increase with increasing HOMA-IR. The differences between quartiles of HOMA-IR were even more pronounced for WC, SAD and BF%. BF% was a significant predictor for insulin resistance. Thus, obesity indicators correlated with the HOMA-IR index. We emphasize the stronger relationship between measures of central adiposity and insulin resistance, suggesting the usefulness of SAD in evaluating elderly subjects.Keywords: Elderly. Anthropometry. Body Composition. HOMA. ResumoA resistência à insulina (RI) aumenta com o avanço da idade, no entanto os mecanismos não estão bem estabelecidos. Os indicadores antropométricos e de composição corporal são instrumentos alternativos para a avaliação da resistência à insulina de maneira rápida, não-invasiva e de baixo custo. O objetivo deste estudo foi avaliar a associação entre os indicadores antropométricos e a resistência à insulina em homens idosos. Estudo transversal com 62 homens com idade entre 60 e 92 anos. Foram avaliados perímetro da cintura (PC), diâmetro abdominal sagital (DAS), índice de massa corporal (IMC), índice sagital (IS), índice de conicidade (ICO), percentual de gordura corporal (%GC) e as relações cintura-quadril (RCQ), cintura-estatura (RCE) e cintura-coxa (RCC). RI foi determinada pelo índice de resistência à insulina (HOMA-IR). Análises estatísticas consistiram de análises de correlação e regressão linear. Todos os indicadores antropométricos avaliados correlacionaram-se com o HOMA-IR, destacando-se o DAS (r = 0,680), o %GC (r = 0,651) e o PC (r = 0,591), que apresentaram as maiores correlações com o índice. Todos os indicadores apresentaram aumento progressivo e diferenças significativas com o aumento do HOMA-IR, sendo que para o PC, DAS e %GC as diferenças entre os quartis do HOMA-IR foram ainda mais acentuadas. %PC foi preditor significativo para resistência à insulina. Portanto, os indicadores de obesidade correlacionaram com o índice HOMA-IR. Ressalta-se a relação mais forte das medidas de adiposidade cen...

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Síndrome metabólica, resistência à ação da insulina e doença cardiovascular no diabete melito tipo 1

Cited by 22 publications

References 72 publications

Utility of the waist-to-height ratio, waist circumference and body mass index in the screening of metabolic syndrome in adult patients with type 1 diabetes mellitus

Utility of the waist-to-height ratio, waist circumference and body mass index in the screening of metabolic syndrome in adult patients with type 1 diabetes mellitus

Use of the Estimated Glucose Disposal Rate as a Measure of Insulin Resistance in an Urban Multiethnic Population With Type 1 Diabetes

Indicadores antropométricos na identificação de resistência à insulina em homens idosos

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