High cumulative insulin exposure: a risk factor of atherosclerosis in type 1 diabetes?

MJ Muis, ML Bots, HJG Bilo, RPLM Hoogma, JBL Hoekstra, DE Grobbee, RP Stolk*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

29 Citations (Scopus)

Abstract

Background: Since insulin therapy might have an atherogenic effect, we studied the relationship between cumulative insulin dose and atherosclerosis in type 1 diabetes. We have focused on patients with type 1 diabetes instead of type 2 diabetes to minimise the effect of insulin resistance as a potential confounder.

Methods: An observational study was performed in 215 subjects with type 1 diabetes treated with multiple insulin injection therapy. Atherosclerosis was assessed by measurement of carotid intima-media thickness (CIMT).

Results: The cumulative dose of regular insulin showed a positive and significant relation with CIMT: increase of 21 mu m in CIMT per S.D. of insulin use (95% CI: 8-35 adjusted for gender and age), which remained unchanged after adjustment for duration of diabetes, HbA1c, BMI, pulse pressure. physical activity and carotid lumen diameter. A similar relation was found for intermediate-acting insulin: 15.5 mu m per S.D. (2-29), which was no longer present after further adjustment.

Conclusions: These findings provide evidence that a high cumulative dose of regular insulin is a risk factor for atherosclerosis. (c) 2005 Elsevier Ireland Ltd. All rights reserved.

Original languageEnglish
Pages (from-to)185-192
Number of pages8
JournalAtherosclerosis
Volume181
Issue number1
DOIs
Publication statusPublished - Jul-2005

Keywords

  • type 1 diabetes
  • carotid arterial wall thickness
  • insulin
  • insulin resistance
  • insulin injections
  • INTIMA-MEDIA THICKNESS
  • CORONARY-HEART-DISEASE
  • AORTIC ENDOTHELIAL-CELLS
  • ARTERIAL-WALL THICKNESS
  • CAROTID ATHEROSCLEROSIS
  • CARDIOVASCULAR-DISEASE
  • NITRIC-OXIDE
  • MACROVASCULAR DISEASE
  • MYOCARDIAL-INFARCTION
  • FEASIBILITY TRIAL

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