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Insulin resistance and carotid atherosclerosis in patients with type 2 diabetes

Authors
 SeokWon Park  ;  Soo Kyung Kim  ;  Yong-Wook Cho  ;  Dae Jung Kim  ;  Young-Duk Song  ;  Young Ju Choi  ;  ByungWook Huh  ;  Sung Hee Choi  ;  Sun Ha Jee  ;  Mi Ae Cho  ;  Eun Jig Lee  ;  Kap Bum Huh 
Citation
 ATHEROSCLEROSIS, Vol.205(1) : 309-313, 2009 
Journal Title
ATHEROSCLEROSIS
ISSN
 0021-9150 
Issue Date
2009
MeSH
Aged ; Body Mass Index ; Carotid Artery Diseases/complications* ; Carotid Artery Diseases/diagnosis* ; Cohort Studies ; Diabetes Mellitus, Type 2/complications* ; Diabetes Mellitus, Type 2/diagnosis* ; Female ; Glucose/metabolism ; Humans ; Hyperinsulinism/complications* ; Hyperinsulinism/diagnosis* ; Insulin Resistance* ; Male ; Middle Aged ; Regression Analysis ; Tunica Intima/pathology ; Tunica Media/pathology
Keywords
Insulin resistance ; Hyperinsulinemia ; Carotid atherosclerosis ; Type 2 diabetes
Abstract
OBJECTIVE: Insulin resistance may provide a crucial link between type 2 diabetes and cardiovascular disease. However, it is still unclear whether insulin resistance itself or hyperinsulinemia is independently associated with subclinical atherosclerosis. We hypothesized that insulin resistance, but not hyperinsulinemia, would be associated with carotid atherosclerosis in patients with type 2 diabetes. METHODS: We examined 2471 patients with type 2 diabetes, consecutively enrolled in Huh Diabetes Center. Insulin sensitivity was directly assessed by a rate constant for plasma glucose disappearance (Kitt) using short insulin tolerance test. Fasting insulin levels were used as a marker of hyperinsulinemia. Both carotid arteries were examined by B-mode ultrasound. Carotid atherosclerosis was defined by having a clearly isolated focal plaque or mean carotid intima-media thickness (IMT) >or=1.1mm. RESULTS: In multiple regression models, insulin sensitivity index (Kitt) but not hyperinsulinemia was significantly associated with carotid IMT adjusting for known risk factors such as age, sex, BMI, smoking, systolic pressure, HDL and LDL cholesterol. One standard deviation decrease in Kitt was associated with 0.046 mm increase in carotid IMT (p=0.015). Furthermore, odds ratio for carotid atherosclerosis was 1.43 (95% CI: 1.10, 1.86) in type 2 diabetic patients with insulin resistance (lowest quartile of insulin sensitivity) adjusting for known risk factors. The results were consistent in all subgroups stratified by sex, age, smoking and hypertension. CONCLUSION: Insulin resistance measured by short insulin tolerance test, but not hyperinsulinemia, is independently associated with carotid atherosclerosis in patients with type 2 diabetes.
Full Text
http://www.sciencedirect.com/science/article/pii/S0021915008008496
DOI
10.1016/j.atherosclerosis.2008.12.006
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
4. Graduate School of Public Health (보건대학원) > Graduate School of Public Health (보건대학원) > 1. Journal Papers
Yonsei Authors
Lee, Eun Jig(이은직) ORCID logo https://orcid.org/0000-0002-9876-8370
Jee, Sun Ha(지선하) ORCID logo https://orcid.org/0000-0001-9519-3068
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/105062
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