Journal Article

Insulin resistance precedes microalbuminuria in patients with insulin-dependent diabetes mellitus.

A V Ekstrand, P H Groop and C Grönhagen-Riska

in Nephrology Dialysis Transplantation

Volume 13, issue 12, pages 3079-3083
Published in print December 1998 | ISSN: 0931-0509
Published online December 1998 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/13.12.3079
Insulin resistance precedes microalbuminuria in patients with insulin-dependent diabetes mellitus.

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BACKGROUND: Insulin resistance has been associated with hypertension and with renal complications in patients with type 1 diabetes mellitus. Causal relationships have not been fully explained. METHODS: We investigated whether insulin resistance precedes microalbuminuria by measuring insulin resistance with a euglycaemic clamp in combination with indirect calorimetry in 16 uncomplicated type 1 diabetic patients and in six healthy control subjects. The patients had over 10 year duration of diabetes, and were expected to experience either a complication-free or complicated disease course within the next few years. They have thereafter been followed for the development of microalbuminuria for 3 years. RESULTS: In a euglycaemic insulin clamp glucose disposal was lower in diabetic patients compared with control subjects (7.5 +/- 2.9 and 12.6 +/- 2.0 mg/kg LBM/min; P<0.002), mainly due to impaired glucose storage (4.3 +/- 2.3 vs 8.6 +/- 1.6 mg/kg LBM/min; P<0.001). Three years later seven IDDM patients had albumin excretion rate over 30 mg/24 h; glucose disposal (5.5 +/- 2.1 vs 9.0 +/- 2.2 mg/kg LBM/min; P<0.01) had been lower in patients who developed microalbuminuria compared with those who remained normoalbuminuric. CONCLUSIONS: Insulin resistance predicts the increment in urinary albumin excretion. Insulin resistance depends mainly on impaired glucose storage in uncomplicated IDDM.

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Subjects: Nephrology

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