Early Diabetic Nephropathy A complication of reduced insulin sensitivity in type 1 diabetes

Petter Bjornstad; Janet K. Snell-Bergeon; Marian Rewers; Diana Jalal; Michel B. Chonchol; Richard J. Johnson; David M. Maahs

doi:10.2337/dc13-0631

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Early Diabetic Nephropathy A complication of reduced insulin sensitivity in type 1 diabetes

Journal article

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Early Diabetic Nephropathy A complication of reduced insulin sensitivity in type 1 diabetes

Petter Bjornstad, Janet K. Snell-Bergeon, Marian Rewers, Diana Jalal, Michel B. Chonchol, Richard J. Johnson and David M. Maahs

Diabetes care, Vol.36(11), pp.3678-3683

11/01/2013

DOI: 10.2337/dc13-0631

PMCID: PMC3816872

PMID: 24026551

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Abstract

OBJECTIVEDiabetic nephropathy (DN) is a major cause of mortality in type 1 diabetes. Reduced insulin sensitivity is a well-documented component of type 1 diabetes. We hypothesized that baseline insulin sensitivity would predict development of DN over 6 years.RESEARCH DESIGN AND METHODSWe assessed the relationship between insulin sensitivity at baseline and development of early phenotypes of DNmicroalbuminuria (albumin-creatinine ratio [ACR] 30mg/g) and rapid renal function decline (glomerular filtration rate [GFR] loss >3 mL/min/1.73 m(2) per year)with three Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations over 6 years. Subjects with diabetes (n = 449) and without diabetes (n = 565) in the Coronary Artery Calcification in Type 1 Diabetes study had an estimated insulin sensitivity index (ISI) at baseline and 6-year follow-up.RESULTSThe ISI was lower in subjects with diabetes than in those without diabetes (P < 0.0001). A higher ISI at baseline predicted a lower odds of developing an ACR 30 mg/g (odds ratio 0.65 [95% CI 0.49-0.85], P = 0.003) univariately and after adjusting for HbA(1c) (0.69 [0.51-0.93], P = 0.01). A higher ISI at baseline conferred protection from a rapid decline of GFR as assessed by CKD-EPI cystatin C (0.77 [0.64-0.92], P = 0.004) and remained significant after adjusting for HbA(1c) and age (0.80 [0.67-0.97], P = 0.02). We found no relation between ISI and rapid GFR decline estimated by CKD-EPI creatinine (P = 0.38) or CKD-EPI combined cystatin C and creatinine (P = 0.50).CONCLUSIONSOver 6 years, a higher ISI independently predicts a lower odds of developing microalbuminuria and rapid GFR decline as estimated with cystatin C, suggesting a relationship between insulin sensitivity and early phenotypes of DN.

Endocrinology & Metabolism

Life Sciences & Biomedicine

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Title: Subtitle: Early Diabetic Nephropathy A complication of reduced insulin sensitivity in type 1 diabetes
Creators: Petter Bjornstad - University of Colorado Health
Janet K. Snell-Bergeon - University of Colorado Denver
Marian Rewers - University of Colorado Anschutz Medical Campus
Diana Jalal - University of Colorado Denver
Michel B. Chonchol - University of Colorado Denver
Richard J. Johnson - University of Colorado Denver
David M. Maahs - University of Colorado Denver
Resource Type: Journal article
Publication Details: Diabetes care, Vol.36(11), pp.3678-3683
DOI: 10.2337/dc13-0631
PMID: 24026551
PMCID: PMC3816872
NLM abbreviation: Diabetes Care
ISSN: 0149-5992
eISSN: 1935-5548
Publisher: Amer Diabetes Assoc
Number of pages: 6
Grant note: P30-DK-57516 / Diabetes Endocrinology Research Center 1-10-JF-5 / American Diabetes Association M01RR000051 / NATIONAL CENTER FOR RESEARCH RESOURCES; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Center for Research Resources (NCRR) 17-2013-313 / JDRF; Juvenile Diabetes Research Foundation UL1TR001082 / NATIONAL CENTER FOR ADVANCING TRANSLATIONAL SCIENCES; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Center for Advancing Translational Sciences (NCATS) National Institutes of Health at the Colorado Heart Imaging Center in Denver; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA DK-075360 / National Institute of Diabetes and Digestive and Kidney Diseases; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK) R01 HL113029 / National Heart, Lung, and Blood Institute; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Heart Lung & Blood Institute (NHLBI) M01-RR-00051 / National Institutes of Health at the Barbara Davis Center for Childhood Diabetes; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA K23DK075360 / NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK) R01HL061753 / NATIONAL HEART, LUNG, AND BLOOD INSTITUTE; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Heart Lung & Blood Institute (NHLBI)
Language: English
Date published: 11/01/2013
Academic Unit: Nephrology; Internal Medicine
Record Identifier: 9984359922402771

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