Therapeutic Advances in Endocrinology and Metabolism (Mar 2020)

Favourable serum calcification propensity with intraperitoneal as compared with subcutaneous insulin administration in type 1 diabetes

  • Peter R. van Dijk,
  • Femke Waanders,
  • Andreas Pasch,
  • Susan J. J. Logtenberg,
  • Titia Vriesendorp,
  • Klaas H. Groenier,
  • Jan-Luuk Hillebrands,
  • Nanno Kleefstra,
  • Rijk O. B. Gans,
  • Harry van Goor,
  • Henk J.G. Bilo

DOI
https://doi.org/10.1177/2042018820908456
Journal volume & issue
Vol. 11

Abstract

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Background: Serum calcification propensity can be monitored using the maturation time of calciprotein particles in serum (T 50 test). A shorter T 50 indicates greater propensity to calcify; this is an independent determinant of cardiovascular disease. As the intraperitoneal (IP) route of insulin administration mimics the physiology more than the subcutaneous (SC) route in persons with type 1 diabetes (T1DM), we hypothesized that IP insulin influences determinants of calcium propensity and therefore result in a longer T 50 than SC insulin administration. Methods: Prospective, observational case-control study. Measurements were performed at baseline and at 26 weeks in age and gender matched persons with T1DM. Results: A total of 181 persons, 39 (21.5%) of which used IP and 142 (78.5%) SC insulin were analysed. Baseline T 50 was 356 (45) minutes. The geometric mean T 50 significantly differed between both treatment groups: 367 [95% confidence interval (CI) 357, 376] for the IP group and 352 (95% CI 347, 357) for the SC group with a difference of –15 (95% CI –25, –4) minutes, in favour of IP treatment. In multivariable analyses, the IP route of insulin administration had a positive relation on T 50 concentrations while higher age, triglycerides and phosphate concentrations had an inverse relation. Conclusion: Among persons with T1DM, IP insulin administration results in a more favourable calcification propensity time then SC insulin. It has yet to be shown if this observation translates into improved cardiovascular outcomes.