School of Medicine, University of Leeds, Leeds, UK.
Leeds Institute of Cardiovascular and Metabolic Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK.
Diabet Med. 2021 May;38(5):e14529. doi: 10.1111/dme.14529. Epub 2021 Feb 19.
To understand the relationship between insulin resistance (IR), assessed as estimated glucose disposal rate (eGDR), and microvascular/macrovascular complications in people with type 1 diabetes.
Individuals with a confirmed diagnosis of type 1 diabetes were included in this cross-sectional study. BMI was categorised into normal weight (18.0-24.9 kg m ), overweight (25.0-29.9 kg m ) and obese groups (≥30.0 kg m ). We categorised eGDR into four groups: eGDR >8, 6-7.9, 4-5.9 and <4 mg kg min . Multiple logistic regression was used to identify associations with vascular complications, after adjusting for relevant confounders.
A total of 2151 individuals with type 1 diabetes were studied. Median [interquartile range (IQR)] age was 41.0 [29.0, 55.0] with diabetes duration of 20.0 [11, 31] years. Odds ratio (OR) for retinopathy and nephropathy in obese compared with normal weight individuals was 1.64 (95% CI: 1.24-2.19; p = 0.001) and 1.62 (95% CI: 1.10-2.39; p = 0.015), while the association with cardiovascular disease just failed to reach statistical significance (OR 1.66 [95% CI: 0.97-2.86; p = 0.066]). Comparing individuals with eGDR ≥8 mg kg min and <4 mg kg min showed OR for retinopathy, nephropathy and macrovascular disease of 4.84 (95% CI: 3.36-6.97; p < 0.001), 8.35 (95% CI: 4.86-14.34; p < 0.001) and 13.22 (95% CI: 3.10-56.38; p < 0.001), respectively. Individuals with the highest eGDR category (≥8 mg kg min ) had the lowest complication rates irrespective of HbA levels.
Obesity is prevalent in type 1 diabetes and diabetes complications are not only related to glucose control. IR, assessed as eGDR, is strongly associated with both microvascular and macrovascular complications, regardless of HbA levels.
了解 1 型糖尿病患者胰岛素抵抗（IR）与微血管/大血管并发症的关系，以估计葡萄糖处置率（eGDR）评估。
本横断面研究纳入了确诊为 1 型糖尿病的患者。BMI 分为正常体重（18.0-24.9kg/m²）、超重（25.0-29.9kg/m²）和肥胖组（≥30.0kg/m²）。我们将 eGDR 分为四组：eGDR>8、6-7.9、4-5.9 和<4mg/kg·min。调整相关混杂因素后，采用多元逻辑回归分析评估与血管并发症的关系。
共纳入 2151 例 1 型糖尿病患者。中位（四分位数间距）年龄为 41.0[29.0, 55.0]岁，糖尿病病程为 20.0[11, 31]年。与正常体重者相比，肥胖者视网膜病变和肾病的比值比（OR）分别为 1.64（95%可信区间：1.24-2.19；p=0.001）和 1.62（95%可信区间：1.10-2.39；p=0.015），而心血管疾病的相关性尚未达到统计学意义（OR 1.66[95%可信区间：0.97-2.86；p=0.066]）。与 eGDR≥8mg/kg·min 和<4mg/kg·min 的个体相比，视网膜病变、肾病和大血管疾病的比值比（OR）分别为 4.84（95%可信区间：3.36-6.97；p<0.001）、8.35（95%可信区间：4.86-14.34；p<0.001）和 13.22（95%可信区间：3.10-56.38；p<0.001）。无论 HbA 水平如何，eGDR 最高组（≥8mg/kg·min）的并发症发生率最低。
肥胖在 1 型糖尿病中很常见，糖尿病并发症不仅与血糖控制有关。IR 以 eGDR 评估，与微血管和大血管并发症密切相关，与 HbA 水平无关。
