5-year overall survival rates of uremic type 1 and type 2 diabetic patients in comparison with age-matched nondiabetic patients with end-stage renal disease from a single dialysis center from 1991 to 1997.

Abstract

An inverse relationship between plasma insulin levels and homocysteine (Hcy) concentrations in type 2 diabetic patients has been previously reported (1) and discussed (2,3). An association between hyperinsulinemia and elevated Hcy levels has been found (4), and others (5) have observed that acute hyperinsulinemia reduces plasma Hcy levels in healthy men. In addition, it has been documented that plasma Hcy could be affected by both metabolic control and duration of disease in type 2 diabetic patients (6). By using the clamp technique, others have found that acute hyperinsulinemia did not influence plasma Hcy levels in patients with type 2 diabetes (7). Although hyperhomocysteinemia has been widely accepted as a risk factor for premature atherosclerosis (8), the complex relationship among insulin levels, insulin resistance, and plasma Hcy has yet to be entirely elucidated.As part of a screening procedure for detecting subjects with clinical characteristics of the metabolic syndrome in Hungary, we measured total plasma Hcy levels (Abbott IMx) in hyperinsulinemic subjects with different stages of glucose intolerance. In a cohort of middle-aged (40-60 years) hyperinsulinemic subjects (38 men and 53 women, [means ± SD] age 47.6 ± 4.3 years, BMI 34.6 ± 4.9 kg/m 2 , waist-to-hip ratio 0.92 ± 0.07, fasting plasma insulin level Ͼ15 µU/ml and/or postprandial [120 min after oral glucose tolerance test with 75 g glucose] plasma insulin level Ͼ45 µU/ml, actual blood pressure 146 ± 16/87 ± 9 mmHg, serum LDL cholesterol level 3.73 ± 1.09 mmol/l, HDL cholesterol level 1.12 ± 0.30 mmol/l, triglycerides level 2.97 ± 2.38 mmol/l, and uric acid level 279 ± 79 µmol/l), the plasma Hcy, vitamin B 12 , and folic acid levels were simultaneously determined. Subjects were classified as having normal glucose tolerance (NGT), impaired glucose tolerance (IGT) or diabetes; subgroups were matched for age, sex, BMI, and actual blood pressure. No antidiabetic or lipid-lowering drugs were used by the patients screened. Normal values of plasma Hcy, folic acid, and vitamin B 12 levels in a nondiabetic and nonhyperinsulinemic control group (19 men and 28 women aged 45.0 ± 7.8 years) were also measured.Although fasting plasma insulin levels were comparable, postprandial values were significantly higher in subjects with IGT or diabetes than in those with NGT. Plasma Hcy levels were not elevated and did not increase significantly with different stages of glucose intolerance in hyperinsulinemic subjects. Folic acid and vitamin B 12 levels were also comparable in the investigated subgroups (Table 1). In addition, no significant difference (P Ͼ 0.05) was observed between hyperinsulinemic subjects (n = 91) and control subjects (n = 47) when plasma Hcy (9.28 ± 3.81 vs. 9.63 ± 2.70 µmol/l, respectively), folic acid (8.5 ± 5.9 vs. 7.5 ± 2.1 ng/ml), and vitamin B 12 levels (423 ± 141 vs. 356 ± 121 pg/ml) were compared. Plasma Hcy levels were significantly (P Ͻ 0.001) higher in hyperinsulinemic men (11.34 ± 4.72 µmol/l, n = 38, age 48.1 ± 4.1 years) than in hype...

Incidences, Treatments, Outcomes, and Sex Effect on Survival in Patients With End-Stage Renal Disease by Diabetes Status in Australia and New Zealand (1991–2005)

“…After the first RRT, overall survival was short in type 2 diabetic patients, with median survival times of Ͻ3.5 years, similar to reports from Europe (8,11) and the U.S. (9,12). Less than 10% of type 2 diabetic patients received RTx, as in France (20) and the U.S. (21).…”

“…Available studies on patients with ESRD who have type 1 and type 2 diabetes have shortcomings because analyses were limited to patients with diabetic nephropathy (6 -7), did not differentiate the two types of diabetes (9), were short-term (10), or were based on single-center experiences (11).…”

Insulin Resistance and Risk of Chronic Kidney Disease in Nondiabetic US Adults

“…Patients with ESRD suffer from poor quality of life and shorter life expectancy compared with individuals of the same age in the general population (3,4). Those with diabetic ESRD have a much less favorable outcome than their counterparts with nondiabetic ESRD (4,7). Prevention of diabetes-related kidney disease is a key to decreasing the societal and personal burden of illness due to ESRD.…”

Death, end-stage renal disease and renal function decline in patients with diabetic nephropathy in French cohorts of type 1 and type 2 diabetes

“…The main findings in this study are that risk for death and annual rate of renal function decline were not significantly different according to the type of diabetes, provided that key variables such as age, sex and baseline serum creatinine are taken into account, considering two complementary statistical To the best of our knowledge, our study is the first prospective large-scale study to comprehensively examine this question, even though some previous small retrospective studies have suggested the similarity in renal outcome risk according to the type of diabetes [19,20]. The data presented here are consistent with the data from Hasslacher et al suggesting a similar risk for the development of proteinuria in type 2 and type 1 diabetes, even though these data were obtained more than 25 years ago, with different standards of care [7].…”