The Association Between Insulin Resistance And Advanced Renal Disease In Type 1 Diabetes

AbstractBackground and Aims. Insulin resistance is documented in type 1 diabetes and it has been associated with chronic complications. Diabetic nephropathy is a major cause of morbidity and mortality. The purpose of this article is to quantify insulin resistance in type 1 diabetes subjects according to the presence or absence of advanced renal disease. A secondary objective was to study the possible association between insulin resistance and advanced renal disease.Material and Methods. This was a cross-sectional study that included 167 type 1 diabetes patients. Insulin resistance was determined using the eGDR (estimated glucose disposal rate) formula. The association between eGDR and diabetic nephropathy was assessed in uni and multivariate models using stepwise logistic regression analysis of variables. The contribution of individual predictors in the final regression model was examined using Wald statistic.Results. Significantly lower eGDR’s values were observed in patients with nephropathy: 5 vs. 7.3 (p<0.001). In univariate analysis eGDR was significantly associated with diabetic nephropathy (p<0.001). eGDR variable was retained in the final model of stepwise logistic regression (p<0.001) and showed the strongest association with diabetic nephropathy (Wald = 30.4).Conclusions. In type 1 diabetes patients insulin resistance was the most important independent risk factor associated with advanced renal disease.

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The association between insulin resistance and proliferative retinopathy in type 1 diabetes

Romanian Journal Of Internal Medicine ◽

10.1515/rjim-2015-0034 ◽

2015 ◽

Vol 53 (3) ◽

pp. 261-266 ◽

Cited By ~ 2

Author(s):

Irina Duţă ◽

Simona Fica ◽

Daniela Adriana Ion

Keyword(s):

Insulin Resistance ◽

Type 1 Diabetes ◽

Logistic Regression ◽

Diabetic Retinopathy ◽

Proliferative Diabetic Retinopathy ◽

Proliferative Retinopathy ◽

Stepwise Logistic Regression ◽

The Relationship ◽

Diabetes Patients

Abstract Introduction. Little is known about the relationship between insulin resistance and proliferative diabetic retinopathy in type 1 diabetes. The aim of this article is to explore the relationship between sight-threatening proliferative diabetic retinopathy and insulin resistance. Methods. This was a cross-sectional study that included 167 type 1 diabetes patients. Insulin resistance was assessed using eGDR (estimated glucose disposal rate) formula. Diabetic retinopathy was assessed by ophthalmoscopy using Early Treatment Diabetic Retinopathy classification. The association between eGDR and proliferative diabetic retinopathy was assessed in uni- and multivariate models using stepwise logistic regression of covariates. The contribution of individual predictors in the final regresion model was examined using Wald statistic. Results. Significantly lower eGDR’s values were observed in patients with proliferative diabetic retinopathy: 5.5 vs. 7 (p = 0.002). The results remained significant (p < 0.001) after adjusting for multiple covariates (sex, diabetes duration, body mass index, HDL cholesterol, LDL cholesterol, triglycerides, smoking). eGDR variable was retained in the final model of stepwise logistic regression (p < 0.001) and showed the strongest association with proliferative diabetic retinopathy (Wald = 12.73). Conclusions. In type 1 diabetes patients insulin resistance was the most important independent risk factor associated with diabetic proliferative retinopathy.

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Urinary Adiponectin Is an Independent Predictor of Progression to End-Stage Renal Disease in Patients With Type 1 Diabetes and Diabetic Nephropathy

Diabetes Care ◽

10.2337/dc14-2276 ◽

2015 ◽

Vol 38 (5) ◽

pp. 883-890 ◽

Cited By ~ 23

Author(s):

Nicolae M. Panduru ◽

Markku Saraheimo ◽

Carol Forsblom ◽

Lena M. Thorn ◽

Daniel Gordin ◽

...

Keyword(s):

Type 1 Diabetes ◽

Diabetic Nephropathy ◽

Renal Disease ◽

End Stage Renal Disease ◽

Independent Predictor ◽

Stage Renal Disease ◽

End Stage

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The Common FTO Genetic Polymorphism rs9939609 is Associated with Increased BMI in Type 1 Diabetes but not with Diabetic Nephropathy

Biomarker Insights ◽

10.4137/bmi.s4599 ◽

2010 ◽

Vol 5 ◽

pp. BMI.S4599 ◽

Cited By ~ 6

Author(s):

Harvest F. Gu ◽

Alexandra Alvarsson ◽

Kerstin Brismar

Keyword(s):

Type 1 Diabetes ◽

Diabetic Nephropathy ◽

Genetic Polymorphism ◽

Kidney Diseases ◽

Renal Diseases ◽

Allelic Association ◽

Fto Gene ◽

The Common ◽

Diabetes Patients

The fat mass and obesity associated (FTO) gene has an important genetic effect on body mass index (BMI) and risk of obesity, and obesity contributes to the progression of renal diseases, including diabetic nephropathy. We thus conducted a genetic association study to evaluate whether the FTO gene confers the risk susceptibility to the development of diabetic nephropathy. Genotyping experiments of the common FTO polymorphism, rs9939609, in 1170 type 1 diabetes patients with (n = 597) or without diabetic nephropathy (n = 573) were performed with TaqMan allelic discrimination. All subjects are of European descent and selected from the Genetics of Kidney Diseases in Diabetes (GoKinD) study. The frequency of T allele of this polymorphism was 0.414 in the studied population. There was no allelic association of this polymorphism with diabetic nephropathy. But, the risk susceptibility of A allele conferring to the increased BMI among type 1 diabetes patients was observed. The subjects carrying with AA genotype had higher BMI compared to the carriers with TA and/or TT genotype(s) ( P ≥ 0.019). The present study provides evidence that the common FTO genetic polymorphism, rs9939609, is associated with increased BMI in type 1 diabetes but not with diabetic nephropathy.

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Adiposity markers and insulin resistance in type 1 diabetes patients

Diabetology & Metabolic Syndrome ◽

10.1186/1758-5996-7-s1-a101 ◽

2015 ◽

Vol 7 (S1) ◽

Author(s):

Camila Lemos Marques ◽

Jussara Carnevale Almeida ◽

Ticiana da Costa Rodrigues

Keyword(s):

Insulin Resistance ◽

Type 1 Diabetes ◽

Diabetes Patients

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Insulin Resistance in Adults with Type 1 Diabetes is Associated with Lower Vitamin D Serum Concentration

Experimental and Clinical Endocrinology & Diabetes ◽

10.1055/a-0895-5166 ◽

2019 ◽

Cited By ~ 3

Author(s):

Mikołaj Kamiński ◽

Aleksandra Uruska ◽

Anita Rogowicz-Frontczak ◽

Dawid Lipski ◽

Paweł Niedźwiecki ◽

...

Keyword(s):

Insulin Resistance ◽

Vitamin D ◽

Type 1 Diabetes ◽

Serum Level ◽

Serum Concentration ◽

Test Group ◽

Glucose Disposal ◽

Endogenous Insulin ◽

Estimated Glucose Disposal Rate

Abstract Aim Type 1 diabetes mellitus (T1DM) is a disease characterized by an absolute deficiency of endogenous insulin secretion. Insulin resistance (IR) may develop among patients with T1DM. Vitamin D deficiency was reported to be a risk factor in the development of IR. The aim of the study was to assess the relationship between serum concentrations of 25-hydroxyvitamin D (25(OH)D) and IR among patients with T1DM. Methods The test group consisted of 110 adult patients [males=65 (59%)] with T1DM. Participants were recruited in Poland between 1st October and 30th April in 2015/2016 and 2016/2017. VD serum level was assessed by ELISA array. IR was assessed by estimated Glucose Disposal Rate (eGDR). Results In the study group 21 (19%) patients were recognized as IR according to eGDR cut-offs (<7.5 mg/kg/min), 52 (47.3%) patients had VD deficiency (25(OH)D<20 ng/ml), 16 (14.5%) patients had 25(OH)D<10 ng/ml. Only 6 (5%) participants reported VD supplementation. Patients with IR, according to eGDR cut-off revealed significantly lower 25(OH)D serum level 15.7 (9.2–28.4) vs. 22.1 (13.0–38.4) ng/ml; p=0.04 as compared to patients without IR. R Spearman analysis found a positive relationship between VD and eGDR (Rs=0.27; p<0.01). Logistic regression analysis revealed significant relationship between the presence of IR and VD serum level/presence of 25(OH)D serum level below 10 ng/ml, both models adjusted to sex, age, BMI, LDL and triglycerides, accordingly (OR=0.95, CI: 0.90–0.99; p=0.04) and (OR=4.19, CI: 1.04–16.93; p=0.04). Conclusion The serum concentration of Vitamin D is negatively associated with insulin resistance in patients with T1DM and may have clinical implications.

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Obstetric and perinatal outcome in type 1 diabetes patients with diabetic nephropathy during 1988–2011

Diabetologia ◽

10.1007/s00125-014-3488-1 ◽

2015 ◽

Vol 58 (4) ◽

pp. 678-686 ◽

Cited By ~ 31

Author(s):

Miira M. Klemetti ◽

Hannele Laivuori ◽

Minna Tikkanen ◽

Mika Nuutila ◽

Vilho Hiilesmaa ◽

...

Keyword(s):

Type 1 Diabetes ◽

Diabetic Nephropathy ◽

Perinatal Outcome ◽

Diabetes Patients

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Estimated Glucose Disposal Rate (eGDR) – A Marker for the Assessment of Insulin Resistance in Type 1 Diabetes Mellitus

Romanian Journal of Diabetes Nutrition and Metabolic Diseases ◽

10.1515/rjdnmd-2016-0021 ◽

2016 ◽

Vol 23 (2) ◽

pp. 177-182 ◽

Cited By ~ 1

Author(s):

Mihaela L. Bîcu ◽

Daniel Bîcu ◽

Sigina Gârgavu ◽

Magdalena Sandu ◽

Mihaela I. Vladu ◽

...

Keyword(s):

Diabetes Mellitus ◽

Insulin Resistance ◽

Type 1 Diabetes ◽

Type 1 Diabetes Mellitus ◽

Glucose Disposal ◽

Chronic Complications ◽

Important Indicator ◽

Estimated Glucose Disposal Rate ◽

Glucose Disposal Rate

AbstractBackground and Aims: Studies have shown an increased incidence of chronic complications in people with type 1 diabetes mellitus (T1DM) with insulin resistance (IR) compared to people with T1DM without IR. Estimated glucose disposal rate (eGDR) is an important indicator of IR in patients with T1DM, lower eGDR levels indicating greater IR. It was shown that T1DM patients with chronic complications (diabetic retinopathy - DR, diabetic peripheral neuropathy - DPN or diabetic kidney disease - DKD) exhibit higher IR compared to patients without chronic complications. The aim of our study was to evaluate eGDR as a marker for the assessment of IR in T1DM patients.Materials and Methods: The study was observational, cross-sectional and included 140 T1DM patients with diabetes duration>10 years. The collected data were analyzed using the Statistic Package for Social Sciences (SPSS) version 22 software (IBM Corporation, Armonk, NY, USA).Results: eGDR presented statistically significant correlations (p<0.05) with the presence of metabolic syndrome (MS), obesity, chronic complications of T1DM, cardiovascular risk (CVR) and smoking status in patients with T1DM duration >10 years.Conclusions: eGDR represents a reliable marker for assessing the IR in T1DM.

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Urinary PC-1 activity in patients with type 1 diabetes mellitus

Annals of Clinical Biochemistry International Journal of Laboratory Medicine ◽

10.1258/000456303321610529 ◽

2003 ◽

Vol 40 (3) ◽

pp. 235-238 ◽

Cited By ~ 2

Author(s):

V Stefanovicć ◽

M Rajicć ◽

S Anticć ◽

M Miticć-Zlatkovicć ◽

S Stojiljkovicć ◽

...

Keyword(s):

Diabetes Mellitus ◽

Insulin Resistance ◽

Type 1 Diabetes ◽

Urinary Excretion ◽

Type 1 Diabetes Mellitus ◽

Control Level ◽

Diabetic Patients ◽

Potential Factor ◽

Diabetes Patients

Background: Insulin resistance characterizes type 1 diabetes mellitus with nephropathy. The molecular mechanisms of insulin resistance are not completely understood. Recently some advances have been made in identification of transmembrane glycoprotein PC-1 as a potential factor of insulin resistance. Methods: We measured urinary excretion of PC-1 (alkaline phosphodiesterase I), a potential factor of insulin resistance, and N-acetyl-β-D-glucosaminidase (NAGA) in 62 type 1 diabetic patients with different damage to the kidney. Results: In newly detected type 1 diabetes patients, before insulin therapy, urine PC-1 excretion was significantly increased (P<0·05) over the control level. However, in patients after 12·4 years of therapy, urinary PC-1 was significantly decreased (P<0·05). Decreased urine PC-1 activity (P<0·05) was found also in type 1 diabetes patients with microalbuminuria and manifest nephropathy, including those with renal failure. Urinary NAGA excretion was found to be significantly increased (P=0·001) in all but the group of type 1 diabetes patients without nephropathy. Conclusion: This study of urinary PC-1 in patients with type 1 diabetes shows increased excretion in newly detected patients with poor glycaemic control, but decreased excretion in patients with micro-/macroalbuminuria as well as in those without apparent kidney damage. In patients with primary glomerulonephritis, urinary excretion of PC-1 was significantly decreased and that of NAGA significantly increased compared with the excretion in healthy controls.

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Lower heart rate variability is associated with higher plasma concentrations of IL-6 in type 1 diabetes

Acta Endocrinologica ◽

10.1530/eje-07-0090 ◽

2007 ◽

Vol 157 (1) ◽

pp. 31-38 ◽

Cited By ~ 38

Author(s):

J-M González-Clemente ◽

C Vilardell ◽

M Broch ◽

A Megia ◽

A Caixàs ◽

...

Keyword(s):

Insulin Resistance ◽

Heart Rate ◽

Heart Rate Variability ◽

Type 1 Diabetes ◽

Systemic Inflammation ◽

Insulin Dose ◽

Plasma Concentrations ◽

Glucose Disposal ◽

Low Grade

Objective: In type 1 diabetes, cardiovascular autonomic neuropathy (CAN) is associated with cardiovascular risk factors related to insulin resistance, which in turn are associated with low-grade systemic inflammation. Reduced heart rate variability (HRV) is considered one of the first indicators of CAN. Since the autonomic nervous system interacts with systemic inflammation, we evaluated CAN to study its possible association with low-grade systemic inflammation. Design: Cross-sectional study of a group of 120 subjects diagnosed with type 1 diabetes mellitus 14 years before. Methods: Information recorded: 1) clinical characteristics: sex, age, body mass index, waist-to-hip ratio (WHR), blood pressure (BP), smoking, alcohol intake, insulin dose, HbA1c, and lipid profile; 2) plasma levels of soluble fractions of tumour necrosis factor α receptors 1 and 2, IL-6, and C-reactive protein; 3) insulin resistance by estimation of the glucose disposal rate (eGDR); and 4) tests for CAN: HRV in response to deep breathing (E/I ratio), HRV in response to the Valsalva maneuver, and changes in systolic BP responding to standing. Results: A significant negative correlation was found between E/I ratio and plasma concentrations of IL-6 (r=−0.244, P=0.032), which remained significant after adjusting for potential confounding factors (age, sex, HbA1c, WHR, diastolic BP, triglycerides, HDL-cholesterol, retinopathy, nephropathy, peripheral neuropathy, insulin dose, and smoking; r=−0.231, P=0.039). No other significant associations were found between inflammation-related proteins, tests for CAN, and eGDR. Conclusions: These findings suggest a link between low-grade inflammation and early alterations of CAN in type 1 diabetes and may be of importance in the pathogenesis of CAN and/or its clinical implications.

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Depression is associated with progression of diabetic nephropathy in type 1 diabetes

10.2337/figshare.13073387 ◽

2020 ◽

Author(s):

Aila J. Ahola ◽

Valma Harjutsalo ◽

Carol Forsblom ◽

François Pouwer ◽

Per-Henrik Groop ◽

...

Keyword(s):

Type 1 Diabetes ◽

Diabetic Nephropathy ◽

Renal Disease ◽

End Stage Renal Disease ◽

Symptoms Of Depression ◽

Increased Risk ◽

Stage Renal Disease ◽

End Stage

OBJECTIVE To investigate the relationship between depression and diabetic nephropathy progression in type 1 diabetes. RESEARCH DESIGN AND METHODS Data from 3730 participants without end-stage renal disease at baseline, participating in the Finnish Diabetic Nephropathy Study, were included. Depression was assessed in three ways. Depression diagnoses were obtained from the Finnish Care Register for Health Care. Antidepressant agent purchase data were obtained from the Drug Prescription Register. Symptoms of depression were assessed using the Beck Depression Inventory (BDI). Based on their urinary albumin excretion rate (AER) participants were classified into those with normal AER, microalbuminuria, and macroalbuminuria. Progression from normal AER to either microalbuminuria, macroalbuminuria, or end-stage renal disease; or from microalbuminuria to macroalbuminuria or ESRD; or from macroalbuminuria to ESRD, during the follow-up period was investigated. RESULTS Over a mean follow-up period of 9.6 years, renal status deteriorated in 18.4% of the participants. Diagnosed depression and antidepressant purchases before baseline were associated with 53% and 32% increased risk of diabetic nephropathy progression, respectively. Diagnosed depression assessed during follow-up remained associated with increased risk of disease progression (32%). BDI-derived symptoms of depression showed no association with the progression, but the total number of antidepressant purchases modestly reduced the risk [0.989 (0.982–0.997), P=0.008]. Dividing the sample based on median age, the observations followed those seen in the whole group. However, symptoms of depression additionally predicted progression in those ≤36.5 years. CONCLUSIONS Diagnosed depression and antidepressant purchases are associated with the progression of diabetic nephropathy in type 1 diabetes. Whether successful treatment of depression reduces the risk needs to be determined.

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