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Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Diabetes. Feb 15, 2015; 6(1): 8-16
Published online Feb 15, 2015. doi: 10.4239/wjd.v6.i1.8
Insulin sensitivity and complications in type 1 diabetes: New insights
Petter Bjornstad, Janet K Snell-Bergeon, Kristen J Nadeau, David M Maahs
Petter Bjornstad, Janet K Snell-Bergeon, Kristen J Nadeau, David M Maahs, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO 80045, United States
Petter Bjornstad, Janet K Snell-Bergeon, Kristen J Nadeau, David M Maahs, Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, CO 80045, United States
Petter Bjornstad, Janet K Snell-Bergeon, Kristen J Nadeau, David M Maahs, Department of Pediatrics, Division of Pediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO 80045, United States
Author contributions: Bjornstad P researched, wrote, contributed to discussion, and reviewed/edited the manuscript; Snell-Bergeon JK and Nadeau KJ researched, contributed to discussion, and reviewed/edited the manuscript; Maahs DM researched, contributed to discussion, and reviewed/edited the manuscript.
Conflict-of-interest: Drs. Bjornstad, Snell-Bergeon, Nadeau and Maahs have no conflict of interests to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Petter Bjornstad, MD, Barbara Davis Center for Diabetes, University of Colorado School of Medicine, 13123 East 16th Avenue, Aurora, CO 80045, United States. petter.bjornstad@childrenscolorado.org
Telephone: +1-720-7771234 Fax: +1-720-7777301
Received: September 23, 2014
Peer-review started: September 23, 2014
First decision: November 13, 2014
Revised: November 27, 2014
Accepted: December 3, 2014
Article in press: December 10, 2014
Published online: February 15, 2015
Abstract

Despite improvements in glucose, lipids and blood pressure control, vascular complications remain the most important cause of morbidity and mortality in patients with type 1 diabetes. For that reason, there is a need to identify additional risk factors to utilize in clinical practice or translate to novel therapies to prevent vascular complications. Reduced insulin sensitivity is an increasingly recognized component of type 1 diabetes that has been linked with the development and progression of both micro- and macrovascular complications. Adolescents and adults with type 1 diabetes have reduced insulin sensitivity, even when compared to their non-diabetic counterparts of similar adiposity, serum triglycerides, high-density lipoprotein cholesterol, level of habitual physical activity, and in adolescents, pubertal stage. Reduced insulin sensitivity is thought to contribute both to the initiation and progression of macro- and microvascular complications in type 1 diabetes. There are currently clinical trials underway examining the benefits of improving insulin sensitivity with regards to vascular complications in type 1 diabetes. Reduced insulin sensitivity is an increasingly recognized component of type 1 diabetes, is implicated in the pathogenesis of vascular complications and is potentially an important therapeutic target to prevent vascular complications. In this review, we will focus on the pathophysiologic contribution of insulin sensitivity to vascular complications and summarize related ongoing clinical trials.

Keywords: Type 1 diabetes, Insulin sensitivity, Vascular complications, Hyperfiltration, Cystatin C, Creatinine, Glomerular filtration rate

Core tip: Adolescents and adults with type 1 diabetes have reduced insulin sensitivity compared to their non-diabetic counterparts. Reduced insulin sensitivity is implicated in the development and progression of micro and macrovascular complications in type 1 diabetes. Clinical trials are underway investigating insulin sensitivity as a therapeutic target to prevent vascular complications in type 1 diabetes. Methods are needed to identify which patients with type 1 diabetes would benefit from treatment of insulin resistance and translation of this to clinical practice.