Estimated glucose disposal rate in assessment of renal function in patients with type 1 diabetes [Utjecaj inzulinske rezistencije na parametre bubrežne funkcije u šećernoj bolesti tipa 1]

Bulum, Tomislav and Duvnjak, Lea and Prkačin, Ingrid (2012) Estimated glucose disposal rate in assessment of renal function in patients with type 1 diabetes [Utjecaj inzulinske rezistencije na parametre bubrežne funkcije u šećernoj bolesti tipa 1]. Collegium Antropologicum, 36 (2). pp. 459-465. ISSN 0350-6134

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Abstract

Insulin resistance has been documented in type 1 diabetes and may contribute to the high risk for cardiovascular disease in this population and progression of nephropathy. We investigated associations of renal parameters, including urinary albumin excretion rate (UAE), serum creatinine and creatinine clearance, with surrogate measure of insulin sensitivity calculated using a formula derived from euglycemic-hyperinsulinemic clamp studies (estimated glucose disposal rate, eGDR). Study included 353 patients with type 1 diabetes, none showed signs of adrenal, thyroid, renal, or cardiovascular diseases. Insulin sensitivity was measured with eGDR calculated with the equation: 24.31-(12.22xWHR)-(3.29xHT)-(0.57xHbA1c). The units were mgkg(-1)min(-1); WHR=waist to hip ratio; HT=hypertension. Correlations and logistic regression analysis were performed to identify relationships between renal parameters and eGDR, individual components of insulin resistance and risk of insulin resistance. UAE and serum creatinine significantly correlated with insulin resistance measured by eGDR (r=-0.13, and -0.17, all p<0.05), and its components disorders, WHR and HbA1c. After stratifying patients in quartiles of eGDR, those in the upper quartile of the eGDR had significantly reduced levels of UAE and serum creatinine, compared to subjects in lowest quartile. In a logistic regression analysis risk for development of insulin resistance in our subjects were independently predicted only by UAE (odds ratio = 1.01, p<0.01). Our results provide evidence of associations between insulin resistance and its components disorders with renal parameters, such as UAE and serum creatinine. Insulin resistance, measured with eGDR, predicts the increment in UAE in subjects with type 1 diabetes. Since progression to microalbuminuria is likely to occur in majority of diabetic patients, there is a need to further explore the role of risk factors such as insulin resistance.

Abstract in Croatian

Pojam inzulinske rezistencije uglavnom se povezuje s razvojem šećerne bolesti tipa 2, ali je pokazano da i osobe sa šećernom bolešću tipa 1 također mogu imati značajke inzulinske rezistencije. Inzulinska rezistencija u tipu 1 šećerne bolesti dokazano pridonosi razvoju mikro i makrovaskularnih komplikacija. Istraživali smo utjecaj inzulinske rezistencije mjerene kliničkim parametrima na parametre bubrežne funkcije: razinu albumina u urinu, serumski kreatinin i klirens kreatinina. U istraživanje je uključeno 353 bolesnika sa šećernom bolešću tipa 1, bez anamneze bubrežne ili kardiovaskularne bolesti. Inzulinska osjetljivost mjerena je eGDR-om (estimated glucose disposal rate) koji se računa prema formuli: 24,31–(12,22xopseg struk/bokovi)–(3,29xpovišeni krvni tlak)–(0,57xHbA1c). Korelacijom i logističkom regresijom analizirao se odnos između parametara bubrežne funkcije i eGDR-a, komponenti inzulinske rezistencije te s rizikom razvoja inzulinske rezistencije. Razina albumina u urinu i serumski kreatinin značajno su korelirali s eGDR-om (r=–0,13, i –0,17, p<0,05), kao i s pojedinim komponentama inzulinske rezistencije (opseg struk/bokovi, HbA1c). Podijelivši razinu inzulinske osjetljivosti u kvartile, bolesnici u 1. kvartili eGDR-a imali su značajno više vrijednosti albumina u urinu i serumskog kreatinina u odnosu na one u 4. kvartili. Logističkom regresijom dokazano je da samo razina albumina u urinu utječe na rizik razvoja inzulinske rezistencije (odds ratio=1,01, p<0,01). Rezultati istraživanja pokazali su da razina inzulinske osjetljivosti mjerena eGDR-om značajno utječe na parametre bubrežne funkcije, i to albumine u urinu i serumski kreatinin. Mikroalbuminurija je parametar povećanog kardiovaskularnog rizika i smrtnosti, a budući da će većina bolesnika sa šećernom bolešću tipa 1 tijekom vremena razviti mikroalbuminuriju, potrebno je istražiti ulogu faktora rizika kao što je inzulinska rezistencija.

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