Insulin resistance is associated with all chronic complications in type 1 diabetes.

Background Insulin resistance (IR) is present in type 1 diabetes mellitus (T1DM) and is suggested to be related to chronic diabetic complications. The primary aim of our study was to assess IR in T1DM patients with and without chronic complications. A secondary aim was to evaluate the possible association between IR and chronic diabetic complications. Methods This cross-sectional study enrolled 272 patients with T1DM. Insulin resistance was quantified using the estimated glucose disposal rate (eGDR). Associations between eGDR and each diabetes complication were first evaluated using binary logistic regression, then multiparametric logistic regression with stepwise selection of covariates. The discriminative value of eGDR was assessed by receiver operating characteristic (ROC) curve analysis. Results Estimated GDR was lower in patients with chronic diabetic complications (6.1 vs 6.9 mg/kg per min [P = 0.02] for retinopathy; 6.3 vs 7.3 mg/kg per min [P < 0.01] for nephropathy; 6.5 vs 7.6 mg/kg per min [P < 0.01] for neuropathy; and 5.2 vs 7.5 mg/kg per min [P < 0.01] for cardiovascular complications). In univariate analysis eGDR was associated all diabetic complications. These associations remained significant after adjustment for different variables in the final regression models. In addition, eGDR was a good discriminator for each diabetic complication, with an area under the curve between 0.609 and 0.759. Conclusions Patients with chronic diabetic complications are more insulin resistant than those without complications. Moreover, IR was independently associated with the presence of each chronic diabetic complication, and seems to be a good discriminator for them all. 摘要 背景 1型糖尿病若存在胰岛素抵抗(Insulin resistance,IR)则提示与慢性糖尿病并发症相关。我们研究的主要目的是评估合并或者不合并慢性并发症的1型糖尿病患者的IR。次要目的是评估IR与慢性糖尿病并发症之间可能存在的关系。 方法 这项横向研究纳入了272名1型糖尿病患者。使用预估葡萄糖处置率(estimated glucose disposal rate,eGDR)来量化胰岛素抵抗。首先使用二元对数回归法,接着使用多参数对数回归法(逐步选择协变量)来评估eGDR与每种糖尿病并发症之间的关系。使用受试者工作特征曲线分析法来评估eGDR的鉴别价值。 结果 合并慢性糖尿病并发症的患者预估的GDR更低(对于视网膜病变来说,分别为6.1与6.9 mg/kg每分钟[P = 0.02] ;对于肾病来说,分别为6.3与7.3 mg/kg/分钟[P < 0.01];对于神经病变来说,分别为6.5与7.6 mg/kg每分钟[P < 0.01];对于心血管并发症来说,分别为5.2与7.5 mg/kg每分钟[P<0.01])。在单变量分析中eGDR与所有的糖尿病并发症都相关。在最终的回归模型中经过不同的变量校正之后这种相关性仍然有显著性意义。另外,对于每种糖尿病并发症来说eGDR都是一种很好的鉴别工具,曲线下面积介于0.609与0.759之间。 结论 与那些没有并发症的患者相比,合并慢性糖尿病并发症的患者胰岛素抵抗更严重。此外,IR与每种慢性糖尿病并发症的存在都具有独立的相关性,对于所有的慢性并发症来说它似乎都是一种很好的鉴别工具。