Abstract: FR-PO643

Insulin Use Is a Surrogate Marker of Insulin Resistance (IR)

Session Information

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 UseNo (50.2 %)
N = 881
Yes (49.8 %)
N = 875
 
Age (yrs)61 ± 958 ± 10<0.001
Male (%)57.553.10.06
Black (%)43.244.70.54
Atherosclerotic Conditions (%)38.045.80.001
CHF (%)11.116.00.003
Duration of DM (yrs)12.0 ± 8.920.3 ± 10.3<0.001
BMI (kg/m2)34.3 ± 8.133.6 ± 8.10.07
Hemoglobin-A1c (%)7.2 ± 1.58.1 ± 1.7<0.001
Sulfonylurea (%)58.014.7<0.001
Biguanide (%)24.18.7<0.001
TZD (%)30.217.4<0.001
Other Hypoglycemic Agents (%)3.52.40.17
HOMA-IR4.9 (3.1, 7.9)8.4 (5.2, 15.1)<0.001
CKD-EPI eGFR (ml/min/1.73 m2)42.9 ± 14.140.8 ± 13.70.001
Urine ACR (mg/g)64.0 (12.3, 623.5)268.2 (33.5, 1238.6)<0.001

Funding

  • NIDDK Support