Lower insulin resistance linked to better CGM metrics for adults with type 1 diabetes
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Key takeaways:
- Adults with type 1 diabetes who had a higher estimated glucose disposal rate spent more time in glycemic range.
- The researchers said targeting insulin resistance should be a part of type 1 diabetes treatment.
Adults with type 1 diabetes who have greater insulin sensitivity as measured by estimated glucose disposal rate are more likely to have better glycemic control, according to study data.
In a retrospective analysis published in The Journal of Clinical Endocrinology & Metabolism, researchers examined associations between insulin resistance and continuous glucose monitoring metrics among participants in the Nonalcoholic Fatty Liver Disease in T1D (NAFLDIA1) study. The researchers found adults who had a higher estimated glucose disposal rate (eGDR), which indicates less insulin resistance, were more likely to spend more time in glycemic range and less time above range.
“Insulin resistance not only contributes to a worse glycemic control, as we have shown, but also confers an increased risk of microvascular and macrovascular complications,” Christophe De Block, MD, PhD, professor in the department of endocrinology, diabetology and metabolism at Antwerp University Hospital in Belgium, and colleagues wrote. “The increased risk of cardiovascular disease was even shown to be independent of glycemic control reflected by HbA1c. Incorporating targeting insulin resistance in the treatment strategies of type 1 diabetes would thus not only contribute to a better glycemic control, but might eventually also reduce the risk of long-term complications.”
Researchers collected data from 335 adults with type 1 diabetes aged 18 years and older who attended the outpatient clinic at Antwerp University Hospital. Of the group, 287 adults participated in NAFLDIA1 and had insulin resistance assessed through eGDR (mean age, 46 years; 55% men), whereas 48 adults had insulin resistance assessed through a hyperinsulinemic-euglycemic clamp as part of a separate study (mean age, 47 years; 63% men). Time in range, time below range, time above range, coefficient of variation and glucose management indicator were obtained from CGM data for all participants.
In linear regression analysis, having a higher time in range was associated with a higher eGDR (beta = 0.016; 95% CI, 0.008-0.024; P < .001), whereas a higher time above range was associated with a lower eGDR (beta = –0.021; 95% CI, –0.029 to –0.012; P < .001).
In logistic regression analysis, participants in NAFLDIA1 were divided into tertiles based on time in range, time above range, time below range and coefficient of variation, with the lowest tertile having the most unfavorable outcome and the highest tertile having the most favorable outcome. Having a higher eGDR was linked to greater odds of being in a more favorable time in range tertile (adjusted OR = 1.251; 95% CI, 1.12-1.399; P < .001) and a more favorable time above range tertile (aOR = 1.281; 95% CI, 1.146-1.443; P < .001). Having a higher eGDR was also associated with being in a more unfavorable time below range tertile (aOR = 0.893; 95% CI, 0.801-0.994; P = .039).
Among adults who had a hyperinsulinemic-euglycemic clamp performed, there were no differences in CGM metrics between the M-value tertiles. No associations were observed in logistic regression analysis where the subgroup was divided into tertiles based on CGM metrics.
“These findings support the role of insulin resistance as a determinant of glycemic control in people with type 1 diabetes and suggests that indirect methods to quantify insulin sensitivity might be worthwhile to explore,” the researchers wrote.
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