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Insulin sensitivity in clinically healthy individuals with microalbuminuria
J S Jensen1, K Borch-Johnsen, G Jensen
1Steno Diabetes Center, Gentofte, Denmark.
Abstract:
In epidemiologic studies microalbuminuria is associated with increased atherosclerotic risk profile, morbidity, and mortality. In order to examine whether such association could be explained by impaired insulin sensitivity, 23 clinically healthy subjects with microalbuminuria (urinary albumin excretion rate (UAER) of 6.6 to 150 micrograms/min) and 24 age- and sex-matched controls with normoalbuminuria (UAER < or = 6.6 micrograms/min) underwent a 3 h hyperinsulinaemic euglycaemic clamp investigation using an intravenous insulin infusion rate on 2 mU/(kg body weight x min). Insulin sensitivity (whole body glucose disposal) was similar in the two groups ((mean (95% C.I.)) 351 (321-381) vs. 364 (339-388) mg/(m2 x min); P = 0.51). Among urinary albumin excretion rate, blood pressure, serum lipid concentrations, body mass index waist-hip ratio, fasting concentrations of serum insulin and blood glucose, tobacco and alcohol consumption, physical activity, and age and sex, fasting serum insulin concentration was the only variable independently associated with insulin sensitivity (r = -0.55; P = 0.0001). It is concluded that microalbuminuria is not associated with impaired insulin sensitivity in clinically healthy individuals. The effect of microalbuminuria as predictor of atherosclerotic vascular disease may be mediated through other factors.
Insights
Microalbuminuria, a marker of kidney damage, does not impair insulin sensitivity in healthy individuals. Atherosclerotic risk associated with microalbuminuria may stem from other underlying factors.
Area of Science:
- Nephrology
- Endocrinology
- Cardiovascular Medicine
Background:
- Microalbuminuria is linked to increased atherosclerotic risk, morbidity, and mortality in epidemiological studies.
- The potential role of impaired insulin sensitivity as an explanation for this association requires investigation.
Purpose of the Study:
- To determine if microalbuminuria is associated with impaired insulin sensitivity in clinically healthy individuals.
Main Methods:
- A hyperinsulinemic euglycemic clamp was performed on 23 healthy subjects with microalbuminuria and 24 matched controls with normoalbuminuria.
- Insulin sensitivity was assessed by measuring whole-body glucose disposal during a 3-hour intravenous insulin infusion.
Main Results:
- Whole-body glucose disposal, a measure of insulin sensitivity, was similar between the microalbuminuria and normoalbuminuria groups (351 vs. 364 mg/(m2 x min); P = 0.51).
- Fasting serum insulin concentration was the only variable independently associated with insulin sensitivity (r = -0.55; P = 0.0001).
Conclusions:
- Microalbuminuria is not associated with impaired insulin sensitivity in clinically healthy individuals.
- The predictive effect of microalbuminuria on atherosclerotic vascular disease may be mediated by factors other than insulin resistance.