Features of Type 1 Diabetes Mellitus in Adults Depending on the Presence of Insulin Resistance



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Abstract

BACKGROUND: Insulin resistance contributes to the clinical course of type 1 diabetes mellitus and increases complication risk in adults.

AIM: This study aimed to assess the clinical characteristics of type 1 diabetes mellitus and prevalence of its complications among men and women with and without insulin resistance.

METHODS: Overall, 317 adults with type 1 diabetes mellitus were examined. The participants were divided into two groups: group 1, 81 patients with insulin resistance; and group 2, 236 patients without insulin resistance. Lipid metabolism parameters and prevalence of macrovascular and microvascular complications were assessed in each group. Anthropometric and laboratory studies included serum creatinine levels with subsequent estimation of glomerular filtration rate, total cholesterol, high- and low-density lipoproteins, triglycerides, and urinary albumin excretion in a random sample. Instrumental examinations involved electroneuromyography, duplex ultrasound scanning of the lower-limb arteries, and fundus examination. Insulin resistance was defined as an estimated insulin sensitivity ≤5.02 in men and ≤5.64 in women. Quantitative data with non-normal distribution were presented as median and 95% confidence interval. For normally distributed variables, the mean and standard deviation were calculated. Categorical data were presented as absolute and relative frequencies. Differences in quantitative parameters were assessed using the Mann–Whitney U test and differences in categorical indicators using the χ2 test. P < 0.05 indicated significant differences.

RESULTS: Insulin resistance prevalence among all patients was 25.6%. Compared to patients without insulin resistance, men and women with insulin resistance more frequently had overweight or obesity (men: 57.1% vs 12.3%, p < 0.001; women: 56.4% vs 21.3%, p < 0.001), higher total cholesterol levels (men: 5.3 vs 4.6 mmol/L, p < 0.001; women: 5.6 vs 4.7 mmol/L, p < 0.001), and increased low-density lipoprotein levels (men: 3.4 vs 2.8 mmol/L, p < 0.001; women: 3.2 vs 2.7 mmol/L, p < 0.001). Men with insulin resistance were more likely to experience hypertension (47.6% vs 14.9%, p < 0.001), atherosclerosis (38.1% vs 14.9%, p = 0.004), diabetic nephropathy (54.8% vs 18.4%, p < 0.001), and retinopathy (81.0% vs 56.1%, p = 0.008). Hypertension (46.1% vs 13.9%, p < 0.001) and atherosclerosis (30.8% vs 11.5%, p = 0.010) were more prevalent in women with insulin resistance.

CONCLUSION: The clinical course of type 1 diabetes mellitus in patients with insulin resistance is characterized by increased cholesterol and low-density lipoprotein levels, higher prevalence of overweight or obesity, and greater incidence of macrovascular complications compared to patients without insulin resistance.

About the authors

Ramsiya I. Malievskaya

Bashkir State Medical University

Email: ramsiya1987@mail.ru
ORCID iD: 0000-0001-9841-0611
SPIN-code: 2226-4343

ассистент, каф. эндокринологии

Russian Federation, Ufa

Oleg A. Malievskiy

Bashkir State Medical University

Author for correspondence.
Email: malievsky@list.ru
ORCID iD: 0000-0003-2599-0867
SPIN-code: 6813-5061

Assistant Professor, Depart. of Endocrinology

Russian Federation, Ufa

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