Original scientific paper
Estimated Glucose Disposal Rate in Assessment of Renal Function in Patients with Type 1 Diabetes
Tomislav Bulum
Lea Duvnjak
Ingrid Prkačin
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–(12.22´WHR)–
(3.29´HT)–(0.57´HbA1c). The units were mgkg–1min–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.
Keywords
diabetes mellitus type 1; estimated glucose disposal rate; urinary albumin excretion; insulin resistance
Hrčak ID:
84798
URI
Publication date:
10.7.2012.
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