Insulin Resistance–Related Factors, but not Glycemia, Predict Coronary Artery Disease in Type 1 Diabetes
Open accessAbstract
OBJECTIVE—To determine the independent risk factors for coronary artery disease (CAD) in type 1 diabetes by type of CAD at first presentation. RESEARCH DESIGN AND METHODS—This is a historical prospective cohort study of 603 patients with type 1 diabetes diagnosed before 18 years of age between 1950 and 1980. The mean age and duration of diabetes at baseline were 28 (range 8–47) and 19 years (7–37), respectively, and patients were followed for 10 years. Patients with prevalent CAD were excluded from the study. Electrocardiogram (ECG) ischemia was defined by Minnesota Code (MC) 1.3, 4.1–3, 5.1–3, or 7.1; angina was determined by Pittsburgh Epidemiology of Diabetes Complications (EDC) study physician diagnosis; and hard CAD was determined by angiographic stenosis ≥50%, revascularization procedure, Q waves (MC 1.1–1.2), nonfatal myocardial infarction (MI), or CAD death. RESULTS—A total of 108 incident CAD events occurred during the 10-year follow-up: 17 cases of ECG ischemia, 49 cases of angina, and 42 cases of hard CAD (5 CAD deaths, 25 nonfatal MI or major Q waves, and 12 revascularization or ≥50% stenosis). Blood pressure, lipid levels, inflammatory markers, renal disease, and peripheral vascular disease showed a positive gradient across the groups of no CAD, angina, and hard CAD (P < 0.01, trend analysis, all variables), although estimated glucose disposal rate (eGDR) and physical activity showed inverse associations (P < 0.01, trend analysis, both variables). In addition, depressive symptomatology predicted angina (P = 0.016), whereas HbA1 showed no association with subsequent CAD. CONCLUSIONS—These data suggest that although the standard CAD risk factors are still operative in type 1 diabetes, greater glycemia does not seem to predict future CAD events. In addition, depressive symptomatology predicts angina and insulin resistance (eGDR) predicts hard CAD end points.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Meta-analyses have clearly shown that tight blood glucose control leads to the suppression of ASCVD incidence.
“Meta-analyses have clearly shown that tight blood glucose control leads to the suppression of ASCVD incidence795, 796).”
From Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017 (2018) · cites this paper as [796]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
Friedewald, W. T., Levy, R. I., & Fredrickson, D. S. (1972) · Clinical Chemistry · doi:10.1093/clinchem/18.6.499 · Cited by 32,423 · see citing works
Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation
Beck, A. T., Steer, R. A., & Carbin, M. G. (1988) · Clinical Psychology Review · doi:10.1016/0272-7358(88)90050-5 · Cited by 11,696 · see citing works
Hemingway, H., & Marmot, M. G. (1999) · BMJ · doi:10.1136/bmj.318.7196.1460 · Cited by 1,342 · see citing works
Hyperglycemie and Microvascular and Macrovascular Disease in Diabetes
Klein, R. (1995) · Diabetes Care · doi:10.2337/diacare.18.2.258 · Cited by 849 · see citing works
Prineas, R. J., Crow, R. S., & BLACKBURN, H. W. (1982) · Cited by 707 · see citing works
Can clinical factors estimate insulin resistance in type 1 diabetes?
Williams, K. V., Erbey, J. R., Becker, D., Arslanian, S., & Orchard, T. J. (2000) · Diabetes · doi:10.2337/diabetes.49.4.626 · Cited by 640 · see citing works
The effect of proteinuria on relative mortality in Type 1 (insulin-dependent) diabetes mellitus
Borch‐Johnsen, K., Andersen, P. K., & Deckert, T. (1985) · Diabetologia · doi:10.1007/bf00281993 · Cited by 601 · see citing works
Orchard, T. J., Dorman, J. S., Maser, R. E., Becker, D. J., DRASH, A. L., Ellis, D., LaPorte, R. E., & Kuller, L. H. (1990) · Diabetes · doi:10.2337/diab.39.9.1116 · Cited by 541 · see citing works
Self-citationPurnell, J. Q., Hokanson, J. E., Marcovina, S. M., Steffes, M. W., Cleary, P. A., & Brunzell, J. D. (1998) · JAMA · doi:10.1001/jama.280.2.140 · Cited by 469 · see citing works
Smith, S. C., Greenland, P., & Grundy, S. M. (2000) · Circulation · doi:10.1161/01.cir.101.1.111 · Cited by 469 · see citing works
The hypertension detection and follow-up program
Hypertension detection and follow-up program cooperative group (1976) · Preventive Medicine · doi:10.1016/0091-7435(76)90039-6 · Cited by 348 · see citing works
Orchard, T. J., & Strandness, D. E. (1993) · Circulation · doi:10.1161/01.cir.88.2.819 · Cited by 251 · see citing works
Self-citationThe hypertension detection and follow-up program.
Langford, H. G. (1984) · PubMed · Cited by 239 · see citing works
Diabetes Mellitus and Macrovascular Complications: An epidemiological perspective
Donahue, R. P., & Orchard, T. J. (1992) · Diabetes Care · doi:10.2337/diacare.15.9.1141 · Cited by 230 · see citing works
Self-citationThe Composition of Coronary-Artery Plaques
Davies, M. J. (1997) · New England Journal of Medicine · doi:10.1056/nejm199705013361809 · Cited by 220 · see citing works
Wagener, D. K., Sacks, J. M., LaPorte, R. E., & MacGregor, J. M. (1982) · Diabetes · doi:10.2337/diab.31.2.136 · Cited by 218 · see citing works
Advanced glycosylation end products in diabetic renal and vascular disease
Bucala, R., & Vlassara, H. (1995) · American Journal of Kidney Diseases · doi:10.1016/0272-6386(95)90051-9 · Cited by 214 · see citing works
Orchard, T. J., Dorman, J. S., Maser, R. E., Becker, D. J., Ellis, D., LaPorte, R. E., Kuller, L. H., Wolfson, S. K., & DRASH, A. L. (1990) · Diabetes Care · doi:10.2337/diacare.13.7.741 · Cited by 207 · see citing works
Self-citationCardiovascular Disease and Its Risk Factors in IDDM in Europe
Koivisto, V. A., Stevens, I. K., Mattock, M. B., et al. (1996) · Diabetes Care · doi:10.2337/diacare.19.7.689 · Cited by 199 · see citing works
Orchard, T. J., Dorman, J. S., Maser, R. E., et al. (1990) · Diabetes · doi:10.2337/diabetes.39.9.1116 · Cited by 157 · see citing works
Self-citationForrest, K. Y. Z., BECKER, D. J., Kuller, L. H., Wolfson, S. K., & Orchard, T. J. (2000) · Atherosclerosis · doi:10.1016/s0021-9150(99)00217-8 · Cited by 147 · see citing works
Self-citationCoronary Artery Disease in IDDM
Lloyd, C. E., Kuller, L. H., Ellis, D., BECKER, D. J., Wing, R. R., & Orchard, T. J. (1996) · Arteriosclerosis Thrombosis and Vascular Biology · doi:10.1161/01.atv.16.6.720 · Cited by 147 · see citing works
Self-citationDepression and the risk of coronary heart disease in the normative aging study
Sesso, H. D., Kawachi, I. I., Vokonas, P., & Sparrow, D. (1998) · The American Journal of Cardiology · doi:10.1016/s0002-9149(98)00491-3 · Cited by 142 · see citing works
Maser, R. E. (1990) · Archives of Internal Medicine · doi:10.1001/archinte.150.6.1218 · Cited by 141 · see citing works
Time Trends in Physical Activity among College Alumni, 1962–1988
Lee, I., Paffenbarger, R. S., & Hsieh, C. (1992) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a116387 · Cited by 136 · see citing works
Mendoza, S. G., Zerpa, A., Carrasco, H., et al. (1983) · PubMed · Cited by 115 · see citing works
Prolonged QT interval as a predictor of mortality in diabetic nephropathy
Sawicki, P. T., DÄhne, R., Bender, R., et al. (1996) · Diabetologia · doi:10.1007/bf00400416 · Cited by 114 · see citing works
Lehto, S., Rönnemaa, T., Pyörälà, K., & Laakso, M. (1999) · Arteriosclerosis Thrombosis and Vascular Biology · doi:10.1161/01.atv.19.4.1014 · Cited by 104 · see citing works
Orchard, T. J., & Strandness, D. E. (1993) · Diabetes Care · doi:10.2337/diacare.16.8.1199 · Cited by 94 · see citing works
Self-citationErbey, J. R., Kuller, L. H., BECKER, D. J., & Orchard, T. J. (1998) · Diabetes Care · doi:10.2337/diacare.21.4.610 · Cited by 90 · see citing works
Self-citationDoes Hyperglycemia Really Cause Coronary Heart Disease?
Barrett-Connor, E. (1997) · Diabetes Care · doi:10.2337/diacare.20.10.1620 · Cited by 82 · see citing works
Olson, J. (2002) · Annals of Epidemiology · doi:10.1016/s1047-2797(01)00269-1 · Cited by 81 · see citing works
Self-citationWagener, D. K., Jm, S., LaPorte, R. E., et al. (1982) · Diabetes · doi:10.2337/diabetes.31.2.136 · Cited by 62 · see citing works
Mautner, S. L., Lin, F., & Roberts, W. C. (1992) · The American Journal of Cardiology · doi:10.1016/0002-9149(92)90759-r · Cited by 53 · see citing works
Orchard, T. J. (1998) · International Journal of Epidemiology · doi:10.1093/ije/27.6.976 · Cited by 50 · see citing works
Self-citationCoronary risk factors influence plaque morphology in patients with unstable angina
Gyöngyösi, M., Yang, P., Hassan, A., et al. (1999) · Coronary Artery Disease · doi:10.1097/00019501-199906000-00002 · Cited by 26 · see citing works
Role of Peptide Growth Factors in Development of Macrovascular Complications of Diabetes
Clemmons, D. R. (1991) · Diabetes Care · doi:10.2337/diacare.14.2.153 · Cited by 14 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes
(2005) · New England Journal of Medicine · doi:10.1056/nejmoa052187 · Cited by 5,138 · see citing works
Meta-analysis: glycosylated hemoglobin and cardiovascular disease in diabetes mellitus
Selvin, E., Marinopoulos, S., Berkenblit, G., Rami, T., Brancati, F. L., Powe, N. R., & Golden, S. H. (2004) · Annals of Internal Medicine · doi:10.7326/0003-4819-141-6-200409210-00007 · Cited by 1,657 · see citing works
Kinoshita, M., Yokote, K., Arai, H., Iida, M., Ishigaki, Y., Ishibashi, S., Umemoto, S., Egusa, G., Ohmura, H., Okamura, T., et al. (2018) · Journal of Atherosclerosis and Thrombosis · doi:10.5551/jat.gl2017 · Cited by 813 · see citing works
The presence and severity of chronic kidney disease predicts all-cause mortality in type 1 diabetes
Groop, P.-H., Thomas, M. C., Moran, J. L., Wadèn, J., Thorn, L. M., Mäkinen, V.-P., Rosengård-Bärlund, M., Saraheimo, M., Hietala, K., Heikkilä, O., et al. (2009) · Diabetes · doi:10.2337/db08-1543 · Cited by 638 · see citing works
Management of newly diagnosed type 2 diabetes mellitus (T2DM) in children and adolescents
Copeland, K. C., Silverstein, J., Moore, K. R., Prazar, G. E., Raymer, T., Shiffman, R. N., Springer, S. C., Thaker, V. V., Anderson, M., Spann, S. J., et al. (2013) · Pediatrics · doi:10.1542/peds.2012-3494 · Cited by 323 · see citing works
Leptin therapy in insulin-deficient type I diabetes
Wang, M.-Y., Chen, L., Clark, G. O., Lee, Y., Stevens, R. D., Ilkayeva, O. R., Wenner, B. R., Bain, J. R., Charron, M. J., Newgard, C. B., et al. (2010) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.0909422107 · Cited by 327 · see citing works
Nouwen, A., Adriaanse, M. C., van Dam, K., Iversen, M. M., Viechtbauer, W., Peyrot, M., Caramlau, I., Kokoszka, A., Kanc, K., de Groot, M., et al. (2019) · Diabetic Medicine · doi:10.1111/dme.14054 · Cited by 301 · see citing works
Libby, P., Nathan, D. M., Abraham, K., Brunzell, J. D., Fradkin, J. E., Haffner, S. M., Hsueh, W., Rewers, M., Roberts, B. T., Savage, P. J., et al. (2005) · Circulation · doi:10.1161/circulationaha.104.529651 · Cited by 265 · see citing works
Schauer, I. E., Snell-Bergeon, J. K., Bergman, B. C., Maahs, D. M., Kretowski, A., Eckel, R. H., & Rewers, M. (2011) · Diabetes · doi:10.2337/db10-0328 · Cited by 230 · see citing works
Risk Factors for Cardiovascular Disease in Type 1 Diabetes
The Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) Research Group (2016) · Diabetes · doi:10.2337/db15-1517 · Cited by 209 · see citing works
“The similar rates of CVD in men and women with T1DM have been seen in other studies (1, 5, 25, 26) and with even higher rates in women than men with type 2 diabetes (27, 28).”
BackgroundResultInfluentialType 1 diabetes, metabolic syndrome and cardiovascular risk
Chillarón, J. J., Flores Le-Roux, J. A., Benaiges, D., & Pedro-Botet, J. (2014) · Metabolism · doi:10.1016/j.metabol.2013.10.002 · Cited by 195 · see citing works
Pambianco, G., Costacou, T., & Orchard, T. J. (2007) · Diabetes Care · doi:10.2337/dc06-2053 · Cited by 198 · see citing works
Self-citationRawshani, A., Rawshani, A., Sattar, N., Franzén, S., McGuire, D. K., Eliasson, B., Svensson, A.-M., Zethelius, B., Miftaraj, M., Rosengren, A., et al. (2019) · Circulation · doi:10.1161/circulationaha.118.037454 · Cited by 177 · see citing works
Pulsatile Portal Vein Insulin Delivery Enhances Hepatic Insulin Action and Signaling
Matveyenko, A. V., Liuwantara, D., Gurlo, T., Kirakossian, D., Dalla Man, C., Cobelli, C., White, M. F., Copps, K. D., Volpi, E., Fujita, S., et al. (2012) · Diabetes · doi:10.2337/db11-1462 · Cited by 163 · see citing works
Double diabetes: a distinct high-risk group?
Kietsiriroje, N., Pearson, S., Campbell, M., Ariëns, R. A. S., & Ajjan, R. A. (2019) · Diabetes, Obesity and Metabolism · doi:10.1111/dom.13848 · Cited by 123 · see citing works
Insulin Resistance in Type 1 Diabetes: Pathophysiological, Clinical, and Therapeutic Relevance
Apostolopoulou, M., Lambadiari, V., Roden, M., & Dimitriadis, G. D. (2025) · Endocrine Reviews · doi:10.1210/endrev/bnae032 · Cited by 90 · see citing works
The Peripheral Peril: Injected Insulin Induces Insulin Insensitivity in Type 1 Diabetes
Gregory, J. M., Cherrington, A. D., & Moore, D. J. (2020) · Diabetes · doi:10.2337/dbi19-0026 · Cited by 76 · see citing works
Szadkowska, A., Madej, A., Ziółkowska, K., Szymańska, M., Jeziorny, K., Mianowska, B., & Pietrzak, I. (2015) · Annals of Agricultural and Environmental Medicine · doi:10.5604/12321966.1141381 · Cited by 62 · see citing works
Bebu, I., Braffett, B. H., Orchard, T. J., Lorenzi, G. M., Lachin, J. M., & the DCCT/EDIC Research Group (2019) · Diabetes Care · doi:10.2337/dc18-1613 · Cited by 62 · see citing works
Self-citation
- Authors
- Orchard, T. J., Olson, J. C., Erbey, J. R., Williams, K., Forrest, K. Y.-Z., Smithline Kinder, L., Ellis, D., & Becker, D. J.
- Affiliations
- University of Pittsburgh (US)
- School of Medicine, Stanford University, Palo Alto, California
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2003-05-01
- Volume
- 26
- Issue
- 5
- Pages
- 1374-1379
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- OpenAlex
- W2141428319
- Cited by
- 492
- References
- 37
- Citations by year
- 2026: 8 · 2025: 16 · 2024: 21 · 2023: 20 · 2022: 22 · 2021: 28 · 2020: 30 · 2019: 23 · 2018: 19 · 2017: 19 · 2016: 13 · 2015: 27 · 2014: 26 · 2013: 30 · 2012: 24
- FWCI
- 10.38
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes Care (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- National Institute of Diabetes and Digestive and Kidney Diseases (DK-34818)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Keywords
- coronary artery disease, type 1 diabetes, insulin resistance, glycemia, HbA1c, estimated glucose disposal rate, angina pectoris, myocardial infarction, depressive symptoms, cardiovascular risk factors, physical activity, glycemic control
- MeSH terms
- Adult, Blood Glucose, Coronary Disease, Creatinine, Diabetes Mellitus, Type 1, Diabetic Angiopathies, Female, Follow-Up Studies, Humans, Insulin Resistance, Male, Predictive Value of Tests, Time Factors, Biomarkers, Incidence, Age of Onset
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
