| Objective To investigate the relationship between the estimated glucose disposal rate(e GDR)of insulin resistance(IR)indirect marker and microvascular complications including diabetes retinopathy(DR)and diabetic kidney disease(DKD)in type 1 diabetes patients,and to provide evidence for the early prevention and treatment of microvascular complications in T1DM patients.Methods The study subjects were 202 patients with T1DM who were hospitalized in the Department of Endocrinology and Metabolism,Lanzhou University Second Hospital from January 2019 to June 2022.The data on their admission were analyzed.Upon admission,all patients were recorded with general and clinical biochemical data,including gender,age,course of T1DM,height,weight,calculated body mass index(BMI),and blood pressure.Blood and urine samples were collected for biochemical measurements,including glycosylated hemoglobin(Hb A1c),blood lipids(TG,TC,LDL,HDL),uric acid(UA),vitamin D,Urinary albumin/creatinine ratio,24-hour urinary protein quantification(UTP),and insulin treatment plans were recorded including the dosage of quick acting insulin and basic insulin and calculated e GDR according to the formula based on the patient’s BMI,Hb A1c,and whether hypertension is present.e GDR was used to assess the impact of IR severity on microvascular complications in T1DM patients.The level of e GDR was grouped according to its four quantiles,and the patients were divided into Q1 group(50 cases),Q2 group(50 cases),Q3 group(52 cases),and Q4 group(50 cases)from low to high.Patients were grouped based on whether the e GDR value was less than 8,where e GDR less than 8 was combined IR.Comparing the general clinical data and biochemical indicators of T1DM patients between different groups,the correlation between e GDR and other clinical variables was analyzed using Spearman correlation and partial correlation.T1DM patients were stratified by age(whether greater than or equal 18years old)and course of disease(whether greater than or equal 10 years)to analyze the impact of age and course of disease on the relationship between e GDR and microvascular complications.The binary logistic regression model was used to explore the correlation between e GDR as a continuous variable and two categorical variable and DR and DKD,which were both bilateral tests.P<0.05 showed that the difference was statistically significant.Results 1.Basic information:202 T1DM patients were included in this study,including 80 male patients and 122 female patients.The average age of diabetes was(27.38±12.88)years,the median duration of diabetes was 4(1,11)years,the average BMI was(19.83±3.30)kg/m~2,the average systolic pressure was 114.28±18.05 mm Hg,the average diastolic pressure was 73.9±12.3 mm Hg,the median Hb A1c was 10.7(8.6,12.9)%,and the median e GDR was 7.77(5.85,10.1).2.Comparison of patient conditions after quartile grouping of e GDR:From group Q1 to group Q4,the e GDR values ranged from low to high.The Q1 group had the heaviest IR degree,with the highest DKD prevalence rate of 76%,which was significantly higher than the other three groups.The other three groups were 58%,59.6%,and 44%,respectively(P=0.014).In the case of combining DKD and DR,the Q1 group was also higher than the other three groups,and the incidence rate decreased with the increase of e GDR levels(P=0.022).There were statistically significant differences in BMI,SBP,DBP,Hb A1c,TG,LDL,TC and quick acting insulin doses among the four groups(P<0.01),while there were no statistically significant differences in other indicators of diabetes duration,UTP,BUN,SCR,e GFR,HDL and UA among the four groups(P>0.05).3.Comparison of clinical characteristics of different insulin resistance groups in patients with T1DM:Among 202 patients with T1DM,92 patients were in the T1DM group without IR(e GDR≥8),and 110 patients were in the T1DM group with IR(e GDR<8).That were 54.4%of T1DM patients with IR.Compared with the group without IR,the group with IR had higher BMI,SBP,DBP,Hb A1c,TG,LDL,TC,and the required dose of quick acting insulin.In addition,the group with IR had higher 24-hour UTP and more patients with DR and DKD,with a statistically significant difference(P<0.05).4.Correlation analysis of e GDR and clinical indicators:after adjusting age,gender and course of diabetes,e GDR was negatively correlated with BMI,SBP,DBP,Hb A1c,TG,LDL,TC,doses of quick acting insulin and total doses of insulin(r was-0.243,-0.274,-0.355,-0.688,-0.31,-0.287,-0.228,-0.225,-0.256,respectively,P<0.05).5.The impact of age and course of disease on the relationship between e GDR and microvascular complications in T1DM patients:A logistic regression analysis was conducted on the risk of microvascular complications in e GDR and T1DM in 56children and adolescents,146 adults,course of disease greater than or equal 10 years of T1DM(n=62),and course of disease less than 10 years of T1DM(n=140)groups,respectively.After gradually adjusting for confounding factors,the results showed that low e GDR was a risk factor for microvascular complications in adult T1DM patients(P<0.05).Whether the course of disease of T1DM patients is greater than or equal to10 years or not,low e GDR is a risk factor for microvascular complications in T1DM patients(P<0.05).6.Logistic regression analysis of e GDR and the risk of DKD and DR:When e GDR was used as a continuous variable and adjusted for confounding factors,the results showed that low e GDR was a risk factor for DKD and DR in patients with T1DM,with OR values of 0.865(95%CI 0.787～0.9523,P=0.003)and 0.777(95%CI 0.621～0.973,P=0.028),respectively.7.Logistic regression analysis of IR and the risk of DKD and DR:when e GDR was used as the second categorical variable,after adjusting for confounding factors,the results showed that the combined IR was the risk factor of T1DM with DKD and DR,and the OR values were 2.275(95%CI 1.805-4.768,P=0.030)and 5.133(95%CI1.263-20.679,P=0.036)respectively.Conclusion 1.IR cannot be ignored in T1DM.IR and low e GDR are risk factors for microvascular complications in T1DM.2.With the decrease of e GDR,the risk of microvascular complications of diabetes in T1DM will increase.3.eGDR is a comprehensive IR marker,which is easy to use in clinical practice and helps to better stratify the risk of diabetes complications in T1DM patients. |
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