Hypoadiponectinemia Is Associated with Insulin Resistance and Glucose Intolerance after Renal Transplantation

Hjelmesæth, Jøran; Flyvbjerg, Allan; Jenssen, Trond; Frystyk, Jan; Ueland, Thor; Hagen, Monica; Hartmann, Anders

doi:10.2215/cjn.01471005

Cited by 41 publications

(46 citation statements)

References 46 publications

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“…However, further analyses by linear regression analyses could not demonstrate any significant effect modification of sex or degree of obesity. McAuley's index was the only index that remained significantly correlated with clamp- A previous study validated insulin resistance indexes in renal transplant recipients at 10 weeks posttransplant (6). In that study, McAuley's index performed best of all indexes based on fasting blood parameters as well (17).…”

Section: Results -mentioning

confidence: 83%

“…However, established indexes have been derived from correlates of insulin resistance in nontransplant populations. Evidence suggests that insulin resistance in the renal transplant population may be caused by other risk factors as well, such as immunosuppression and antihypertensive medication (6). Consequently, it remains uncertain whether these indexes are applicable to the stable renal transplantation population.…”

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confidence: 99%

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Validation of Insulin Resistance Indexes in a Stable Renal Transplant Population

Oterdoom

Vries²,

Son³

et al. 2005

Diabetes Care

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OBJECTIVE -The purpose of this study was to investigate the validity of established insulin resistance indexes, based on fasting blood parameters, in a stable renal transplant population.RESEARCH DESIGN AND METHODS -Fasting insulin, homeostasis model assessment (HOMA), the quantitative insulin sensitivity check index (QUICKI), and McAuley's index were assessed for correlation and agreement with whole-body glucose uptake (M value) divided by prevailing serum insulin concentrations (I value) assessed during a hyperinsulinemiceuglycemic clamp in 51 stable renal transplant recipients, who were at a median of 7.5 years after transplant. Multivariate linear regression analyses were used to determine independent risk factors for insulin resistance.RESULTS -The M/I value correlated with fasting insulin concentration (r ϭ Ϫ0.56), HOMA (r ϭ Ϫ0.53), QUICKI (r ϭ 0.52), and McAuley's index (r ϭ 0.61) (all P Ͻ 0.01). Linear regression showed agreement between all indexes and insulin resistance. However, McAuley's index showed the strongest agreement irrespective of age, sex, renal allograft function, and obesity. In multivariate analysis, fasting insulin concentration (␤ ϭ Ϫ0.59, P ϭ 0.002), fasting triglyceride concentration (␤ ϭ Ϫ0.33, P ϭ 0.04), and BMI (␤ ϭ Ϫ1.22, P ϭ 0.05) were independently associated with the M/I value.CONCLUSIONS -All investigated insulin resistance indexes were valid estimates of insulin resistance in the long-term stable renal transplant population. However, correlation and agreement were strongest for McAuley's index. In addition to fasting insulin and triglyceride concentrations, of which McAuley's index is composed, only BMI seemed to be independently associated with insulin resistance in this population. Diabetes Care 28:2424 -2429, 2005T he incidence and prevalence of cardiovascular disease have been estimated to be three to five times greater in the renal transplant population than in the general population (1,2). A recent study showed that the majority of renal transplant outpatients have a constellation of cardiovascular risk factors, i.e., obesity, dyslipidemia, hypertension, and posttransplant diabetes, which are consistent with the metabolic syndrome (3). According to preliminary data of the ALERT (Assessment of Lescol in Renal Transplantation) trial, metabolic syndrome is associated with an increased risk of cardiovascular mortality (4).Insulin resistance is thought to be the central pathophysiological feature underlying the metabolic syndrome (5). To study the role of insulin resistance in the high incidence of cardiovascular morbidity and mortality in this population, validated insulin resistance indexes are needed. Insulin resistance indexes have not yet been validated in comparison to the hyperinsulinemic-euglycemic clamp in the stable renal transplant population. Indexes that are based on fasting blood parameters alone have distinct advantages over other methods of quantifying insulin resistance in that they are less cumbersome and less time consuming for large-scale epidemiological...

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Section: Results -mentioning

confidence: 83%

mentioning

confidence: 99%

Validation of Insulin Resistance Indexes in a Stable Renal Transplant Population

Oterdoom

Vries²,

Son³

et al. 2005

Diabetes Care

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“…where SecrAUC is secretion area under the curve (AUC), Secr 1PH is first-phase insulin secretion, and Secr 2PH is secondphase insulin secretion. The OGTTderived insulin sensitivity index for transplantation (ISI TX ) was estimated by the following equation (17,18): …”

Section: Measurementsmentioning

confidence: 99%

Risk Factors Associated With the Onset and Progression of Posttransplantation Diabetes in Renal Allograft Recipients

Hur

Kim

et al. 2007

Diabetes Care

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OBJECTIVE -The aim of this study was to assess the incidence of posttransplantation diabetes mellitus (PTDM) in renal allograft recipients and to investigate factors contributing to the onset and progression of PTDM and its underlying pathogenic mechanism(s).RESEARCH DESIGN AND METHODS -A total of 77 patients with normal glucose tolerance (NGT) were enrolled in this study. An oral glucose tolerance test was performed 1 week before transplantation and repeated at 1 and 7 years after transplantation.RESULTS -The overall incidence of PTDM was 39% at 1 year and 35.1% at 7 years posttransplantation. The incidence for each category of PTDM was as follows: persistent PTDM (P-PTDM) (patients who developed diabetes mellitus within 1 year of transplantation and remained diabetic during 7 years), 23.4%; transient PTDM (T-PTDM) (patients who developed diabetes mellitus during the 1st year after transplantation but eventually recovered to have NGT), 15.6%; late PTDM (L-PTDM) (patients who developed diabetes mellitus later than 1 year after transplantation), 11.7%; and non-PTDM during 7 years (N-PTDM 7 ) (patients who did not develop diabetes mellitus during 7 years), 49.3%. Older age (Ն40 years) at transplantation was a higher risk factor for P-PTDM, whereas a high BMI (Ն25 kg/m 2 ) and impaired fasting glucose (IFG) at 1 year posttransplantation were higher risk factors for L-PTDM. Impaired insulin secretion rather than insulin resistance was significantly associated with the development of Pand L-PTDM.CONCLUSIONS -Impaired insulin secretion may be the main mechanism for the development of PTDM. Older age at transplantation seems to be associated with P-PTDM, whereas a high BMI and IFG at 1 year after transplantation were associated with L-PTDM. Diabetes Care 30:609 -615, 2007P osttransplantation diabetes mellitus (PTDM) is a major complication after kidney transplantation and can lead to a wide range of complications including graft loss, increased mortality, increased number of rejections, and increased risk of cardiovascular disease (1-4). A recent meta-analysis of observational studies and randomized, controlled trials showed that the incidence of PTDM during the 1st year after transplantation varied from 2 to 50% (5). There have been several previous reports on PTDM in Korean patients, albeit for a short period of observation. We reported previously that the incidence of PTDM was 23.7% in 114 patients treated with cyclosporine A (CsA) at 9 -12 months after transplantation (6), whereas Cho et al. (7) reported that it was 57.1% in 21 patients treated with tacrolimus at 6 months after transplantation in Korea.PTDM and type 2 diabetes are similar in many ways. One example is that the onset of both can be insidious (8); individuals may experience glucose intolerance and remain asymptomatic for years before symptoms manifest clinically (9,10). Furthermore, PTDM is not always permanent and may resolve within weeks or months, sometimes without treatment (11). Although several recent reports on a consensus definition of PTDM ha...

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“…Hjelmesaeth et al 10 have proposed an insulin sensitivity index, ISI TX , incorporating postchallenge glucose and insulin levels to estimate insulin sensitivity and reported a close correlation between ISI TX and glucose clamp results. Gutt et al 11 proposed an index of insulin sensitivity (ISI 0,120 ) composed from both fasting and 2 h measures of glucose and insulin and demonstrated that the index correlated well with directly measured insulin sensitivity.…”

Section: Reavenmentioning

confidence: 99%

“…26 However, it needs both 90-min postloading glucose and 2 h insulin values to calculate the ISI STUMO . Hjelmesaeth et al 10 have demonstrated that when 2 h glucose (instead of 90-min glucose) was used for the calculation, the ISI STUMOD would overestimate the clamp-measured insulin sensitivity. The authors adjusted the Stumvoll equation and derived the insulin sensitivity index (ISI TX ) from the original ISI STUMOD .…”

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confidence: 99%

Surrogate estimates of insulin sensitivity in subjects with hypertension

et al. 2007

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The purpose of the study is to compare surrogate estimates of insulin sensitivity with a directly measured insulin sensitivity index, steady-state plasma glucose (SSPG) from insulin suppression test (IST), in subjects with hypertension. Two hundred and twenty-eight hypertensive patients who received IST for SSPG were included for analysis. Estimates from fasting measurements alone, homeostasis model assessment for insulin resistance (HOMA-IR) and quantitative insulin sensitivity check index (QUICKI)), and indices from fasting and/or 2 h samples (ISI 0,120 and ISI TX ) were calculated. In addition to Pearson and partial correlations, variancecomponent models were used to test the relationship between surrogate estimates of insulin sensitivity and SSPG. A large proportion of variance owing to covariates in the variance-component models indicated the goodness of model fit, irrespective of the independence among variables. SSPG was positively correlated with logarithmic transformation (Log) (HOMA-IR) and negatively correlated with QUICKI, Log (ISI 0,120 ) and ISI TX (all Po0.0001). Log (ISI 0,120 ) seemed to have a better correlation with SSPG (r ¼ À0.72) than other measures in partial correlation. The proportion of variance owing to all covariates of Log (ISI 0,120 ) and ISI TX were larger than those of Log (HOMA-IR) and QUICKI in the variancecomponent models. After adjustments for demographic and obesity covariates, the proportion of variance explained by Log (ISI 0,120 ) were largest among the surrogate measures in the variance-component models. Our results showed that ISI 0,120 and ISI TX correlated better with SSPG than those used fasting measures alone (HOMA-IR and QUICKI). Log (ISI 0,120 ) currently showing the strongest association with SSPG than other estimates is adaptable for use in large studies of hypertension.

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Hypoadiponectinemia Is Associated with Insulin Resistance and Glucose Intolerance after Renal Transplantation

Cited by 41 publications

References 46 publications

Validation of Insulin Resistance Indexes in a Stable Renal Transplant Population

Validation of Insulin Resistance Indexes in a Stable Renal Transplant Population

Risk Factors Associated With the Onset and Progression of Posttransplantation Diabetes in Renal Allograft Recipients

Surrogate estimates of insulin sensitivity in subjects with hypertension

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