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Insulin dose and cardiovascular risk factors in type 1 diabetic children and adolescents
Insights
High daily insulin doses in children with Type 1 diabetes correlate with elevated triglycerides, a key cardiovascular risk factor. This association was observed even after accounting for metabolic control and other variables.
Area of Science:
- Pediatric Endocrinology
- Metabolic Disorders
- Cardiovascular Risk Factors
Background:
- Type 1 diabetes management requires careful insulin dosing.
- Cardiovascular risk factors are a concern in children with diabetes.
- Insulin resistance is linked to cardiovascular disease.
Purpose of the Study:
- To investigate associations between high daily insulin doses and cardiovascular risk factors in children with Type 1 diabetes.
- To explore how insulin dose relates to insulin resistance syndrome components.
Main Methods:
- Studied 479 children aged 6-18 with Type 1 diabetes.
- Analyzed insulin dose in relation to cardiovascular risk factors, adjusting for age, pubertal stage, diabetes duration, and metabolic control (fructosamine).
Main Results:
- Insulin dose increased with diabetes duration and was higher in girls.
- Insulin requirements rose with age and puberty, particularly in girls.
- Triglyceride concentrations showed a significant positive association with insulin dose in both genders, independent of other factors.
Conclusions:
- In Type 1 diabetic children, insulin dose is linked to triglyceride levels, a significant cardiovascular risk factor.
- No consistent associations were found with other cardiovascular risk factors like BMI, blood pressure, or cholesterol levels.
Abstract:
Associations between a high daily insulin dose and cardiovascular risk factors, including those of the insulin-resistance syndrome, were studied in 479 Type 1 diabetic children 6 to 18 years of age. Insulin dose increased over the first two years after diagnosis of diabetes (p = 0.0001) and was significantly higher in girls (p = 0.01). For those children with diabetes duration of more than 2 years, the insulin requirement increased up to 13-14 years of age (p < 0.05) and was higher in pubertal than pre-pubertal children (p < 0.05). For girls, the requirement was higher in puberty than in post-puberty (p < 0.05) and increased with diabetes duration (p < 0.05). Triglyceride concentrations were associated positively and significantly with the insulin dose of both boys and girls, after adjustment for age, pubertal stage, diabetes duration, and metabolic control (fructosamine levels). No other consistent associations were found between insulin dose and other cardiovascular risk factors: body mass index, central adiposity, arterial blood pressures, serum total cholesterol, apoA1, apoB, Lp(a), uric acid, or urinary albumin excretion. Parental obesity, hypertension and diabetes were not related to the insulin dose of children. The results did not differ when the population was limited to the 375 children with diabetes duration of more than 2 years. It is concluded that in these Type 1 diabetic children the insulin dose for a given level of metabolic control (our surrogate measure of insulin resistance) was related to a single cardiovascular risk factor: triglyceride concentrations.