1413-P: Triglycerides, Insulin Resistance, Severe Hypoglycemia, Modifiers, and CVD in Type 1 Diabetes (T1D)

Introduction and Objective: The role of insulin resistance (IR) and potential modifiers in CVD in T1D patients with severe hypoglycemia history (SH) is unknown. Accounting for reports of IR exacerbation by increased sympathetic activity (reflected by increased pulse) and correlations between HbA1c and triglycerides (TRG), we explore CVD associations with TRG, IR defined by TRG to HDL ratio (Ratio), metabolic syndrome (MS) and their relevant interactions in a T1D cohort with SH. Methods: NIDDK Central Repository available DCCT/EDIC data of 1441 generally healthy T1D volunteers at baseline (mean age ~27 years, 680 females, follow-up of ~30 years) were analyzed. MS was defined per NCEP; BMI replaced waist circumference (no data). TRG and Ratio were log-transformed. Time dependent multivariable COX regression was performed. CVD events (CVE) included acute/silent myocardial infarct, cardiac death, confirmed angina, and revascularization. Aike criteria was used to compare models. Results: Of 946 patients with SH, 110 reported a CVE; 58 CVEs were reported in no SH group. In separate models without interactions, hazard ratios of TRG, Ratio, and MS for SH patients experiencing CVE were 1.60 [95% CI:1.10-2.32], p~0.0129, 1.45 [95% CI:1.08-1.94], p~0.015, 1.54 [95% CI:0.94-2.52], p~0.09, respectively. TRG model was best fit model. TRG- and Ratio-model were not significantly different, but TRG- and MS-model were. In fully adjusted models, p-values for interaction (TRG*HbA1c) and (Ratio*HbA1c) were ~0.13 and 0.21. Fully adjusted interactions (TRG*pulse) or (Ratio*pulse) were significant (p<0.01). Neither LDL nor insulin dose were significant in these 2 models. In no SH group, TRG, Ratio, or MS were not significant CV risk factors. Interaction p values for pulse with TRG or Ratio were <0.1. Conclusion: TRG and Ratio but not MS correlated with CVD in a T1D cohort with SH. Our novel findings of interplays between pulse (potentially HbA1c) and TRG/Ratio provide new valuable insights into the role of TRG/IR in CVD and warrant further investigation. Disclosure E.R. Fahrmann: None. H. Driscoll: None. Funding A special big thank you to the DCCT/EDIC investigators for their generosity and making their data publicly accessible. The authors extend another special thank you to the NIDDK Central Repositories. The DCCT and its follow-up, the Epidemiology of Diabetes Interventions and Complications (EDIC) study, were conducted by the DCCT/EDIC Research Group and supported by National Institute of Health grants and contracts and by the General Clinical Research Center Program, National Center for Research Resources. The data from the DCCT/EDIC study were supplied by the NIDDK Central Repositories. This manuscript was not prepared under the auspices of the DCCT/EDIC study and does not represent analyses or conclusions of the DCCT/EDIC study group, the NIDDK Central Repositories, or the National Institutes of Health.