OBJECTIVE The association of insulin resistance (IR) with cardiovascular disease (CVD) and all-cause mortality in type 1 diabetes (T1D) remains unclear. PURPOSE To investigate whether IR is associated with CVD and all-cause mortality among individuals with T1D. DATA SOURCES PubMed, Embase, and the Cochrane Library databases were searched from inception to 31 October 2023. STUDY SELECTION Observational studies reporting the associations between IR, as calculated by the estimated glucose disposal rate (eGDR), and the risk of CVD and all-cause mortality in individuals with T1D were eligible for inclusion. DATA EXTRACTION Data from eight selected studies were extracted, pooled by random-effects models, and results are presented as hazard ratios (95% CIs). DATA SYNTHESIS Eight studies involving 21,930 individuals were included, of which five studies involving 19,960 individuals with T1D reported the risk of CVD. During a median follow-up of 10 years, there were 2,149 cases of incident CVD. The pooled hazard ratio for composite CVD outcome per 1-unit increase in the eGDR index was 0.83 (95% CI 0.78–0.90, I2 = 58.9%). Five studies involving 19,403 individuals reported the risk of all-cause mortality. During a median follow-up of 10 years, 1,279 deaths were observed. The pooled hazard ratio for all-cause mortality per 1-unit increase in the eGDR index was 0.84 (95% CI 0.81–0.87, I2 = 0%). LIMITATIONS The small number of available studies restricted our ability to perform meta-regression analyses or more detailed subgroup analyses. CONCLUSIONS IR, as calculated by the eGDR, may be an additional risk factor for CVD and all-cause mortality in T1D.

中文翻译：

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胰岛素抵抗与 1 型糖尿病心血管疾病和全因死亡率的关系：系统评价和荟萃分析


目的 胰岛素抵抗 （IR） 与 1 型糖尿病 （T1D） 心血管疾病 （CVD） 和全因死亡率的相关性尚不清楚。目的 调查 IR 是否与 T1D 患者的 CVD 和全因死亡率相关。数据来源 检索了 PubMed、Embase 和 Cochrane 图书馆数据库，检索时间从建库到 2023 年 10 月 31 日。研究选择 报告了 IR 之间的关联（通过估计葡萄糖处理率 （eGDR） 计算）与 T1D 个体的 CVD 和全因死亡风险之间的关联符合纳入条件。资料提取 提取来自 8 项选定研究的数据，通过随机效应模型进行汇总，结果以风险比 （95% CI） 表示。数据综合 纳入了涉及 21,930 人的研究，其中 5 项研究涉及 19,960 名 T1D 患者报告了 CVD 的风险。在中位 10 年的随访期间，有 2,149 例 CVD 新发病例。eGDR 指数每增加 1 个单位，复合 CVD 结局的合并风险比为 0.83 （95% CI 0.78–0.90，I2 = 58.9%）。涉及 19,403 名个体的 5 项研究报告了全因死亡的风险。在中位 10 年的随访期间，观察到 1,279 例死亡。eGDR 指数每增加 1 个单位的全因死亡率的汇总风险比为 0.84 （95% CI 0.81–0.87，I2 = 0%）。局限性 可用的研究数量少限制了我们进行meta回归分析或更详细的亚组分析的能力。结论 根据 eGDR 计算的 IR 可能是 T1D 患者 CVD 和全因死亡率的额外危险因素。