Estimated Insulin Sensitivity and Cardiovascular Disease Risk Factors in Adolescents with and without Type 1 Diabetes

Abstract

Objective To test the hypothesis that cardiovascular disease (CVD) risk factors are similar in adolescents with and without diabetes (T1D) in the most insulin sensitive (IS) tertile and CVD risk factors are more atherogenic with decreasing IS in adolescents with T1D. Study design Adolescents with IS T1D (n=292; age=15.4±2.1 years; duration=8.8±3.0 years, HbA1c=8.9±1.6%) and non-diabetic (non-DM) controls (n=89; age=15.4±2.1 years) was estimated using the model: logeIS=4.64725 – 0.02032(waist, cm) – 0.09779(HbA1c, %) – 0.00235(triglycerides, mg/dl). CVD risk factors (blood pressure, fasting total, LDL and HDL-cholesterol, hs-CRP, and BMI Z-score) were compared between all non-DM adolescents and those with T1D in the most IS tertile, and then examined for a linear trend by IS tertile in adolescents with T1D, adjusted for sex, race/ethnicity and Tanner Stage. Results Estimated IS was significantly lower in adolescents with T1D compared with those without (T1D=7.8±2.4, non-DM=11.5±2.9; p<0.0001). CVD risk factors were similar for non-DM compared with the adolescents with most IS T1D, except for higher HDL-c and DBP in adolescents with T1D (p<0.05). Among adolescents with T1D, all CVD risk factors except for HDL-c, were more atherogenic across decreasing IS tertiles in linear regression analysis (p<0.05). Conclusion Adolescents with T1D who are the most IS have similar CVD risk factors compared with non-DM adolescents. CVD risk factors are inversely associated with adolescents with IS T1D. IS may be an important therapeutic target for reducing CVD risk factors in adolescents with T1D.

Obesity in Youth with Type 1 Diabetes in Germany, Austria, and the United States

“…Insulin resistance is increased in youth with T1D compared to non-diabetic youth of similar age, sex, and BMIz, especially in children who fail to achieve target HbA1c levels (31,32). As insulin resistance increases so do cardiovascular disease risk factors (33). Similarly, data from the DCCT/EDIC Page 11 of 23 study in adults with T1D indicate that excessive weight gain is associated with insulin resistance, hypertension, dyslipidemia, central obesity, and more extensive atherosclerosis (as assessed by coronary artery calcium and carotid intima media thickness) (5).…”

Insulin sensitivity and arterial stiffness in youth with type 1 diabetes: the SEARCH CVD study

“…Recent hyperinsulinemic-euglycemic clamp studies have shown that significant insulin resistance also exists in adolescents with T1D compared with age-, sex-, pubertal stage-, BMI and activity-matched controls (Nadeau et al, 2010). Using the same insulin sensitivity index used here, one study showed that nearly 33% of youth with T1D had insulin resistance (Specht et al, 2013). The mechanisms responsible for the association between insulin resistance and increased arterial stiffness in T1D are incompletely understood.…”

Serum uric acid and insulin sensitivity in adolescents and adults with and without type 1 diabetes

“…Insulin sensitivity is recognized to play an important role in the development of vascular complications in type 1 diabetes (2, 38, 39), and SUA has been shown to predict both the development of albuminuria (40–42) and progression of coronary artery calcification (19) in subjects with type 1 diabetes. In non-diabetic subjects and subjects with type 2 diabetes, there is a strong association between SUA and reduced insulin sensitivity.…”