Abstract: FR-PO643
Insulin Use Is a Surrogate Marker of Insulin Resistance (IR)
Session Information
- Diabetic and Obesity Induced Kidney Disease - Clinical - II
November 03, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Diabetes
- 502 Diabetes Mellitus and Obesity: Clinical
Authors
- Raj, Christine K., UC Berkeley, Saratoga, California, United States
- Boucher, R. E., Univ. of Utah, SLC, Utah, United States
- Wei, Guo, Univ. of Utah, SLC, Utah, United States
- Bjordahl, Terrence S., Univ. of Utah, SLC, Utah, United States
- Habib, A. N., Univ. of Utah, SLC, Utah, United States
- Beddhu, Srini, Univ. of Utah, SLC, Utah, United States
Background
We previously noted that diabetics needing insulin therapy are at ↑ risk of reaching ESRD than those that do not need insulin adjusted for duration of diabetes mellitus (DM), concurrent use of other hypoglycemic agents and HbA1C levels. We hypothesized that need for insulin is a reflection of underlying IR.
Methods
We examined whether insulin use is reflective of IR in 1756 participants with DM and non-missing data for insulin use and IR in the Chronic Renal Insufficiency Cohort. Insulin use was related to IR estimated by homeostatic model of assessment of insulin resistance (HOMA-IR) in logistic regression models.
Results
Mean age was 59 ±10 years, 55.4% were men and 44.0% were black. Baseline characteristics of diabetics on insulin and not on insulin are summarized in the table.Compared to the lowest quartile of HOMA-IR, there was a graded ↑ in odds of insulin use in the upper three quartiles in a multivariate logistic regression model (Figure).
Conclusion
We conclude that need for insulin use is a surrogate marker of insulin resistance and interventions that target insulin resistance might ↓ the need for insulin use in DKD.
| Insulin Use | No (50.2 %) N = 881 | Yes (49.8 %) N = 875 | |
| Age (yrs) | 61 ± 9 | 58 ± 10 | <0.001 |
| Male (%) | 57.5 | 53.1 | 0.06 |
| Black (%) | 43.2 | 44.7 | 0.54 |
| Atherosclerotic Conditions (%) | 38.0 | 45.8 | 0.001 |
| CHF (%) | 11.1 | 16.0 | 0.003 |
| Duration of DM (yrs) | 12.0 ± 8.9 | 20.3 ± 10.3 | <0.001 |
| BMI (kg/m2) | 34.3 ± 8.1 | 33.6 ± 8.1 | 0.07 |
| Hemoglobin-A1c (%) | 7.2 ± 1.5 | 8.1 ± 1.7 | <0.001 |
| Sulfonylurea (%) | 58.0 | 14.7 | <0.001 |
| Biguanide (%) | 24.1 | 8.7 | <0.001 |
| TZD (%) | 30.2 | 17.4 | <0.001 |
| Other Hypoglycemic Agents (%) | 3.5 | 2.4 | 0.17 |
| HOMA-IR | 4.9 (3.1, 7.9) | 8.4 (5.2, 15.1) | <0.001 |
| CKD-EPI eGFR (ml/min/1.73 m2) | 42.9 ± 14.1 | 40.8 ± 13.7 | 0.001 |
| Urine ACR (mg/g) | 64.0 (12.3, 623.5) | 268.2 (33.5, 1238.6) | <0.001 |
Funding
- NIDDK Support