Can clinical factors estimate insulin resistance in type 1 diabetes?
Can clinical factors estimate insulin resistance in type 1 diabetes?
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DOI：
10.2337/diabetes.49.4.626
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发表时间：
2000-04-01
期刊：
影响因子：
7.7
通讯作者：
Orchard, TJ
中科院分区：
文献类型：
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作者：
Williams, KV;Erbey, JR;Orchard, TJ
胰岛素抵抗综合征（IRS）评分是根据糖尿病并发症流行病学（EDC）研究中儿童期发病的1型糖尿病成人的临床风险因素制定的，并使用正常血糖-高胰岛素钳夹研究进行验证，高血压、腰臀比（WHR）、甘油三酯和HDL胆固醇水平、2型糖尿病家族史和血糖控制是用于定义评分的风险因素。每个风险因素的评分为1（最低似然IRS）至3（最高似然IRS）。基于IRS评分的三分位数，从EDC队列中招募合格受试者（n = 24）。受试者接受过夜胰岛素输注以使葡萄糖水平正常化，然后进行3小时血糖正常-高胰岛素血症（60 mU . m（-2）。min（-1））钳位。在钳夹的最后30 min期间测定葡萄糖处置率（GDR）。IBS组的GDR差异显著（9.65 +/- 2.99，8.02 +/- 1.39和5.68 +/- 2.16 mg . kg（-1）。min（-1），P < 0.01）。GDR与IRS评分呈负相关（r =-0.64，P < 0.01）。采用线性回归分析，校正后r（2）值最高（0.57，P < 0.001）的危险因素组合为腰臀比、高血压和HbA 1。这项研究发现，临床危险因素可以用来确定1型糖尿病患者是否存在胰岛素抵抗，并且它提供了一个基于临床因素的评分来确定1型糖尿病患者胰岛素抵抗程度的验证。该评分将在未来研究中应用于整个EDC人群，以确定胰岛素抵抗对并发症的影响。
An insulin resistance syndrome (IRS) score was developed based on clinical risk factors in adults with childhood-onset type 1 diabetes in the Epidemiology of Diabetes Complications (EDC) Study and was validated using euglycemic-hyperinsulinemic clamp studies, Hypertension, waist-to-hip ratio (WHR), triglyceride and HDL cholesterol levels, family history of type 2 diabetes, and glycemic control were risk factors used to define the score. A score of 1 (lowest likelihood IRS) to 3 (highest likelihood IRS) was assigned for each risk factor. Eligible subjects (n = 24) were recruited from the EDC cohort based on tertile of IRS score. Subjects received an overnight insulin infusion to normalize glucose levels, then underwent a 3-h euglycemic-hyperinsulinemic (60 mU . m(-2) . min(-1)) clamp. Glucose disposal rate (GDR) was determined during the last 30 min of the clamp. The GDR differed significantly by IBS group (9.65 +/- 2.99, 8.02 +/- 1.39, and 5.68 +/- 2.16 mg . kg(-1) . min(-1), P < 0.01). The GDR was inversely correlated with the IRS score (r = -0.64, P < 0.01). Using linear regression, the combination of risk factors that Sielded the highest adjusted r(2) value (0.57, P < 0.001) were WHR, hypertension, and HbA(1). This study found that clinical risk factors can be used to identify subjects with type 1 diabetes mho are insulin resistant, and it provides validation of a score based on clinical factors to determine the extent of insulin resistance in type 1 diabetes. This score will be applied to the entire EDC population in future studies to determine the effect of insulin resistance on complications.