DİYABETİK OLMAYAN BİREYLERDE İNSÜLİN DİRENCİ MİKROALBÜMİNÜRİ İLİŞKİSİ

Year 2014, Volume: 4 Issue: 3, 34 - 40, 03.12.2014

Ahmet Ahsen , Memnune Ulu Akif Acay Alper Elbir Şeref Yüksel

Abstract

ÖZET
Amaç: İnsülin direnci ve mikroalbüminüri, tip 2 diyabetli hastalarda daha belirgin olmak üzere, kardiyovasküler hastalıklar için risk faktörüdür. Biz bu parametreleri diyabetik olmayan bireylerde araştırmayı amaçladık.
Gereç ve yöntemler: Çalışmamız hastanemiz iç hastalıkları polikliniğine başvuran 49 hastanın dosya verileri incelenerek insülin direnci, mikroalbüminüri düzeyi, bel kalça oranı (BKO), beden kitle indeksi (BKİ), yağ yüzdesi ve rutin biyokimyasal parametreleri kaydedildi.
Bulgular: İnsülin direnci olan hastaların mikroalbüminüri düzeyleri, BKİ, yağ yüzdeleri ve yüksek duyarlıklı C-reaktif protein (hs-CRP) düzeyleri, insülin direnci olmayanlara göre yüksekti. BKO, açlık kan şekeri, ve lipid değerleri açısından ise fark yoktu. Mikroalbüminüri düzeyi ile insülin direnci, BKİ ve yağ yüzdesi düzeyleri arasında pozitif korelasyon vardı.
Sonuç: Diyabetik hastalarda, insülin direnci ve mikroalbüminüri varlığında kardiyovasküler risk artmıştır. Bu bulguların diyabetik olmayan hastalarda da bulunması kardiyovasküler mortalite ris- kini arttıracağından daha yakın takip edilmesi gerekir.

Anahtar kelimeler: İnsülin direnci; Albüminüri; Obezite

ABSTRACT

Objective: Insulin resistance and microalbuminuria are being more pronounced risk factors for cardiovascular diseases in patients with type 2 diabetes. We aimed to investigate the relationship between these parameters in non-diabetic patients.
Materials and Methods: Fourty-nine patients, who have been admitted to the hospital and examined in terms ofinsulin resistance, microalbuminuria levels, waist-hip ratio (WHR), body mass index (BMI), fat percentage and routine biochemical parameters were recorded.
Results: Microalbuminuria levels, BMI, fat percentages and hs-CRP levels of the patients with insulin resistance were higher than those without insulin resistance.There was no difference in terms of WHR, fasting blood glucose, and lipid levels.
Conclusion: There is an increased cardiovascular risk in the presence of insulin resistance and microalbuminuria in diabetic patients. Nondiabetic subjects, with these findings, will increase the risk of cardiovascular mortality and should be followed up closely.

Key words: Insulin resistance; Albuminuria; Obesity

Keywords

İnsülin direnci; Albüminüri; Obezite

References

• Orchard TJ, Chang YF, Ferrell RE, Petro N, Ellis DE. Nephropathy in type 1 diabetes: a manifestation of insulin resistance and multiple genetic susceptibilities? Further evidence from the Pittsburg Epidemiology of Diabetes Complications Study. Kidney Int. 2002;62(3):963–70.
• Mykkanen L, Zaccaro DJ, Wagenknecht LE, Robbins DC, Gabriel M, Haffner SM. Microalbuminuria is associated with insulin resistance innondiabetic subjects: the Insulin Resistance Atherosclerosis Study. Diabetes. 1988;47(5):793800.
• Vedovato M, Lepore G, Coracina A, Dodesini AR, Jori E, Tiengo A, et al. Effect of sodium intake on blood pressure an albuminuria in type 2 diabetic patients: the role of insulin resistance. Diabetologia. 2004;47(2):300-3.
• Nielsen S, Schmitz O, Orskov H, Mogensen CE. Similar insulin sensitivity in NIDDN patients with normo- and microalbuminuria. Diabetes Care. 1995;18(6):834-42.
• Jager A, Kostense PJ, Nijpels G, Heine RJ, Bouter LM, Stehouwer CD. Microalbuminuria is strongly associated with NIDDM and hypertension but not with the insulin resistance syndrome: The Hoorn study. Diabetologia. 1998;41(6):694700.
• Balkau B, Charles MA. Comment on the provisional report from the WHO consultation. European Group for the study of Insulin Resistance (EGIR). Diabet Med. 1999;16(5):442-3.
• Niskanen L, Laasko M. Insulin resistance is related to albuminuria in patients with type II (non-insulin-dependent) diabetes mellitus. Metabolism. 1993;42(12):1541-5.
• Nosadini R, Manzato E, Solini A, Fioretto P, Brocco E, Zambon S, et al. Peripheral, rather than hepatic, insulin resistance and atherogenic lipoprotein phenotype predict cardiovascular complications in NIDDM. Eur J Clin Invest. 1994;24(4):258-66.
• Parvanova AI, Trevisan R, Iliev IP, Dimitrov BD, Vedovato M, Tiengo A, et al. Insulin resistance and microalbuminuria: A cross-sectional, casecontrol study of 158 patients with type 2 diabetes and different degrees of urinary albumin excretion. Diabetes. 2006;55(5):1456–62.
• Viswanathan V, Tilak P, Meerza R, Kumpatla S. Insulin resistance at different stages of diabetic kidney disease in India. J Assoc Physicians India. 2010;58(1):612-5.
• Shin DI, Seung KB, Yoon HE, Hwang BH, Seo SM, Shin SJ, et al. Microalbuminuria is independently associated with arterial stiffness and vascular inflammation but not with carotid intima–mediathickness in patients with newly diagnosed type 2 diabetes or essential hypertension. J Korean Med Sci. 2013;28(2):252–60.
• Gerstein HC, Mann JF, Yi Q, Zinman B, Dinneen SF, Hoogwerf B, et al. Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic individuals. JAMA. 2001;286(4):421-6.
• Onat A, Hergene G, Uyarel H, Ozhan H, Esen AM, Karabulut A, et al. Association between mild renal dysfunction and insulin resistance or metabolic syndrome in a random non diabetic population sample. Kidney Blood Press Res. 2007;30(2):88-96.
• Juncos LA, Ito S. Disparate effects of insulin on isolated rabbit afferent and efferent arterioles. J Clin Invest. 1993;92(4):1981-5.
• Fujihara CK, Padilha RM, Zatz R. Glomerular abnormalities in long-term experimental diabetes. Role of hemodynamic and nonhemodynamic factors and effects of antihypertensive therapy. Diabetes. 1992;41(3):286-93.
• Jarrett JR, Viberti GC, Argyropoulos A, Hill RD, Mahmud U, Murrells TJ. Microalbuminuria predicts mortality in noninsulin-dependent diabetes. Diabet Med. 1984;1(1):17-9.
• Stehouwer CD, Gall MA, Twisk JW, Knudsen E, Emeis JJ, Parving HH. Increased urinary albumin excretion, endothelial dysfunction, and chronic low-grade inflammation in type 2 diabetes: progressive, interrelated, and independently associated with risk of death. Diabetes. 2002 51(4):1157-65. Forsblom CM, Eriksson JG, Ekstrand AV, Teppo AM, Taskinen MR, Groop LC. Insulin resistance andabnormal albumin excretion in non-diabetic first-degree relatives of patients with NIDDM. Diabetologia. 1995;38(3):363-9.
• Chen J, Muntner P, Hamm LL, Fonseca V, Batuman V, Whelton PK, et al. Insulin resistance and risk of chronic kidney disease in non diabetic US adults. J Am Soc Nephrol. 2003;14(2):469-77.
• Fujikawa R, Okubo M, Egusa G, Kohno N. Insulin resistance preceeds the appearance of albuminuria in non diabetic subjects: 6 years follow up study. Diab Res Clin Pract. 2001;53(2):99-106.
• Brantsma AH, Bakker SJ, Hillege HL, de Zeeuw D, de Jong PE, Gansevoort RT. PREVEND Study Group. Urinary albumin excretion and its relation with C-reactive protein and the metabolic syndrome in the prediction of type 2 diabetes. Diabetes Care. 2005;28(10):2525-30.
• Tamakoshi K, Yatsuya H, Kondo T,Hori Y, Ishikawa M, Zhang H, et al. The metabolic syndrome is associated with elevated circulating C-reactive protein in healthy reference range, a systemic low-grade inflammatory state. Int J Obes Relat Metab Disord. 2003; 27(4):443-9.
• Hoekstra T,Geleijnse JM, SchoutenEG, Kok FJ, Kluft C. Relationship of C-reactive proteinwith components of themetabolic syndrome in normal-weight and overweight elderly. Nutr Metab Cardiovasc Dis. 2005;15(4):270-8.
• Wannamethee SG, LoweGD, ShaperAG, Rumley A, Lennon L, Whincup PH. The metabolic syndrome and insulin resistance: relationship to haemostatic and inflammatory markers in older non-diabetic men. Atherosclerosis. 2005;181(1):101-8.
• Freeman DJ, Norrie J, Caslake MJ, Gaw A, Ford I, Lowe GD, et al. C-reactive protein is an independentpredictor of risk for the development of diabetes in the West of Scotland Coronary Prevention Study. Diabetes. 2002;51(5):1596–600.
• Van Der Velde M, Bello A K, Brantsma H A,El Nahas M, Bakker SJ, de Jong PE, et al. Do albuminuria and hs-CRP add to the International Diabetes Federation definition of the metabolic syndrome in predicting outcome? Nephrol Dial Transplant. 2012;27(6):2275-83.