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Open Access Highly Accessed Original investigation

Early signs of atherosclerosis are associated with insulin resistance in non-obese adolescent and young adults with type 1 diabetes

Björn Rathsman1*, Stefan Rosfors2, Åke Sjöholm3 and Thomas Nyström3

Author Affiliations

1 Karolinska Institutet, Department of Clinical Science and Education, Sachs’ Childrens’ Hospital, Södersjukhuset AB, Stockholm, SE-118 83, Sweden

2 Karolinska Institutet, Department of Clinical Science and Education, Section of Clinical Physiology, Södersjukhuset AB, Stockholm, Sweden

3 Karolinska Institutet, Department of Clinical Science and Education, Division of Internal Medicine, Södersjukhuset AB, Stockholm, Sweden

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Cardiovascular Diabetology 2012, 11:145  doi:10.1186/1475-2840-11-145

Published: 27 November 2012

Abstract

Background

Patients with type 1 diabetes have a substantial risk of developing cardiovascular complications early in life. We aimed to explore the role of insulin sensitivity (Si) as an early factor of atherosclerosis in young type 1 diabetes vs. non-diabetic subjects.

Methods

Forty adolescent and young adult individuals (20 type 1 diabetics and 20 non-diabetics), age 14–20 years, without characteristics of the metabolic syndrome, participated in this cross-sectional study. After an overnight fast, Si was measured by hyperinsulinemic euglycemic clamp (40 mU/m2) and calculated by glucose infusion rate (GIR). Carotid intima-media thickness (cIMT) was measured in the common carotid artery with high-resolution ultrasonography. Risk factors of atherosclerosis (Body mass index [BMI], waist circumference, systolic blood pressure [sBP], triglycerides, low HDL-cholesterol and HbA1c) were also investigated.

Results

cIMT was increased (0.52 ± 0.1 vs. 0.47 ± 0.1 mm, P < 0.01), whereas GIR was decreased (5.0 ± 2.1 vs. 7.1 ± 2.2 mg/kg/min, P < 0.01) in type 1 diabetics vs. non-diabetics. The differences in cIMT were negatively associated with Si (r = −0.4, P < 0.01) and positively associated with waist circumference (r = 0.34, P = 0.03), with no such associations between BMI (r = 0.15, P = 0.32), sBP (r = 0.09, P = 0.58), triglycerides (r = 0.07, P = 0.66), HDL-cholesterol (r = 0.10, P = 0.55) and HbA1c (r = 0.24, P = 0.13). In a multivariate regression model, between cIMT (dependent) and group (explanatory), only adjustment for Si affected the significance (ß = 0.08, P = 0.11) vs. (ß = 0.07, P < 0.01) for the whole model. No interaction between cIMT, groups and Si was observed.

Conclusions

cIMT is increased and associated with insulin resistance in adolescent, non-obese type 1 diabetic subjects. Although, no conclusions toward a causal relationship can be drawn from current findings, insulin resistance emerges as an important factor reflecting early signs of atherosclerosis in this small cohort.

Keywords:
Adolescent; Atherosclerosis; Carotid intima-media thickness; Insulin sensitivity; Type 1 diabetes