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

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 cutoff points for MS detection. Results: Thirty three percent of the patients were considered to have MS. The patients with MS had lower eGDR (5.

Comparison of waist-height ratio and other obesity indices in the prediction of diabetic peripheral neuropathy

“…Similarly, other reports have shown that WHtR is one of the obesity indices that best predicts hypertension, diabetes, and cardiovascular diseases ( 1 – 7 ). However, fewer reports have shown similar predictions of peripheral neuropathy by obesity indices ( 8 – 10 ).…”

Association of estimated glucose disposal rate and chronic diabetic complications in patients with type 1 diabetes

“…The identification of an eGDR cut‐off point associated with MS has been explored before. 23 , 24 For MS identification, Chillarón et al 4 reported that an eGDR level below 8.77 mg/kg/min had 100% sensitivity and 85.2% specificity, Ferreira‐Hermosillo et al 14 showed that a cut‐off value of 7.32 mg/kg/min had 85% sensitivity and 84% specificity. In our cohort, a lower cut‐off of eGDR (6.99 mg/kg/min) had a 90.5% sensitivity and 91.8% specificity to identify the presence of MS using the same criteria and with a similar prevalence of the MS (approximately 30%).…”

“…The estimated glucose disposal rate (eGDR) is an equation that includes clinical parameters measured in clinical practice to determine the degree of insulin sensitivity 9 . In addition, it has been associated and considered as a good discriminator of diabetic complications in T1D 4,12‐14 …”

“… 9 In addition, it has been associated and considered as a good discriminator of diabetic complications in T1D. 4 , 12 , 13 , 14 …”

“…9 In addition, it has been associated and considered as a good discriminator of diabetic complications in T1D. 4,[12][13][14] As the frequency for macro-and microvascular complications from diabetes is expected to rise, 15 effective and practical cardiovascular risk assessment and treatment is needed for T1D population. The aim of this study is to evaluate insulin resistance using the eGDR among adults with T1D with and without MS and to examine the performance of the eGDR for the identification of diabetic chronic complications.…”