Association Between Insulin Resistance and Development of Microalbuminuria in Type 2 Diabetes

Hsu, Chih‐Cheng; Chang, Hsing-Yi; Huang, Meng‐Chuan; Hwang, Shang-Jyh; Yang, Yu−Ching; Tai, Tong-Yuan; Yang, Hung‐Jen; Chang, Chwen‐Tzuei; Chang, Cheng-Chieh; Li, Yusheng; Shin, Shyi–Jang; Kuo, Ken N.

doi:10.2337/dc10-1718

Cited by 80 publications

(69 citation statements)

References 25 publications

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“…This is in line with experimental data suggesting that insulin resistance and hyperglycemia contribute to malfunction and loss of podocytes, which are considered initial steps in the development of diabetic nephropathy and albuminuria (10)(11)(12)(13). Clinical studies addressing this issue were mainly performed in diabetic patients and have largely, but not consistently, confirmed an association between insulin resistance and microalbuminuria in this setting (10)(11)(12)(13)(14)(15)(16)(17)(18). Data in nondiabetic populations are sparse and show conflicting results (19)(20)(21)(22).…”

supporting

confidence: 50%

Insulin Sensitivity and Albuminuria: The RISC Study

Pilz

Rutters²,

Nijpels³

et al. 2014

Diabetes Care

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OBJECTIVEAccumulating evidence suggests an association between insulin sensitivity and albuminuria, which, even in the normal range, is a risk factor for cardiovascular diseases. We evaluated whether insulin sensitivity is associated with albuminuria in healthy subjects. RESEARCH DESIGN AND METHODSWe investigated 1,415 healthy, nondiabetic participants (mean age 43.9 6 8.3 years; 54.3% women) from the RISC (Relationship between Insulin Sensitivity and Cardiovascular Disease) study, of whom 852 participated in a follow-up examination after 3 years. At baseline, insulin sensitivity was assessed by hyperinsulinemiceuglycemic clamps, expressed as the M/I value. Oral glucose tolerance test-based insulin sensitivity (OGIS), homeostasis model assessment of insulin resistance (HOMA-IR), and urinary albumin-to-creatinine ratio (UACR) were determined at baseline and follow-up. RESULTSMicroalbuminuria (UACR ‡30 mg/g) was present in fewer than 2% at either study visit. After multivariate adjustments, there was no cross-sectional association between UACR and any measure of insulin sensitivity. Neither OGIS nor HOMA-IR was significantly associated with follow-up UACR, but in a multivariate regression analysis, baseline M/I emerged as an independent predictor of UACR at follow-up (b-coefficient 20.14; P = 0.001). CONCLUSIONSIn healthy middle-aged adults, reduced insulin sensitivity, assessed by hyperinsulinemic-euglycemic clamp, is continuously associated with a greater risk of increasing albuminuria. This finding suggests that reduced insulin sensitivity either is simply related to or might causally contribute to the initial pathogenesis of albuminuria.Higher levels of albuminuria are associated with an increased risk of mortality and cardiovascular events in patients with diabetes mellitus or arterial hypertension and the general population (1-3). Insights into the pathophysiology of albuminuria are of high clinical relevance since therapeutic interventions to reduce albuminuria are often accompanied by improvements in cardiovascular outcomes (3). Microalbuminuria is also regarded as a marker of a certain form of endothelial dysfunction, but there exists still no clear picture on the direction of the cause and effect relationship (4-6). Alternatively, microalbuminuria and vascular diseases/endothelial dysfunction may also be caused by a common pathophysiologic process (7).

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supporting

confidence: 50%

Insulin Sensitivity and Albuminuria: The RISC Study

Pilz

Rutters²,

Nijpels³

et al. 2014

Diabetes Care

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“…Second, the ary 2012 26,27) . Moreover, previous clinical studies have suggested an independent association between insulin resistance and DKD progression 28,29) . The present findings may be unique to Asian populations, as lower statin doses have been shown to achieve lipid improvements in Asians comparable to those obtained with higher doses in Caucasians 30) .…”

Section: Discussionmentioning

confidence: 99%

Comparative Effects of Statins on the Kidney Function in Patients with Type 2 Diabetes

Hanai

Babazono

Takemura

et al. 2015

JAT

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Aim:Whether there are differences among statins in their effect on the kidney function in diabetic patients remains controversial. In this report, we aimed to examine the comparative effects of statins on the kidney function in a long-term follow-up study. Methods: This was a single-center longitudinal observational historical cohort study. We enrolled 326 Japanese adult ambulatory patients with type 2 diabetes who were newly prescribed one of four statins (pravastatin, rosuvastatin, atorvastatin and pitavastatin) and who had an estimated glomerular filtration rate (

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“…An association between insulin resistance and microalbuminuria in T2DM has often been found in cross-sectional studies. In Taiwan, insulin resistance was reported as a predictive marker for the development of microalbuminuria in patients with T2DM (23). SDB is thought to cause insulin resistance via the following three steps.…”

Section: Discussionmentioning

confidence: 99%

Nocturnal intermittent hypoxia as an associated risk factor for microalbuminuria in Japanese patients with type 2 diabetes mellitus

Furukawa

Saito

Yamamoto

et al. 2013

European Journal of Endocrinology

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Objective: We estimated the prevalence of nocturnal intermittent hypoxia, a surrogate marker of obstructive sleep apnoea, among type 2 diabetes mellitus (T2DM) patients and examined the association between nocturnal intermittent hypoxia and microvascular diseases. Design and methods: We recruited 513 Japanese patients (292 men and 221 women) with T2DM. Nocturnal intermittent hypoxia was diagnosed using the 3% oxygen desaturation index, with less than five events per hour corresponding to normal and five events or more per hour corresponding to nocturnal intermittent hypoxia. Results: The prevalence of nocturnal intermittent hypoxia was 45.4% among T2DM patients. The nocturnal intermittent hypoxia group was older and had a higher BMI, greater weight change since the age of 20 years, higher smoking rate and increased prevalence of hypertension, hyperlipidaemia, microalbuminuria and macroalbuminuria. Microalbuminuria (model 1: odds ratio (OR), 3.41; 95% CI, 1.85-6.40; model 2: OR, 3.69; 95% CI, 1.85-7.59 and model 3: OR, 3.12; 95% CI, 1.45-6.95) and nephropathy (model 1: OR, 4.51; 95% CI, 1.58-15.1; model 2: OR, 7.31; 95% CI, 2.11-31.6 and model 3: OR, 5.23; 95% CI, 1.45-23.8) were derived as factors from all the three statistical models and constantly associated with nocturnal intermittent hypoxia only in women. Conclusions: Nocturnal intermittent hypoxia was highly prevalent among T2DM patients and may be an independent associated risk factor for microalbuminuria in Japanese women with T2DM.

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Association Between Insulin Resistance and Development of Microalbuminuria in Type 2 Diabetes

Cited by 80 publications

References 25 publications

Insulin Sensitivity and Albuminuria: The RISC Study

Insulin Sensitivity and Albuminuria: The RISC Study

Comparative Effects of Statins on the Kidney Function in Patients with Type 2 Diabetes

Nocturnal intermittent hypoxia as an associated risk factor for microalbuminuria in Japanese patients with type 2 diabetes mellitus

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