Low serum creatinine is associated with type 2 diabetes in morbidly obese women and men: a cross-sectional study

Abstract

BackgroundLow skeletal muscle mass is associated with insulin resistance and metabolic syndrome. Serum creatinine may serve as a surrogate marker of muscle mass, and a possible relationship between low serum creatinine and type 2 diabetes has recently been demonstrated. We aimed to validate this finding in a population of Caucasian morbidly obese subjects.MethodsCross-sectional study of 1,017 consecutive morbidly obese patients with an estimated glomerular filtration rate >60 ml/min/1.73 m2. Logistic regression (univariate and multiple) was used to assess the association between serum creatinine and prevalent type 2 diabetes, including statistically testing for the possibility of non-linearity in the relationship by implementation of Generalized Additive Models (GAM) and piecewise linear regression. Possible confounding variables such as age, family history of diabetes, waist-to-hip ratio, hypertension, current smoking, serum magnesium, albuminuria and insulin resistance (log HOMA-IR) were adjusted for in three separate multiple logistic regression models.ResultsThe unadjusted GAM analysis suggested a piecewise linear relationship between serum creatinine and diabetes. Each 1 μmol/l increase in serum creatinine was associated with 6% (95% CI; 3%-8%) and 7% (95% CI; 2%-13%) lower odds of diabetes below serum creatinine levels of 69 and 72 μmol/l in women and men, respectively. Above these breakpoints the serum creatinine concentrations did not reduce the odds further. Adjustments for non-modifiable and modifiable risk factors left the piecewise effect for both women and men largely unchanged. In the fully adjusted model, which includes serum magnesium, albuminuria and log HOMA-IR, the piecewise effect for men was statistically non-significant, but it remained present for women. Patients with creatinine levels below median had approximately 50% (women) and 75% (men) increased odds of diabetes.ConclusionsLow serum creatinine is a predictor of type 2 diabetes in Caucasian morbidly obese patients, independent of age, gender, family history of diabetes, anthropometric measures, hypertension, and current smoking. Longitudinal studies of both obese and non-obese populations are needed to investigate whether serum creatinine may be causally linked with type 2 diabetes, and if so, precisely how they are linked.

Anti-Diabetic Effects of the Ethyl-Acetate Fraction of Trichilia catigua in Streptozo-tocin-Induced Type 1 Diabetic Rats

“…These results are consistent with improvement of diabetes and kidney function as observed in other studies [18,22]. Furthermore, previous studies have demonstrated lower serum creatinine levels and increased serum uric acid in STZ-diabetic animals and in type 2 diabetic humans [23]. Similarly, in this work, serum creatinine was lower and uric acid higher in the STZ-diabetic group, which could suggest renal impairments associated with diabetic complications [22].…”

Perirenal Fat Promotes Renal Arterial Endothelial Dysfunction in Obese Swine through Tumor Necrosis Factor-α

“…GFR was markedly increased (Figure 1J, P <0.01), while plasma creatinine level was decreased (Figure 1K, P <0.05), probably secondary to glomerular hyperfiltration. 14 Urinary protein level was unchanged in ObM compared to the lean group (data not shown).…”

Poor Glycemic Control Is a Major Factor in the Overestimation of Glomerular Filtration Rate in Diabetic Patients

“…Serum creatinine levels are significantly lower in the diabetic patients (9,10). Low serum creatinine levels were associated with type 2 DM in a recent study of nonobese middle-aged Japanese men (11), leading to the hypothesis that low creatinine might reflect low muscle mass volume (12,13). Low serum creatinine may also be related to significantly higher estimated GFR (eGFR) when calculated based on serum creatinine.…”