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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