Utility of Insulin Resistance in Estimating Cardiovascular Risk in Subjects with Type 1 Diabetes According to the Scores of the Steno Type 1 Risk Engine

Albert Cano; Gemma Llauradó; Lara Albert; Isabel Mazarico; Brenno Astiarraga; Montserrat González-Sastre; Laia Martínez; Sonia Fernández-Veledo; Rafael Simó; Joan Vendrell; José-Miguel González-Clemente

doi:10.3390/jcm9072192

Utility of Insulin Resistance in Estimating Cardiovascular Risk in Subjects with Type 1 Diabetes According to the Scores of the Steno Type 1 Risk Engine

J Clin Med. 2020 Jul 11;9(7):2192. doi: 10.3390/jcm9072192.

Authors

Albert Cano¹, Gemma Llauradó^{2

3

4}, Lara Albert¹, Isabel Mazarico¹, Brenno Astiarraga^{3

4

5}, Montserrat González-Sastre⁶, Laia Martínez⁵, Sonia Fernández-Veledo^{3

4

5}, Rafael Simó^{4

7}, Joan Vendrell^{3

4

5}, José-Miguel González-Clemente^{1

3

4}

Affiliations

¹ Department of Endocrinology and Nutrition, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208 Sabadell, Spain.
² Department of Endocrinology and Nutrition, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona, Pg. Marítim 25-29, 08003 Barcelona, Spain.
³ Institut d'Investigacions Sanitàries Pere Virgili (IISPV), Universitat Rovira i Virgili, Avda. de la Universitat, 43204 Reus, Spain.
⁴ Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, 08029 Madrid, Spain.
⁵ Department of Endocrinology and Nutrition, Hospital Universitari Joan XXIII de Tarragona, IISPV, Universitat Rovira i Virgili, C. Dr Mallafré Guasch 4, 43005 Tarragona, Spain.
⁶ Ophthalmology Department, Parc Taulí Hospital Universitari, Institut d'Investigació i Innovació Parc Taulí I3PT, Universitat Autònoma de Barcelona, Parc Taulí 1, 08208 Sabadell, Spain.
⁷ Diabetes and Metabolism Research Unit, Institut de Recerca Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Pg. de la Vall d'Hebron, 119-129, 08035 Barcelona, Spain.

Abstract

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 Complications Study (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.

Keywords: cardiovascular risk; estimated insulin sensitivity; insulin resistance; steno type 1 risk engine; type 1 diabetes.

Abstract

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