Insulin resistance and carotid atherosclerosis in patients with type 2 diabetes

Seok Won Park, Soo Kyung Kim, Yong Wook Cho, Dae Jung Kim, Young Duk Song, Young Ju Choi, Byung Wook Huh, Sung Hee Choi, Sun Ha Jee, Mi Ae Cho, Eunjig Lee, Kap Bum Huh

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11 Citations (Scopus)

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) ≥1.1 mm. 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.

Original languageEnglish
Pages (from-to)309-313
Number of pages5
JournalAtherosclerosis
Volume205
Issue number1
DOIs
Publication statusPublished - 2009 Jul 1

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Carotid Artery Diseases
Type 2 Diabetes Mellitus
Insulin Resistance
Hyperinsulinism
Carotid Intima-Media Thickness
Insulin
Smoking
Carotid Arteries
LDL Cholesterol
HDL Cholesterol
Fasting
Atherosclerosis
Cardiovascular Diseases
Odds Ratio
Blood Pressure
Hypertension
Glucose

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Park, S. W., Kim, S. K., Cho, Y. W., Kim, D. J., Song, Y. D., Choi, Y. J., ... Huh, K. B. (2009). Insulin resistance and carotid atherosclerosis in patients with type 2 diabetes. Atherosclerosis, 205(1), 309-313. https://doi.org/10.1016/j.atherosclerosis.2008.12.006
Park, Seok Won ; Kim, Soo Kyung ; Cho, Yong Wook ; Kim, Dae Jung ; Song, Young Duk ; Choi, Young Ju ; Huh, Byung Wook ; Choi, Sung Hee ; Jee, Sun Ha ; Cho, Mi Ae ; Lee, Eunjig ; Huh, Kap Bum. / Insulin resistance and carotid atherosclerosis in patients with type 2 diabetes. In: Atherosclerosis. 2009 ; Vol. 205, No. 1. pp. 309-313.
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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) ≥1.1 mm. 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.",
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Park, SW, Kim, SK, Cho, YW, Kim, DJ, Song, YD, Choi, YJ, Huh, BW, Choi, SH, Jee, SH, Cho, MA, Lee, E & Huh, KB 2009, 'Insulin resistance and carotid atherosclerosis in patients with type 2 diabetes', Atherosclerosis, vol. 205, no. 1, pp. 309-313. https://doi.org/10.1016/j.atherosclerosis.2008.12.006

Insulin resistance and carotid atherosclerosis in patients with type 2 diabetes. / Park, Seok Won; Kim, Soo Kyung; Cho, Yong Wook; Kim, Dae Jung; Song, Young Duk; Choi, Young Ju; Huh, Byung Wook; Choi, Sung Hee; Jee, Sun Ha; Cho, Mi Ae; Lee, Eunjig; Huh, Kap Bum.

In: Atherosclerosis, Vol. 205, No. 1, 01.07.2009, p. 309-313.

Research output: Contribution to journalArticle

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T1 - Insulin resistance and carotid atherosclerosis in patients with type 2 diabetes

AU - Park, Seok Won

AU - Kim, Soo Kyung

AU - Cho, Yong Wook

AU - Kim, Dae Jung

AU - Song, Young Duk

AU - Choi, Young Ju

AU - Huh, Byung Wook

AU - Choi, Sung Hee

AU - Jee, Sun Ha

AU - Cho, Mi Ae

AU - Lee, Eunjig

AU - Huh, Kap Bum

PY - 2009/7/1

Y1 - 2009/7/1

N2 - 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) ≥1.1 mm. 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.

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