Insulin Resistance in Adolescents with Type 1 Diabetes and Its Relationship to Cardiovascular Function (original) (raw)
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1University of Colorado Denver School of Medicine, Division of Pediatric Endocrinology (K.J.N., A.H., P.Z.), The Children’s Hospital, Aurora, Colorado 80045
*Address all correspondence and requests for reprints to: Kristen J. Nadeau, M.D., Assistant Professor of Pediatrics, University of Colorado Health Sciences Center, The Children’s Hospital, Department of Pediatric Endocrinology B265, 13123 East 16th Avenue, Aurora, Colorado 80045.
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2Division of General Internal Medicine (J.G.R.), Center for Women’s Health Research, Aurora, Colorado 80045
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3Division of General Internal Medicine (T.A.B.), Veterans Administration Hospital, Aurora, Colorado 80045
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4Division of Radiology (M.S.B.), Veterans Administration Hospital, Aurora, Colorado 80045
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5Division of Cardiology (J.L.D.), Veterans Administration Hospital, Aurora, Colorado 80045
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1University of Colorado Denver School of Medicine, Division of Pediatric Endocrinology (K.J.N., A.H., P.Z.), The Children’s Hospital, Aurora, Colorado 80045
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1University of Colorado Denver School of Medicine, Division of Pediatric Endocrinology (K.J.N., A.H., P.Z.), The Children’s Hospital, Aurora, Colorado 80045
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6Division of Endocrinology (B.D.), Veterans Administration Hospital, Aurora, Colorado 80045
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7Division of Endocrinology (J.E.B.R.), Veterans Administration Hospital, Aurora, Colorado 80045
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Accepted:
27 October 2009
Published:
01 February 2010
Cite
Kristen J. Nadeau, Judith G. Regensteiner, Timothy A. Bauer, Mark S. Brown, Jennifer L. Dorosz, Amber Hull, Phil Zeitler, Boris Draznin, Jane E. B. Reusch, Insulin Resistance in Adolescents with Type 1 Diabetes and Its Relationship to Cardiovascular Function, The Journal of Clinical Endocrinology & Metabolism, Volume 95, Issue 2, 1 February 2010, Pages 513–521, https://doi.org/10.1210/jc.2009-1756
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Abstract
Context: Cardiovascular disease is the major cause of death in adults with diabetes, yet little is specifically known about the effects of type 1 diabetes (T1D) on cardiovascular outcomes in youth. Although insulin resistance (IR) likely contributes to exercise and cardiovascular dysfunction in T2D, IR is not typically considered a contributor in T1D.
Objective: We hypothesized that cardiopulmonary fitness would be reduced in T1D youth in association with IR and cardiovascular dysfunction.
Design and Participants: This cross-sectional study at an academic hospital included 12 T1D adolescents compared with 12 nondiabetic controls, similar in age, pubertal stage, activity level, and body mass index.
Outcome Measures: Cardiopulmonary fitness was measured by peak oxygen consumption (VO2peak) and oxygen uptake kinetics (VO2kinetics), IR by hyperinsulinemic clamp, cardiac function by echocardiography, vascular function by venous occlusion plethysmography, intramyocellular lipid by magnetic resonance spectroscopy, and body composition by dual-energy x-ray absorptiometry.
Results: T1D adolescents had significantly decreased VO2peak, peak work rate, and insulin sensitivity compared with nondiabetic adolescents. T1D youth also had reduced vascular reactivity and evidence of diastolic dysfunction and left ventricular hypertrophy. Despite their IR and reduced cardiovascular fitness, T1D youth had paradoxically normal intramyocellular lipid, waist to hip ratio, and serum lipids and high adiponectin levels. In multivariate analysis, IR primarily, and forearm blood flow secondarily, independently predicted VO2peak.
Conclusions: T1D youth demonstrated IR, impaired functional exercise capacity and cardiovascular dysfunction. The phenotype of IR in T1D youth was unique, suggesting a pathophysiology that is different from T2D, yet may adversely affect long-term cardiovascular outcomes.
Copyright © 2010 by The Endocrine Society
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