Endocrine Abstracts

Background: Patients with type 1 diabetes (T1D) have an increased risk of cardiovascular disease (CVD), despite insulin therapy. Insulin resistance is strongly associated with non-alcoholic fatty liver disease (NAFLD) and CVD. The euglycemic clamp, the gold standard to assess insulin resistance in T1D, is unsuited for clinical practice. The estimated glucose disposal rate (eGDR) is increasingly used as an alternative in T1D, but its role as a NAFLD or CVD predictor is unexplored.

Methods: T1D subjects were screened for steatosis with ultrasound (US), Fatty Liver Index (FLI) and controlled attenuation parameter (CAP). CVD was defined based on documented events.

Results: CVD was present in 34 out of 355 subjects. Divided into tertiles (<5.39, 5.39–7.79, >7.79), 36.6% expressed low eGDR; 32.7% intermediate eGDR and 30.7% high eGDR. The eGDR is inversely associated with insulin resistance. There was moderate correlation between eGDR and FLI (r 0.68, P<0.001) and weak correlation with US (r 0.33, P<0.001) and CAP (r 0.50, P<0.001). In the low eGDR group (=insulin resistant group) was not only steatosis (38.5% vs. 11.2% (intermediate eGDR) and 12.8% (high eGDR)), but also composite CVD (18.5% vs. 6.0% and 2.8%) significantly more present (P<0.001 for both). Low eGDR (OR: 4.2 [2.2–8.2], P<0.001), but not BMI or dyslipidaemia was independently associated with US-defined NAFLD. Low eGDR was also independently associated with FLI-determined NAFLD (OR: 5.5 [1.7–17.6], P=0.004) together with BMI (OR: 1.6 [1.4–1.9], P<0.001). Low eGDR (OR: 8.0 [2.3–27.4], P=0.001) and NAFLD (OR: 2.7 [1.2–6.1], P=0.022 (US-defined), OR: 2.9 [1.4–6.0], P=0.005 (FLI-defined)) were independently associated with CVD, but presence of metabolic syndrome, dyslipidaemia and BMI were not.

Conclusions: Insulin resistance is prevalent in T1D. eGDR correlates with the presence of NAFLD. Both eGDR and NAFLD correlate with major cardiovascular adverse events.