title: Estimated insulin sensitivity predicts incident micro- and macrovascular complications in adults with type 1 diabetes over 6 years: the coronary artery calcification in type 1 diabetes study.
abstract: OBJECTIVE
  Reduced insulin sensitivity (IS) is well documented in type 1 diabetes (T1D) and may contribute to vascular complications. We examined the association of estimated IS (eIS) with incident macro- and microvascular complications in adults with T1D in the prospective CACTI study.
  
  
  METHODS
  Participants (N=652) were 19-56 years old at baseline and re-examined 6.2±0.6years later. Urinary albumin excretion was measured, and categorized as microalbuminuria or greater. Diabetic retinopathy (DR) was based on self-reported history, proliferative DR (PDR) as history of laser eye therapy and coronary artery calcium (CAC) was measured using electron-beam CT. Progression of CAC was defined as a change in the square root transformed CAC volume score of ≥2.5. IS was estimated (eIS) by an equation derived from clamp studies. Predictors of each complication were examined using stepwise logistic regression and subjects with complications at baseline excluded. Age, T1D duration, sex, HbA1c, SBP, LDL-C, and eIS were considered for inclusion.
  
  
  RESULTS
  Greater eIS at baseline predicted lower odds of developing albuminuria (OR: 0.67, 95% CI 0.51-0.88), DR (OR 0.79, 0.64-0.97), PDR (OR: 0.76, 0.57-0.99) and CACp (OR: 0.71, 0.60-0.85) in multivariable models.
  
  
  CONCLUSIONS
  Greater eIS conferred protection from the development of vascular complications over 6-years in T1D.
authors.affiliation: Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO; Barbara Davis Center for Diabetes, University of Colorado Denver, Aurora, CO. Electronic address: Petter.Bjornstad@childrenscolorado.org.
authors.forename: Petter
authors.initials: P
authors.lastname: Bjornstad
authors.affiliation: Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO; Barbara Davis Center for Diabetes, University of Colorado Denver, Aurora, CO; Department of Nephrology, University of Colorado Denver, Aurora, CO.
authors.forename: David M
authors.initials: DM
authors.lastname: Maahs
authors.affiliation: Barbara Davis Center for Diabetes, University of Colorado Denver, Aurora, CO; Colorado School of Public Health, University of Colorado Denver, Aurora, CO.
authors.forename: Lindsey M
authors.initials: LM
authors.lastname: Duca
authors.affiliation: Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO.
authors.forename: Laura
authors.initials: L
authors.lastname: Pyle
authors.affiliation: Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO; Barbara Davis Center for Diabetes, University of Colorado Denver, Aurora, CO.
authors.forename: Marian
authors.initials: M
authors.lastname: Rewers
authors.affiliation: Department of Nephrology, University of Colorado Denver, Aurora, CO.
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Johnson
authors.affiliation: Department of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO; Barbara Davis Center for Diabetes, University of Colorado Denver, Aurora, CO.
authors.forename: Janet K
authors.initials: JK
authors.lastname: Snell-Bergeon
mesh_terms: D000328:Adult; D000419:Albuminuria / Q000209:etiology; D015331:Cohort Studies; D003120:Colorado / Q000453:epidemiology; D003324:Coronary Artery Disease / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000378:metabolism / Q000503:physiopathology / Q000652:urine; D003925:Diabetic Angiopathies / Q000453:epidemiology* / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000453:epidemiology* / Q000503:physiopathology; D003930:Diabetic Retinopathy / Q000453:epidemiology* / Q000503:physiopathology / Q000601:surgery; D018450:Disease Progression; D005260:Female; D006801:Humans; D015994:Incidence; D007333:Insulin Resistance; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D061205:Vascular Calcification / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology; D018630:Vitreoretinopathy, Proliferative / Q000209:etiology; D055815:Young Adult
keywords: Insulin resistance; Insulin sensitivity; Macrovascular complications; Microvascular complications; Type 1 diabetes