Peripheral blood cell counts as correlates of insulin sensitivity in children and youth with type 1 diabetes: A retrospective study from western India

Abstract

Type 1 diabetes mellitus (T1DM) is an insulin dependent diabetes treated with exogenous insulin therapy. A subset of individuals with T1DM develops reduced insulin sensitivity, a phenomenon often referred to as ‘double diabetes’, which is associated with an increased risk of complications. The pathophysiology of double diabetes in T1DM is not well understood. We hypothesize that changes in peripheral blood in T1DM may act as cellular correlates and provide insights into the development of double diabetes. A retrospective study (N = 343) was performed at a tertiary care centre in western India. An estimated insulin sensitivity (eIS) score was calculated using the Coronary Artery Calcification in T1DM (CACTI) equation. A partial correlation, univariate, and multiple regression were performed to study the association of eIS with the components of hemogram (lymphocytes, neutrophils, monocytes, eosinophils, platelets, erythrocytes, and hemoglobin). Additionally, stratified multiple regression analyses were performed to assess the association of eIS with age, sex, and Body Mass Index (BMI). Peripheral blood cell counts were associated with eIS in children and youth with T1DM. Across BMI, age, and sex strata, eosinophils consistently showed modest-to-moderate positive associations with eIS, whereas monocytes, neutrophils, lymphocytes, and platelets showed negative associations that varied by subgroup. In overall cohort, neutrophils and lymphocytes demonstrated statistically significant but minimal negative associations. The development of double diabetes may occur independent of obesity and the cellular patterns observed paralleled those reported in non-obese populations. Larger studies are warranted to confirm these findings and to identify population-specific cellular correlates of declining insulin sensitivity in T1DM. Children and youth with type 1 diabetes exhibit normal-to-low BMI yet low estimated insulin sensitivity. Peripheral blood cell counts associate with estimated insulin sensitivity in children and youth with type 1 diabetes. Eosinophils associate positively, whereas neutrophils, lymphocytes, and platelets associate negatively with insulin sensitivity, with extent of association varying by age, sex, and BMI.