期刊
DIABETES
卷 60, 期 1, 页码 306-314出版社
AMER DIABETES ASSOC
DOI: 10.2337/db10-0328
关键词
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资金
- National Institutes of Health National Heart, Lung, and Blood Institute [R01 HL-61753, R01 HL-079611]
- Diabetes Endocrinology Research Center Clinical Investigation Core [P30 DK-57516]
- National Institutes of Health Office of Research in Women's Health, Building Interdisciplinary Research Careers in Women's Health [BIRCWH K12]
- American Diabetes Association [7-09-CVD-06]
- National Institutes of Health at the Barbara Davis Center for Childhood Diabetes in Denver, Colorado [M01 RR-000051]
- Colorado Heart Imaging Center in Denver, Colorado
- NATIONAL CENTER FOR RESEARCH RESOURCES [M01RR000051] Funding Source: NIH RePORTER
- NATIONAL HEART, LUNG, AND BLOOD INSTITUTE [R01HL079611, R01HL061753, R01HL113029] Funding Source: NIH RePORTER
- NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES [P30DK057516] Funding Source: NIH RePORTER
OBJECTIVE-To assess insulin action on peripheral glucose utilization and nonesterified fatty acid (NEFA) suppression as a predictor of coronary artery calcification (CAC) in patients with type 1 diabetes and nondiabetic controls. RESEARCH DESIGN AND METHODS-Insulin action was measured by a three-stage hyperinsulinemic-euglycemic clamp (4, 8, and 40 mU/m(2)/min) in 87 subjects from the Coronary Artery Calcification in Type 1 Diabetes cohort (40 diabetic, 47 nondiabetic; mean age 45 +/- 8 years; 55% female). RESULTS-Peripheral glucose utilization was lower in subjects with type 1 diabetes compared with nondiabetic controls: glucose infusion rate (mg/kg FFM/min) = 6.19 +/- 0.72 vs. 12.71 +/- 0.66, mean +/- SE, P < 0.0001, after adjustment for age, sex, BMI, fasting glucose, and final clamp glucose and insulin. Insulin-induced NEFA suppression was also lower in type 1 diabetic compared with nondiabetic subjects: NEFA levels (mu M) during 8 mU/m(2)/min insulin infusion = 370 +/- 27 vs. 185 +/- 25, P < 0.0001, after adjustment for age, sex, BMI, fasting glucose, and time point insulin. Lower glucose utilization and higher NEFA levels, correlated with CAC volume (r = -0.42, P < 0.0001 and r = 0.41, P < 0.0001, respectively) and predicted the presence of CAC (odds ratio [OR] = 0.45, 95% CI = 0.22-0.93, P = 0.03; OR = 2.4, 95% CI = 1.08-5.32, P = 0.032, respectively). Insulin resistance did not correlate with GHb or continuous glucose monitoring parameters. CONCLUSIONS-Type 1 diabetic patients are insulin resistant compared with nondiabetic subjects, and the degree of resistance is not related to current glycemic control. Insulin resistance predicts the extent of coronary artery calcification and may contribute to the increased risk of cardiovascular disease in patients with type 1 diabetes as well as subjects without diabetes. Diabetes 60:306-314, 2011
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