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

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.
Competing Interests: Conflict of interest statement: AP is an employee and stockholder of Calciscon. All other authors declare they have no conflict of interest.
(© The Author(s), 2020.)