Insulin resistance in insulin-dependent diabetic patients with microalbuminuria

Yip, Jeannie; Mattock, M. B.; Morocutti, Anna; Sethi, Mieran; Trevisan, Roberto; Viberti, Giancarlo

doi:10.1016/0140-6736(93)91943-g

Cited by 224 publications

(122 citation statements)

References 26 publications

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“…Insulin resistance is a feature of Type 1 diabetic patients with microalbuminuria, and this contributes to the increased risk of cardiovascular disease in these patients [34,35]. Notably, in the univariate analysis of this study, both fasting triglyceride and vWF plasma levels, both of which are associated with the insulin resistance syndrome, were significantly higher in patients progressing to overt albuminuria.…”

Section: Discussionmentioning

confidence: 55%

Factors associated with progression to macroalbuminuria in microalbuminuric Type 1 diabetic patients: the EURODIAB Prospective Complications Study

et al. 2004

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Aims/hypothesis. Type 1 diabetic patients who develop microalbuminuria are clearly disadvantaged in terms of their risk of morbidity and mortality from renal and cardiovascular diseases. It is therefore important to identify potential factors that can predict progression to macroalbuminuria. Methods. This is a 7-year follow-up study of 352 microalbuminuric Type 1 diabetic patients from 31 European centres. Risk factors at baseline were compared in patients who progressed to macroalbuminuria and in patients who remained microalbuminuric or reverted to normoalbuminuria. Risk factors and albumin excretion rate (AER) were measured centrally. Results. Over 7.3 years, 13.9% of the microalbuminuric patients progressed to macroalbuminuria, 35.5% remained microalbuminuric and 50.6% reverted to normoalbuminuria. Independent baseline risk factors for progression to macroalbuminuria were HbA 1 c (7.9% vs 6.8%, p=0.004), AER (64.4 vs 44.9 µg/min, p=0.0001) and-after adjusting for diabetes duration, HbA 1 c and AER-body weight (72 vs 67 kg, p=0.05). Independent factors associated with regression to normoalbuminuria were diabetes duration (15 vs 18 years, p=0.004), AER (37.2 vs 44.9 µg/min, p=0.0001) andafter adjusting for diabetes duration, HbA 1 c and AER-waist-to-hip ratio (0.83 vs 0.86, p=0.05) and incidence of peripheral neuropathy at baseline (24% vs 38%, p=0.001). Blood pressure and smoking did not emerge as risk factors at baseline for the outcome of microalbuminuria. Conclusions/interpretation. A significant fraction of microalbuminuric Type 1 diabetic patients will progress to overt proteinuria. Patients with higher AER values, sub-optimal metabolic control, excess body fat and peripheral neuropathy may carry a particularly high risk of clinical nephropathy requiring aggressive therapeutic intervention.

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Section: Discussionmentioning

confidence: 55%

Factors associated with progression to macroalbuminuria in microalbuminuric Type 1 diabetic patients: the EURODIAB Prospective Complications Study

et al. 2004

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“…Such observations conflict with data showing associations between insulin resistance and risk of microvascular complications in type 1 diabetes [14]. It is possible that adiponectin levels may not simply reflect levels of insulin resistance in type 1 diabetes.…”

Section: Introductionmentioning

confidence: 63%

The development of microalbuminuria is associated with raised longitudinal adiponectin levels in female but not male adolescent patients with type 1 diabetes

et al. 2008

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Aims/hypothesis We determined the longitudinal relationship between adiponectin levels and the development of microalbuminuria in an inception cohort of children with type 1 diabetes. Methods Blood samples collected annually over a median of 9.0 (range 1.3-14.9) years were assayed for adiponectin and HbA 1c in 55 children (36 girls) with type 1 diabetes and microalbuminuria whose age of onset of diabetes was 9.4 years (range 2.2-15.4). Samples were also assayed from normoalbuminuric children (controls) matched for age, sex and duration of diabetes. Results Overall, adiponectin levels were higher in girls than in boys, but only after 11 years of age (median [range]: 15.3 [5.8-124.4] vs 11.6 [4.1-26.5] mg/l, p<0.001). Furthermore, adiponectin levels were higher in girls with microalbuminuria than in control girls, but this was only apparent after the onset of microalbuminuria (p=0.001, adjusted for BMI, daily insulin dose, HbA 1c and age). In boys, adiponectin levels did not differ between those with microalbuminuria and controls. Further sex-related discordant associations with adiponectin levels were observed; in girls, adiponectin levels were positively related to HbA 1c levels (r=0.2, p=0.05) and urine albumin excretion (r=0.3, p<0.05) and inversely related to BMI (r=−0.2, p<0.05). These associations were absent in boys. Conclusions/interpretation In adolescent girls with type 1 diabetes but not in boys, adiponectin levels increase with increasing urine albumin excretion and onset of microalbuminuria. Although causal links cannot be inferred, this sexual dimorphism may reflect interactive effects of hyperglycaemia and sex steroids on risk of complications and adiponectin production.

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“…We did not find cholesterol to be associated with PDR. One possible explanation of this finding is that raised triglycerides, but not cholesterol, are associated with insulin resistance, which may play a role in the development of albuminuria in type 1 diabetes [39].…”

Section: Discussionmentioning

confidence: 97%

Low cumulative incidence of proliferative retinopathy in childhood-onset type 1 diabetes: a 24-year follow-up study

et al. 2006

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Insulin resistance in insulin-dependent diabetic patients with microalbuminuria

Cited by 224 publications

References 26 publications

Factors associated with progression to macroalbuminuria in microalbuminuric Type 1 diabetic patients: the EURODIAB Prospective Complications Study

Factors associated with progression to macroalbuminuria in microalbuminuric Type 1 diabetic patients: the EURODIAB Prospective Complications Study

The development of microalbuminuria is associated with raised longitudinal adiponectin levels in female but not male adolescent patients with type 1 diabetes

Low cumulative incidence of proliferative retinopathy in childhood-onset type 1 diabetes: a 24-year follow-up study

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