Favourable serum calcification propensity with intraperitoneal as compared with subcutaneous insulin administration in type 1 diabetes. 2020

Peter R van Dijk, and Femke Waanders, and Andreas Pasch, and Susan J J Logtenberg, and Titia Vriesendorp, and Klaas H Groenier, and Jan-Luuk Hillebrands, and Nanno Kleefstra, and Rijk O B Gans, and Harry van Goor, and Henk J G Bilo
Department of Internal Medicine, University Medical Center Groningen, 9713 GZ, HPA AA41, Groningen, The Netherlands.

BACKGROUND Serum calcification propensity can be monitored using the maturation time of calciprotein particles in serum (T50 test). A shorter T50 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 T50 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 T50 was 356 (45) minutes. The geometric mean T50 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 T50 concentrations while higher age, triglycerides and phosphate concentrations had an inverse relation. CONCLUSIONS 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.

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