Pop Andrei, Clenciu Diana, Anghel Monica, Radu Stefania, Socea Bogdan, Mota Eugen, Mota Maria, Panduru Nicolae M
Department of Cardiology, Professor Dr C. C. Iliescu Institute of Cardiovascular Diseases, Bucharest, Romania.
Filantropia City Hospital, Diabetes Nutrition and Metabolic Diseases Department, Craiova, Romania.
J Diabetes. 2016 Mar;8(2):220-8. doi: 10.1111/1753-0407.12283. Epub 2015 Apr 28.
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.
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.
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.
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.
胰岛素抵抗（IR）存在于1型糖尿病（T1DM）中，提示与慢性糖尿病并发症有关。我们研究的主要目的是评估有无慢性并发症的T1DM患者的IR情况。次要目的是评估IR与慢性糖尿病并发症之间的可能关联。
这项横断面研究纳入了272例T1DM患者。使用估计的葡萄糖处置率（eGDR）对胰岛素抵抗进行量化。首先使用二元逻辑回归评估eGDR与每种糖尿病并发症之间的关联，然后使用逐步选择协变量的多参数逻辑回归进行评估。通过受试者工作特征（ROC）曲线分析评估eGDR的判别价值。
慢性糖尿病并发症患者的估计GDR较低（视网膜病变患者为6.1 vs. 6.9 mg/kg每分钟[P = 0.02]；肾病患者为6.3 vs. 7.3 mg/kg每分钟[P < 0.01]；神经病变患者为6.5 vs. 7.6 mg/kg每分钟[P < 0.01]；心血管并发症患者为5.2 vs. 7.5 mg/kg每分钟[P < 0.01]）。在单变量分析中，eGDR与所有糖尿病并发症相关。在最终回归模型中对不同变量进行调整后，这些关联仍然显著。此外，eGDR对每种糖尿病并发症都是一个良好的判别指标，曲线下面积在0.609至0.759之间。
有慢性糖尿病并发症的患者比无并发症的患者胰岛素抵抗更强。此外，IR与每种慢性糖尿病并发症的存在独立相关，并且似乎对所有这些并发症都是一个良好的判别指标。
