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Better vascular health profile in type 1 diabetes insulin pump users (#163)

Andrzej S Januszewski 1 , David N O'Neal 2 , Connie S Karschimkus 2 , Daniel A Calandro 1 , Sybil McAuley 2 , Alicia J Jenkins 2
  1. NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
  2. Department of Medicine, University of Melbourne, Fitzroy, VIC, Australia
Insulin lowers glucose and has anti-inflammatory and vasoactive effects. Continuous subcutaneous insulin infusion (CSII, or pump therapy) can improve glycaemia vs. multiple daily injections (MDI) in Type 1 diabetes (T1D). Little is known about effects on vascular health. We studied 206 T1D-MDI, 55 T1D-CSII and 360 non-diabetic subjects, mean age 39 yrs, 40% male, and measured arterial elasticity, glycaemia (HbA1c, 1,5 anhydroglucitol), lipids, inflammation (CRP, sVCAM-1, sICAM-1, sE-selectin) and oxidative stress (myloperoxidase (MPO), oxidized (Ox)LDL, AGEs). Results are mean±SD or geometric mean(LQ-UQ). CSII vs. MDI users had better HbA1c: 7.5±1.1 vs. 8.2±1.5%), lipids (TC: 4.4(3.9–5.0) vs. 4.8(4.2–5.7) mM; LDL-C: 2.3(1.9–2.8) vs. 2.7(2.1–3.5) mM; all p<0.001), artery elasticity (large: 19.9±7.2 vs. 16.5±5.6 ml/mmHgx10; p<0.001; small:7.7±3.3 vs. 6.6±3.4 ml/mmHgx100; p=0.03) and inflammation (sVCAM:490(396–523) vs. 580(470–706)ng/ml, p=0.006; sICAM:191(159–225) vs. 269(227–334)ng/ml, p<0.001; sE-selectin: 31(23–45) vs. 50(34–74)ng/ml, p<0.001). MPO, OxLDL and AGEs (not shown) were higher (p<0.001) in T1D vs. controls, but similar in CSII and MDI. After adjustment (age, sex, HbA1c, BMI, T1D complications and smoking) CSII users had better large artery elasticity, total and LDL-C, AGEs, sICAM and sE-selectin (all p<0.05). In summary, T1D-CSII users have better vascular health than MDI users, and more closely resemble non-diabetic subjects. A longitudinal study is merited.