Insulin resistance and hepatic steatosis in type 1 diabetes mellitus and their association with diabetic chronic complications

BACKGROUND: The aim of this study was to evaluate insulin resistance and hepatic steatosis and their association with diabetes duration, control and chronic complications in patients with type 1 diabetes.METHODS: We studied medical records of 181 consecutive hospitalized adult patients with type 1 diabetes. Estimated glucose disposal rate (eGDR), Insulin Sensitivity Score (ISS), Fatty Liver Index (FLI) and Hepatic Steatosis Index (HSI) were calculated.RESULTS: Patients in the 1st tertile of eGDR (<4.1 mg/kg-1-min-1) and ISS (<4.8) had higher prevalence of ischemic cardiovascular disease (ICVD) (P<0.001), hepatic steatosis, higher gamma glutamyl transpeptidase, HSI, FLI compared with participants from the 2ndand 3rd tertile of eGDR and ISS. Compared with those without steatosis, patients with ultra-sound-diagnosed steatosis (30.5%) had a lower ISS (4.4 +/- 1.9 vs. 6.3 +/- 2.4, P<0.001), eGDR (4.5 +/- 3.0 vs. 5.8 +/- 2.7, P=0.01), higher FLI (72.5 +/- 25.1 vs. 51.0 +/- 27.2, P<0.001), HSI (37.5 +/- 6.1 vs. 35.2 +/- 4.7, P=0.03) and prevalence of ICVD (71.7 vs. 45.7%, P=0.004) and retinopathy (69.6 vs. 52.4%, P=0.03). Factors independently associated with hepatic steatosis were only ICVD (OR=2.584, P=0.029), ISS (OR 0.148, P<0.001), aspartate aminotransferase (OR=1.025, P=0.038) and male gender (OR=2.726, P=0.016). CONCLUSIONS: Insulin resistance and hepatic steatosis are common in type 1 diabetes and have a significant associa-tion with ICVD, independently of diabetes duration, control and insulin doses.