Jonathan Mertens, Belgium
University of Antwerp Laboratory of Experimental Medicine and PaediatricsPresenter of 1 Presentation
THE ROLE OF EGDR AS A PREDICTOR OF INSULIN RESISTANCE AND CARDIOVASCULAR DISEASE
Abstract
Background and Aims
People with type 1 diabetes (T1D) have a high risk of cardiovascular disease (CVD) which may be accelerated by insulin resistance. Estimated glucose disposal rate (eGDR) correlates well with the euglycaemic clamp. We aimed to assess the association between eGDR, liver steatosis and CVD.
Methods
Adult T1D subjects were consecutively screened for liver steatosis using ultrasound (US), Fatty Liver Index (FLI) and controlled attenuation parameter (CAP). The eGDR was calculated based on hypertension, HbA1c and waist circumference. CVD was assessed based on patient files.
Results
CVD was present in 34 out of 355 subjects. Divided into tertiles (<5.39,5.39-7.79,>7.79), 36.6% expressed low eGDR; 32.7% intermediate eGDR and 30.7% high eGDR. There was moderate correlation between eGDR and FLI (r=0.68,p<0.001) and weak correlation with US (r=0.33,p<0.001) and CAP (r=0.50,p<0.001). In the low eGDR group (=insulin resistant group) not only steatosis (38.5% vs. 11.2% (intermediate eGDR) and 12.8% (high eGDR)) but also composite CVD (18.5% vs. 6.0% and 2.8%) were significantly more present (p<0.001 for both). Low eGDR (OR:4.2[2.2-8.2],p<0.001), but not BMI or dyslipidaemia was independently associated with US-defined liver steatosis. Low eGDR was also independently associated with FLI-determined steatosis (OR:5.5[1.7-17.6],p=0.004) together with BMI (OR:1.6[1.4-1.9],p<0.001). Low eGDR (OR:8.0[2.3-27.4],p=0.001) and liver steatosis (OR:2.7[1.2-6.1],p=0.022 (US-defined), OR:2.9[1.4-6.0],p=0.005 (FLI-defined)) were independently associated with composite CVD, but presence of metabolic syndrome, dyslipidemia and BMI were not.
Conclusions
Insulin resistance is prevalent in T1D. eGDR correlates with the presence of liver steatosis. Both eGDR and liver steatosis correlate with prevalent CVD.