Utility of insulin resistance in estimating cardiovascular risk in subjects with type 1 diabetes according to the scores of the Steno Type 1
Cano, Albert (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Mazarico, Isabel (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Astiarraga, Brenno (Hospital Universitari Joan XXIII de Tarragona)
González-Sastre, Montserrat (Universitat Autònoma de Barcelona. Departament de Cirurgia)
Martínez, Laia (Hospital Universitari Joan XXIII de Tarragona)
Fernández-Veledo, Sonia (Hospital Universitari Joan XXIII de Tarragona)
Simó Canonge, Rafael (Hospital Universitari Vall d'Hebron)
Vendrell, Joan (Hospital Universitari Joan XXIII de Tarragona)
González-Clemente, José-Miguel (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Llauradó, Gemma (Universitat Autònoma de Barcelona)
Albert Fàbregas, Lara (Universitat Autònoma de Barcelona. Departament de Medicina)

Data:	2020
Resum:	Background: We sought to assess the potential of insulin resistance (IR) for estimating cardiovascular disease (CVD) risk in adults with type 1 diabetes (T1DM) according to the scores of the Steno Type 1 Risk Engine (ST1RE). Methods: A total of 179 adults with T1DM (50. 8% men, age 41. 2±13. 1 years, duration of T1DM 16 (12-23) years) without established CVD were evaluated. IR was assessed by the estimation of insulin sensitivity (eIS) using two validated prediction equations: the estimated insulin sensitivity developed from the Pittsburgh Epidemiology of Diabetes ComplicationsStudy(eIS-EDC)and the estimated insulin sensitivity developed from Coronary Artery Calcification in T1DM Study (eIS-CACTI) ST1RE was used to estimate 10-year CVD risk and to classify subjects into three groups according to their risk: low (<10%; n = 105), moderate (10-20%; n = 53), and high (≥20%; n = 21). Results: Both eIS-EDC and eIS-CACTI correlated negatively with ST1RE scores (eIS-EDC: r =-0. 636, p < 0. 001; eIS-CACTI: r =-0. 291, p < 0. 001). The C-statistic for predicting moderate/high risk and high risk was 0. 816 (95% confidence interval (CI): 0. 754-0. 878) and 0. 843 (95% CI: 0. 772-0. 913), respectively, for the eIS-EDC equation, and was 0. 686 (95% CI: 0. 609-0. 763) and 0. 646 (95% CI: 0. 513-0. 778), respectively, for the eIS-CACTI equation. The eIS-EDC equation had a significantly higher C-statistic both for moderate-/high-risk (p = 0. 001) and high-risk (p = 0. 007) subjects. Two cut-off points of eIS-EDC were identified for detecting moderate/high risk (8. 52 mg·kg-1·min-1; sensitivity 74% and specificity 76%) and high risk (8. 08 mg·kg-1·min-1;sensitivity 65% and specificity 95%) with potential applicability in clinical practice. Conclusions: eIS negatively correlates with the score of CVD risk in the ST1RE. Two cut-off points of eIS are reported with potential utility in clinical practice for detecting adults with T1DM with the highest CVD risk.
Nota:	Altres ajuts: Financial support was provided through the Fondo de Investigación Sanitaria (FIS) PI09/01360 PI12/00954 and PI15/00567 as part of the National R+D+I Plan and was co-financed by the Instituto de Salud Carlos III-General Evaluation Branch (Spanish Ministry of Economy and Competitiveness) and the European Regional Development Fund (ERDF).
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Type 1 diabetes ; Cardiovascular risk ; Steno type 1 risk engine ; Estimated insulin sensitivity ; Insulin resistance
Publicat a:	Journal of clinical medicine, Vol. 9 Núm. 7 (2020) , p. 2192, ISSN 2077-0383

DOI: 10.3390/jcm9072192
PMID: 32664522

12 p, 1.1 MB

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