Insulin resistance and risk of vascular events, interventions and mortality in type 1 diabetes
Insulin resistance and risk of vascular events, interventions and mortality in type 1 diabetes
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DOI：
10.1530/eje-21-0636
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发表时间：
2021-12-01
影响因子：
5.8
通讯作者：
Westerink, Jan
中科院分区：
文献类型：
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作者：
Helmink, Marga A. G.;de Vries, Marieke;Westerink, Jan
目的 确定与胰岛素抵抗相关的决定因素，并评估心血管疾病高危 1 型糖尿病患者的胰岛素抵抗与心血管事件、血管干预和死亡率之间的关联。设计前瞻性队列研究。方法 纳入 195 名来自 ARTerial 疾病次要表现 (SMART) 队列的 1 型糖尿病患者。胰岛素抵抗通过估计的葡萄糖处理率 (eGDR) 进行量化，较高的 eGDR 水平表明较高的胰岛素敏感性（即较低的 eGDR 水平表明较高的胰岛素抵抗）。线性回归模型用于评估与 eGDR 相关的决定因素。使用针对混杂因素进行调整的 Cox 比例风险模型分析了 eGDR 对心血管事件、心血管事件或血管干预（组合终点）以及全因死亡率的影响。结果 在 195 名受试者中（中位随访时间 12.9 年，IQR 6.7-17.0），总共观察到 25 例心血管事件、26 例血管介入治疗和 27 例死亡。高 eGDR 作为保留胰岛素敏感性的标志物与较低的心血管事件风险（HR：0.75；95% CI：0.61-0.91）、较低的心血管事件和血管干预风险（HR：0.74；95% CI：0.63-0.87）以及较低的全因死亡率风险（HR：0.81；95% CI： 0.67-0.98）。结论 eGDR 测量的胰岛素抵抗是 1 型糖尿病患者发生心血管疾病的另一个危险因素。通过生活方式干预或药物治疗来改变胰岛素抵抗可能是降低心血管疾病风险的可行治疗目标。
Objective To identify determinants associated with insulin resistance and to assess the association between insulin resistance and cardiovascular events, vascular interventions and mortality in people with type 1 diabetes at high risk of cardiovascular disease. Design Prospective cohort study. Methods One hundred and ninety-five people with type 1 diabetes from the Secondary Manifestations of ARTerial disease (SMART) cohort were included. Insulin resistance was quantified by the estimated glucose disposal rate (eGDR) with higher eGDR levels indicating higher insulin sensitivity (i.e. lower eGDR levels indicating higher insulin resistance). Linear regression models were used to evaluate determinants associated with eGDR. The effect of eGDR on cardiovascular events, cardiovascular events or vascular interventions (combined endpoint) and on all-cause mortality was analysed using Cox proportional hazards models adjusted for confounders. Results In 195 individuals (median follow-up 12.9 years, IQR 6.7-17.0), a total of 25 cardiovascular events, 26 vascular interventions and 27 deaths were observed. High eGDR as a marker for preserved insulin sensitivity was independently associated with a lower risk of cardiovascular events (HR: 0.75; 95% CI: 0.61-0.91), a lower risk of cardiovascular events and vascular interventions (HR: 0.74; 95% CI: 0.63-0.87) and a lower risk of all-cause mortality (HR: 0.81; 95% CI: 0.67-0.98). Conclusions Insulin resistance as measured by eGDR is an additional risk factor for cardiovascular disease in individuals with type 1 diabetes. Modification of insulin resistance by lifestyle interventions or pharmacological treatment could be a viable therapeutic target to lower the risk of cardiovascular disease.