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This version published online on July 7, 2009
Journal of Clinical Endocrinology & Metabolism , doi:10.1210/jc.2009-0960
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Submitted on May 20, 2009
Accepted on June 25, 2009

Estimated Glucose Disposal Rate in Assessment of the Metabolic Syndrome and Microvascular Complications in Patients with Type 1 Diabetes

Juan J. Chillarón, Alberto Goday, Juana A. Flores-Le-Roux, David Benaiges, María J. Carrera, Jaume Puig, Juan F. Cano-Pérez, and Juan Pedro-Botet*

Department of Endocrinology (J.J.C., J.A.F-L-R, D.V., M.J.C., J.P., J.F.C-P.) and Medicine (J.P-B.) Hospital del Mar, Barcelona, Spain; Universitat Autònoma de Barcelona (J.J.C., A.G., J.F.C-P, J.P-B.), Barcelona, Spain

* To whom correspondence should be addressed. E-mail: 86620{at}imas.imim.es.

Objective: To quantify insulin resistance in type 1 diabetes patients by estimated glucose disposal rate (eGDR), according to the presence or absence of the metabolic syndrome, and its relationship with chronic complications.

Design: Cross-sectional study in 91 patients with type 1 immune-mediated diabetes managed at an outpatient Endocrinology Clinic. All participants were Caucasian aged 18 years or older with type 1 diabetes duration of more than 6 months who had completed the study protocol.

Results: Twenty-nine patients met metabolic syndrome criteria, yielding a prevalence of 31.9%. Although no differences in insulin requirements were found between diabetic patients with and without metabolic syndrome, lower eGDR levels, indicating greater insulin resistance, were observed in metabolic syndrome patients compared with those without (6.19 ± 1.5 mg.Kg-1.min-1 vs 9.93 ± 1.6 mg.Kg-1.min-1) (p < 0.001). An eGDR level under 8.77 mg.Kg-1.min-1 showed 100% sensitivity and 85.2% specificity for metabolic syndrome diagnosis. All patients with diabetes complications had eGDR values below 8.16 mg.Kg-1.min-1. eGDR level was significantly lower in patients with diabetic retinopathy (5.97 ± 1.2 mg.Kg-1.min-1), diabetic neuropathy (5.06 ± 0.4 mg.Kg-1.min-1), or diabetic nephropathy (5.79 ± 1.5 mg.Kg-1.min-1) compared with those without (9.38 ± 2.0 mg.Kg-1.min-1, p < 0.001; 9.26 ± 2.0 mg.Kg-1.min-1, p < 0.001; and 9.19 ± 2.2 mg.Kg-1.min-1, p < 0.001).

Conclusions: Insulin resistance is common in type 1 diabetes patients and is associated with microvascular complications. eGDR, as an insulin resistance marker, provides more useful information than other classical variables such as insulin requirements.
Key words: type 1 diabetes • microvascular complications • metabolic syndrome • insulin resistance






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