Insulin sensitivity and complications in type 1 diabetes：New insights

Despite improvements in glucose, lipids and bloodpressure control, vascular complications remain themost important cause of morbidity and mortality inpatients with type 1 diabetes. For that reason, there is aneed to identify additional risk factors to utilize in clinicalpractice or translate to novel therapies to preventvascular complications. Reduced insulin sensitivityis an increasingly recognized component of type 1diabetes that has been linked with the developmentand progression of both micro- and macrovascularcomplications. Adolescents and adults with type 1diabetes have reduced insulin sensitivity, even whencompared to their non-diabetic counterparts of similaradiposity, serum triglycerides, high-density lipoproteincholesterol, level of habitual physical activity, and inadolescents, pubertal stage. Reduced insulin sensitivityis thought to contribute both to the initiation andprogression of macro- and microvascular complicationsin type 1 diabetes. There are currently clinical trialsunderway examining the benefits of improving insulinsensitivity with regards to vascular complications in type1 diabetes. Reduced insulin sensitivity is an increasinglyrecognized component of type 1 diabetes, is implicatedin the pathogenesis of vascular complications and ispotentially an important therapeutic target to preventvascular complications. In this review, we will focus onthe pathophysiologic contribution of insulin sensitivity tovascular complications and summarize related ongoingclinical trials.