Estimated insulin sensitivity, cardiovascular risk and hepat
This study aimed to test the hypothesis that intensive insulin treatment and optimal glycemic control are not fully protective against reduction of insulin sensitivity in children with type 1 diabetes.

Cohort study of 78 normal-weight patients with prepubertal onset (T0) and follow-up waves at 1 (T1), 5 (T5), 10 (T10) and 12 (T12) years; matched for age and sex to 30 controls at T12.

Estimated insulin sensitivity (eIS) by three formulas; ultrasound evaluation of para and perirenal fat thickness; hepatic steatosis (HS); carotid intima media thickness (cIMT) at T12.

-- At T12, the 36 patients (46%) who had constantly or prevalently hemoglobin A1c (HbA1c) less than 58 mmol/l during follow-up had better eIS indexes; lipid profile, reduced fat mass and required lower insulin dose than the 42 patients (54%) with HbA1c more than 58 at T12. Patients (N=25) with eISEDCless than 8.77 mg·kg-1·min-1 had higher cIMT.

-- HS was found in 6 patients (around 8%).

-- In patients and normal-weight controls, fat mass, age, cIMT predicted HS; eIS indexes predicted cIMT.

-- Body mass index, perirenal fat, fat mass and triglycerides to HDL cholesterol ratio were associated with eIS indexes.

Conclusively, young T1D patients have reduced insulin sensitivity and higher cIMT. Adiposity, glucose and lipid control over the follow-up are likely to influence both. Enhanced adiposity seems paramount for the onset of hepatic steatosis in T1D patients alike in healthy youths.