Insulin Sensitivity and Albuminuria: The RISC Study

• Published in: Diabetes care Vol. 37; no. 6; pp. 1597 - 1603
• Main Authors: Pilz, Stefan, Rutters, Femke, Nijpels, Giel, Stehouwer, Coen D.A., Højlund, Kurt, Nolan, John J., Balkau, Beverley, Dekker, Jacqueline M.
• Format: Journal Article
• Language: English
• Published: Alexandria, VA American Diabetes Association 01.06.2014
• Subjects: Adult; Albuminuria - epidemiology; Albuminuria - physiopathology; Associated diseases and complications; Biological and medical sciences; Cardiovascular disease; Cardiovascular Diseases - epidemiology; Creatinine - urine; Cross-Sectional Studies; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Europe - epidemiology; Female; Follow-Up Studies; Glucose; Glucose Clamp Technique; Glucose Tolerance Test; Homeostasis; Humans; Hyperinsulinism - diagnosis; Incidence; Insulin - metabolism; Insulin Resistance; Insulin Secretion; Kidneys; Male; Medical sciences; Metabolic diseases; Middle Aged; Multivariate Analysis; Nephrology. Urinary tract diseases; Pathogenesis; Prospective Studies; Regression analysis; Risk assessment; Risk Factors; Urinary system involvement in other diseases. Miscellaneous; Europe; Endocrinopathy; Kidney disease; Human; Urine; Pancreatic hormone; Urinary system disease; Nutrition; Insulin sensitivity; Diabetes mellitus; Albumin; Metabolic diseases; Insulin; Concomitant disease; Diabetic nephropathy; Endocrinology
• ISSN: 0149-5992; 1935-5548; 1935-5548
• DOI: 10.2337/dc13-2573

Accumulating evidence suggests an association between insulin sensitivity and albuminuria, which, even in the normal range, is a risk factor for cardiovascular diseases. We evaluated whether insulin sensitivity is associated with albuminuria in healthy subjects. We investigated 1,415 healthy, nondiabetic participants (mean age 43.9 ± 8.3 years; 54.3% women) from the RISC (Relationship between Insulin Sensitivity and Cardiovascular Disease) study, of whom 852 participated in a follow-up examination after 3 years. At baseline, insulin sensitivity was assessed by hyperinsulinemic-euglycemic clamps, expressed as the M/I value. Oral glucose tolerance test-based insulin sensitivity (OGIS), homeostasis model assessment of insulin resistance (HOMA-IR), and urinary albumin-to-creatinine ratio (UACR) were determined at baseline and follow-up. Microalbuminuria (UACR ≥30 mg/g) was present in fewer than 2% at either study visit. After multivariate adjustments, there was no cross-sectional association between UACR and any measure of insulin sensitivity. Neither OGIS nor HOMA-IR was significantly associated with follow-up UACR, but in a multivariate regression analysis, baseline M/I emerged as an independent predictor of UACR at follow-up (β-coefficient -0.14; P = 0.001). In healthy middle-aged adults, reduced insulin sensitivity, assessed by hyperinsulinemic-euglycemic clamp, is continuously associated with a greater risk of increasing albuminuria. This finding suggests that reduced insulin sensitivity either is simply related to or might causally contribute to the initial pathogenesis of albuminuria.