Prevalence of insulin resistance based on the estimated rate of glucose utilization among adult patients with type 1 diabetes and its role in predicting diabetic complications

BACKGROUND: The significance of determining insulin resistance (IR) in people with type 1 diabetes mellitus (T1DM) is determined by the acceleration of the transition from the first stage of development of T1DM to the second and third, and is also a risk factor for the development of chronic complications of diabetes. The lack of a unified criterion for determining metabolically significant insulin resistance in patients with T1DM determines the need to study this problem.

AIM: To study the incidence of insulin resistance in individuals with T1DM over 18 years of age and disease duration of more than 1 year based on the estimated rate of glucose utilization and to determine the association between the eGDR value <8.77 mg/kg/min and the incidence of chronic complications of diabetes.

MATERIALS AND METHODS: 201 patients with T1DM over 18 years of age and T1DM duration of more than 1 year were examined. Among them, 95 (47%) were men, 106 (53%) were women. Median age was 30.0 [28.1; 33.0] years, median duration of T1DM — 13 [12; 15] years. The estimated rate of glucose utilization was estimated using the equation of Williams K. et al. (2000). Patients with an eGDR value <8.77 ml/kg/min were considered to have metabolically significant IR.

RESULTS: The value of eGDR <8.77 ml/kg/min (group 1) was observed in 113 (56.2%) patients. The doses of prolonged insulin both in absolute units and per kilogram of weight were significantly higher with eGDR <8.77 ml/kg/min (p=0.007 and p=0.037, respectively). Smoking, triglyceride levels, and patient age were risk factors for IR. Low insulin sensitivity was an independent risk factor for diabetic nephropathy and vascular atherosclerosis of lower extremity.

CONCLUSION: The fairly high prevalence of IR among patients with type 1 diabetes, the risk of developing diabetic nephropathy and atherosclerosis of the arteries of the lower extremities in these individuals, justifies the need to identify this condition in clinical practice in order to improve the course of type 1 diabetes.

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