No Direct Link between Albumin Excretion Rate and Insulin Resistance - A Study in Type 1 Diabetes Patients with Mild Nephropathy

Abstract

Aims: Albuminuria is thought to be associated with insulin resistance in patients with type 1 and type 2 diabetes as well as in non-diabetic subjects. The aim of this study was to find out about any direct correlation between the albumin excretion rate (AER) and insulin resistance; this was investigated in patients with type 1 diabetes. Methods: Euglycemic hyperinsulinemic clamps were performed in 18 patients with type 1 diabetes and incipient nephropathy - elevated albumin excretion rate (AER > 20 µg/min) but normal glomerular filtration rate (GFR) (81 - 135 ml/min/1.73 m²). Results: AER, determined as mean of two overnight urine collections, was 137 ± 157 (mean ± S.D.) µg/min (range 24 - 447). Insulin sensitivity, expressed as the M-value, was 6.8 ± 2.9 mg/kg/min, insulin sensitivity index (ISI = 100 × M/plasma insulin) 7.9 ± 3.4 and insulin clearance (MCR_ins) 17.0 ± 4.0 ml/kg/min. Simple regression analyses showed no direct association between AER and M, ISI or MCR_ins. GFR was not associated with M, ISI or MCR_ins in this group, either. AER was, however, positively associated with poor glucose control (high HbAlc) and tobacco use. Conclusions: These results suggest that the degree of albuminuria is not directly linked to insulin resistance. This was shown in type 1 diabetics, but could possibly be applicable in other subjects as well.

Key words

Type 1 Diabetes - Albuminuria - Euglycemic Hyperinsulinemic Clamp - Insulin Sensitivity

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