Dietary sodium restriction impairs insulin sensitivity in noninsulin-dependent diabetes mellitus

• Published in: The journal of clinical endocrinology and metabolism Vol. 83; no. 5; pp. 1552 - 1557
• Main Authors: PETRIE, J. R, MORRIS, A. D, MINAMISAWA, K, HILDITCH, T. E, ELLIOTT, H. L, SMALL, M, MCCONNELL, J
• Format: Journal Article
• Language: English
• Published: Bethesda, MD Endocrine Society 01.05.1998
• Subjects: Aged; Aldosterone - blood; Angiotensin II - blood; Biological and medical sciences; Cross-Over Studies; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - diet therapy; Diabetes. Impaired glucose tolerance; Diet, Sodium-Restricted; Double-Blind Method; Electrolytes - blood; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Glucose - biosynthesis; Glucose Clamp Technique; Humans; Insulin - blood; Insulin - pharmacology; Male; Medical sciences; Middle Aged; Placebos; Renin - blood; Triglycerides - blood; Endocrinopathy; Human; Protein hormone; Pancreatic hormone; Sensitivity; Deficient diet; Sodium; Biological effect; Glucose; Metabolism; Non insulin dependent diabetes; Insulin
• ISSN: 0021-972X; 1945-7197
• DOI: 10.1210/jc.83.5.1552

Dietary sodium restriction has a variety of effects on metabolism, including activation of the renin-angiotensin system. Angiotensin II has complex metabolic and cardiovascular effects, and these may be relevant to the effects of both nonpharmacological and pharmacological interventions in noninsulin-dependent diabetes mellitus (NIDDM). We have assessed the effect of dietary sodium restriction on insulin sensitivity and endogenous glucose production in eight normotensive patients with diet-controlled NIDDM who underwent hyperinsulinemic clamp studies in a randomized, double-blind, placebo-controlled cross-over protocol after two 4-day periods on sodium replete (160 mmol/day) and sodium deplete (40 mmol/day) diets. Mean +/- SD 24-h urinary sodium was 197 +/- 76.0 mmol (replete) and 67 +/- 19.5 mmol (deplete), P = 0.03. Insulin sensitivity was 42.0 +/- 11.3 mumol/kg.min (replete) and 37.0 +/- 11.6 mumol/kg.min (deplete), P = 0.04 (a reduction of 12%). Blood pressure was 130 +/- 21/78 +/- 11 mmHg (replete) and 128 +/- 12/73 +/- 10 mmHg (deplete). Dietary sodium restriction may result in a decrease in peripheral insulin sensitivity in normotensive patients with NIDDM, possibly via an elevation in prevailing angiotensin II concentrations.