The relationship of acute insulin sensitivity to the progression of vascular disease in long-term Type 1 (insulin-dependent) diabetes mellitus

Abstract

In 51 individuals with Type 1 (insulin-dependent) diabetes mellitus initially of more than 15 years' duration, the acute hypoglycaemic effect of intravenous insulin (0.11 IU/ kg) was related to outcome over 18 years. This acute insulin sensitivity, or glucose assimilation index, was reproducible over the period of study. At 18-year follow-up, initial low glucose assimilation index (<0.082 mmol·1-1· min-1 was significantly (p<0.01) associated with death from vascular disease. Low glucose assimilation index was similarly significantly (p<0.01) associated with progression of atherosclerotic disease, but not with microangiopathy alone. Hypertension (systolic blood pressure > 150mmHg and/or diastolic blood pressure > 95 mmHg) was the only other parameter significantly (p<0.01) related to outcome, but this relationship was no longer significant once glucose assimilation index had been taken into account. A linear logistic analysis confirmed that acute insulin sensitivity was independently associated with outcome. Neither initial clinical control of diabetes nor glycosylated haemoglobin level in the 26 survivors was related to vascular prognosis. © 1987 Springer-Verlag.