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Insulin resistance and hypertension in patients with type 1 diabetes
Juan J Chillarón1, María P Sales, Juana A Flores-Le-Roux
1Department of Endocrinology, Hospital del Mar, Barcelona, Spain.
Insights
Hypertension affects nearly one-third of type 1 diabetes patients, particularly men and those with longer diabetes duration. Lower insulin sensitivity and kidney complications significantly increase hypertension risk in this population.
Area of Science:
- Endocrinology
- Cardiovascular Health
- Metabolic Disorders
Background:
- Type 1 diabetes (T1D) is a chronic autoimmune condition characterized by insulin deficiency.
- Hypertension is a significant comorbidity in T1D, increasing the risk of cardiovascular and renal complications.
- Understanding the prevalence and associated factors of hypertension in T1D is crucial for effective management.
Purpose of the Study:
- To determine the prevalence of hypertension in patients with type 1 diabetes.
- To investigate the relationship between hypertension, insulin resistance, and other clinical factors in T1D.
- To identify independent predictors of hypertension in individuals with T1D.
Main Methods:
- A cross-sectional study involving 291 Caucasian patients aged 18+ with T1D duration >6 months.
- Hypertension defined as blood pressure ≥130/80 mmHg or use of antihypertensive medication.
- Insulin sensitivity assessed using estimated glucose disposal rate (eGDR).
Main Results:
- Hypertension was identified in 29.9% of T1D patients.
- Hypertensive patients were older, predominantly male, with higher BMI and longer diabetes duration.
- Lower insulin sensitivity (eGDR) and nephropathy were independently associated with increased hypertension prevalence.
Conclusions:
- Approximately one-third of T1D patients have hypertension, linked to male sex, microangiopathy, obesity, older age, and longer diabetes duration.
- Hypertension prevalence escalates with renal impairment severity.
- Insulin sensitivity is inversely related to hypertension in type 1 diabetes.
Aim:
The aims of this study were to determine the prevalence of hypertension in type 1 diabetes patients and to analyze its relationship with insulin resistance and other associated factors.
Design And Methods:
A cross-sectional study on 291 patients with type 1 immune-mediated diabetes managed at two outpatient endocrinology clinics was performed. All participants were Caucasian, 18 years or older with type 1 diabetes duration of more than 6 months, who had completed the study protocol. Hypertension was defined as blood pressure ≥130/80 mmHg or use of antihypertensive medication, excluding angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers when used as treatment for micro- or macroalbuminuria.
Results:
Hypertension was found in 87 [29.9% (95% confidence interval, or CI): 24.6%-35.2%] patients with type 1 diabetes. Hypertensive patients presented older age, male predominance, higher body mass index and overweight/obesity prevalence, and longer diabetes duration compared with normotensive patients. Insulin sensitivity quantified by estimated glucose disposal rate (eGDR) was lower in patients with hypertension compared with normotensives (5.2±1.4 vs. 9.1±1.2 mg kg(-1) min(-1), P<.001) and showed a negative correlation with systolic blood pressure level (r=-0.612, P<.01). In multivariate logistic regression analysis, eGDR, besides nephropathy, emerged significantly and independently associated with hypertension. An increment of 1 unit in insulin sensitivity assessed by eGDR was associated with a 5.7% decrease in hypertension prevalence (95% CI: 0.018-0.175) and the absence of nephropathy with an 88.2% decrease (95% CI: 0.15-0.92).
Conclusions:
Hypertension was present in approximately one third of patients with type 1 diabetes, especially in men, those with microangiopathy, overweight or obesity, older age and longer diabetes duration. Hypertension prevalence increased in parallel to the degree of renal impairment and was inversely related to insulin sensitivity.
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