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Kidney function, β-cell function and glucose tolerance in older men.

Ting Jia1, Ulf Risérus, Hong Xu

  • 1Divisions of Renal Medicine and Baxter Novum, Departments of Clinical Science, Intervention and Technology (T.J., H.X., B.L., T.E.L., J.J.C.), Public Health Sciences (T.J.), and Center for Molecular Medicine (J.J.C.), Karolinska Institutet, Stockholm, Sweden; Department of Public Health and Caring Sciences, Section of Geriatrics (J.A.), Clinical Nutrition and Metabolism (U.R., P.S., T.C.), Uppsala University, Uppsala, Sweden; School of Health and Social Studies (J.A.), Dalarna University, Falun, Sweden; and Department of Medicine (T.A.I.), Division of Nephrology, Vanderbilt University Medical Center, Nashville, Tennessee.

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Kidney dysfunction impairs insulin sensitivity but older men

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Area of Science:

  • Endocrinology
  • Nephrology
  • Metabolic Health

Background:

  • Kidney dysfunction is known to cause insulin resistance.
  • The impact of kidney dysfunction on pancreatic beta cell function remains unclear.

Purpose of the Study:

  • To examine beta cell function and glucose tolerance in relation to kidney function.
  • Investigate insulin release during an oral glucose tolerance test (OGTT) across different kidney function levels.

Main Methods:

  • A community-based cohort study (Uppsala Longitudinal Study of Adult Men - ULSAM) included 1015 non-diabetic men aged 70-71.
  • Participants underwent OGTT and euglycaemic hyperinsulinaemic clamp (HEGC) tests to assess insulin sensitivity, beta cell function, and glucose tolerance.
  • Kidney function was estimated using cystatin C-based algorithms; mixed models analyzed insulin secretion determinants.

Main Results:

  • Nearly half the participants (46%) had moderate-to-advanced kidney disease.
  • Insulin sensitivity decreased with declining kidney function.
  • Despite reduced insulin sensitivity, beta cell function indices (insulin release) increased after the OGTT, preserving glucose tolerance.

Conclusions:

  • In older men, pancreatic beta cell function adequately compensates for reduced insulin sensitivity associated with kidney dysfunction.
  • The overall balance between insulin sensitivity and beta cell function is maintained despite impaired kidney function.