Division of Endocrinology, Montefiore Medical Center, Bronx, New York, USA.
Diabetes Care. 2013 Aug;36(8):2280-5. doi: 10.2337/dc12-1693. Epub 2013 Apr 17.
Insulin resistance has been described in type 1 diabetes mellitus, is related to risk of vascular complications, and may be more common in certain ethnic groups. Estimated glucose disposal rate (eGDR) is a validated clinical tool for estimating insulin sensitivity in type 1 diabetes. Because previous reports of eGDR in adults with type 1 diabetes have included few ethnic minorities, this study explored interethnic differences in eGDR and the relationship of eGDR with diabetic vascular complications.
We conducted a cross-sectional study using a sample that included 207 white, black, or Hispanic adults with prior clinical diagnosis of type 1 diabetes who were receiving care at an urban academic medical center. eGDR (milligrams per kilogram per minute) was calculated using HbA1c, waist circumference, and hypertensive status. Race/ethnicity was self-reported. Multivariable logistic regression models were used to estimate odds ratios (ORs) and 95% CIs of association of eGDR with diabetes complications (cardiovascular disease, retinopathy, albuminuria, and chronic kidney disease above stage 3).
Forty-two percent of the participants were women, and mean age was 45 ± 15 years; 34% were white, 32% were Hispanic, and 34% were black. Ethnicity was significantly associated with eGDR; blacks had significantly lower eGDR (5.66 ± 2.34) than Hispanics (6.70 ± 2.29) and whites (7.20 ± 2.03) (P < 0.001). Patients with the lowest eGDR compared with the highest had a significantly greater risk of any diabetes complication (OR 3.1 [95% CI 1.2-8.1]) compared with the least insulin-resistant patients.
In an urban clinic population of patients with type 1 diabetes, blacks were significantly less insulin sensitive than whites or Hispanics, and lower eGDR was associated with diabetes complications. Further study is needed to determine whether using eGDR to target interventions can improve outcomes.
1 型糖尿病患者存在胰岛素抵抗，与血管并发症风险相关，并且在某些种族群体中可能更为常见。估计葡萄糖处置率（eGDR）是一种评估 1 型糖尿病患者胰岛素敏感性的验证临床工具。由于之前关于 1 型糖尿病成人 eGDR 的报告中包括的少数族裔较少，因此本研究探讨了 eGDR 的种族间差异及其与糖尿病血管并发症的关系。
我们进行了一项横断面研究，使用了一个样本，该样本包括 207 名白人、黑人和西班牙裔成年人，他们在城市学术医疗中心接受过 1 型糖尿病的临床诊断。使用 HbA1c、腰围和高血压状态计算 eGDR（毫克/公斤/分钟）。种族/民族是自我报告的。使用多变量逻辑回归模型来估计 eGDR 与糖尿病并发症（心血管疾病、视网膜病变、白蛋白尿和 3 期以上的慢性肾脏病）之间的关联的优势比（OR）和 95%置信区间（CI）。
42%的参与者为女性，平均年龄为 45±15 岁；34%为白人，32%为西班牙裔，34%为黑人。种族与 eGDR 显著相关；黑人的 eGDR（5.66±2.34）明显低于西班牙裔（6.70±2.29）和白人（7.20±2.03）（P<0.001）。与胰岛素抵抗最低的患者相比，eGDR 最低的患者任何糖尿病并发症的风险显著更高（OR 3.1[95%CI 1.2-8.1]）。
在城市诊所的 1 型糖尿病患者人群中，黑人的胰岛素敏感性明显低于白人或西班牙裔，较低的 eGDR 与糖尿病并发症相关。需要进一步研究确定是否使用 eGDR 来确定干预目标是否可以改善结局。
