Body mass index, estimated glucose disposal rate and vascular complications in Type 1 Diabetes: Beyond Glycated Haemoglobin

Helliwell, Rebecca, Warnes, Harriet, Kietsiriroje, Noppadol, Campbell, Matthew, Birch, Rebecca, Pearson, Sam and Ajjan, Ramzi A. (2021) Body mass index, estimated glucose disposal rate and vascular complications in Type 1 Diabetes: Beyond Glycated Haemoglobin. Diabetic Medicine. ISSN 0742-3071

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Abstract

Aims
To understand the relationship between insulin resistance (IR), assessed as estimated glucose disposal rate (eGDR), and microvascular/macrovascular complications in people with type 1 diabetes.

Materials and methods
Individuals with a confirmed diagnosis of type 1 diabetes were included in this cross‐sectional study. BMI was categorised into normal weight (18.0–24.9 kg m−2), overweight (25.0–29.9 kg m−2) and obese groups (≥30.0 kg m−2). We categorised eGDR into four groups: eGDR >8, 6–7.9, 4–5.9 and <4 mg kg−1 min−1. Multiple logistic regression was used to identify associations with vascular complications, after adjusting for relevant confounders.

Results
A total of 2151 individuals with type 1 diabetes were studied. Median [interquartile range (IQR)] age was 41.0 [29.0, 55.0] with diabetes duration of 20.0 [11, 31] years. Odds ratio (OR) for retinopathy and nephropathy in obese compared with normal weight individuals was 1.64 (95% CI: 1.24–2.19; p = 0.001) and 1.62 (95% CI: 1.10–2.39; p = 0.015), while the association with cardiovascular disease just failed to reach statistical significance (OR 1.66 [95% CI: 0.97–2.86; p = 0.066]). Comparing individuals with eGDR ≥8 mg kg−1 min−1 and <4 mg kg−1 min−1 showed OR for retinopathy, nephropathy and macrovascular disease of 4.84 (95% CI: 3.36–6.97; p < 0.001), 8.35 (95% CI: 4.86–14.34; p < 0.001) and 13.22 (95% CI: 3.10–56.38; p < 0.001), respectively. Individuals with the highest eGDR category (≥8 mg kg−1 min−1) had the lowest complication rates irrespective of HbA1c levels.

Conclusions
Obesity is prevalent in type 1 diabetes and diabetes complications are not only related to glucose control. IR, assessed as eGDR, is strongly associated with both microvascular and macrovascular complications, regardless of HbA1c levels.

Item Type: Article
Subjects: Sciences > Health Sciences
Divisions: Faculty of Health Sciences and Wellbeing
Depositing User: Matthew Campbell
Date Deposited: 01 Mar 2021 09:41
Last Modified: 01 Mar 2021 09:45
URI: http://sure.sunderland.ac.uk/id/eprint/13182
ORCID for Matthew Campbell: ORCID iD orcid.org/0000-0001-5883-5041

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