Insulin resistance correlates with maculopathy and severity of retinopathy in young adults with Type 1 Diabetes Mellitus

  • C.W. Rowe
    Correspondence
    Corresponding author at: Department of Endocrinology and Diabetes, John Hunter Hospital, Lookout Road, New Lambton Heights, Newcastle, Australia.
    Affiliations
    Department of Endocrinology and Diabetes, John Hunter Hospital, Newcastle, Australia

    School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
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  • A.S. Haider
    Affiliations
    School of Medicine and Public Health, University of Newcastle, Callaghan, Australia

    Department of Ophthalmology, John Hunter Hospital, Newcastle, Australia
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  • D. Viswanathan
    Affiliations
    Department of Ophthalmology, John Hunter Hospital, Newcastle, Australia
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  • M. Jones
    Affiliations
    Clinical Research Design, IT, and Statistical Support (CReDITSS) Unit, Hunter Medical Research Institute, Newcastle, Australia
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  • J. Attia
    Affiliations
    School of Medicine and Public Health, University of Newcastle, Callaghan, Australia

    Clinical Research Design, IT, and Statistical Support (CReDITSS) Unit, Hunter Medical Research Institute, Newcastle, Australia
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  • K. Wynne
    Affiliations
    Department of Endocrinology and Diabetes, John Hunter Hospital, Newcastle, Australia

    School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
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  • S. Acharya
    Affiliations
    Department of Endocrinology and Diabetes, John Hunter Hospital, Newcastle, Australia

    School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
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      Highlights

      • Insulin resistance (IR) is now common in patients with Type 1 diabetes.
      • Retinopathy and microvascular disease are associated with IR in multiple studies.
      • Maculopathy associated with IR in Type 1 DM is a novel finding of this study.
      • IR has similar predictive value for retinal pathology as duration of disease and HbA1c.
      • Prospective studies examining IR and complications over time are required.

      Abstract

      Aims

      To assess the relationship between insulin resistance (IR), retinopathy and maculopathy in young adults with Type 1 diabetes mellitus.

      Methods

      A cross-sectional study at a regional Australian tertiary hospital. Retinal pathology, assessed by colour fundus photography, was correlated with two surrogate measures of IR: estimated Glucose Disposal Rate (eGDR) and Insulin Sensitivity Score (ISS), where lower scores reflect greater IR.

      Results

      107 patients were recruited, with mean age 24.7 years, 53% male, and mean duration of disease 10.8 years. Mean eGDR scores (5.6 vs 8.0 p < 0.001) and ISS (4.7 vs 7.9, p < 0.001) were lower in subjects having at least moderate non-proliferative diabetic retinopathy (NPDR; relative to nil/mild-NPDR). Similarly, mean eGDR (4.2 vs 6.2, p = 0.001) and ISS (3.8 vs 6.1, p = 0.003) were lower in patients with maculopathy. Multivariate logistic regression modelling was used to control for confounding. For retinopathy severity, a unit increase in eGDR or ISS (representing lower IR) was associated with a 50% decrease in odds of moderate-NPDR or worse (eGDR OR 0.5, 95%CI 0.32–0.77, p = 0.002; ISS OR 0.49, 95%CI 0.29–0.84, p = 0.01). A unit increase in eGDR or ISS was associated with a 46–56% decrease in odds of maculopathy (eGDR OR 0.54, 95%CI 0.37–0.81, p = 0.003; ISS OR 0.44, 95%CI 0.22–0.88, p = 0.02).

      Conclusions

      IR correlates with more severe retinopathy in young adults with Type 1 DM. This is the first description of a correlation between IR and maculopathy in Type 1 DM, warranting further evaluation. Prospective studies examining whether reducing IR can improve microvascular complications are required.

      Keywords

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