Key result
Higher insulin resistance (highest vs lowest HOMA-IR quartile) significantly predicted the development of microalbuminuria in type 2 diabetic patients (adjusted HR 1.76; 95% CI 1.20-2.59).
Why the study?
Does higher insulin resistance predict the development of microalbuminuria in normoalbuminuric type 2 diabetic patients?
Cohort (n=738)
Does higher insulin resistance predict the development of microalbuminuria in normoalbuminuric type 2 diabetic patients?
Hazard Ratio: 1.76 (95% CI 1.2–2.59)
Absolute Event Rate: 99% vs 64.8%
p-value: p=<0.001
Insulin resistance, as measured by HOMA-IR, is an independent predictor of developing microalbuminuria in patients with type 2 diabetes.
May support HOMA-IR for nephropathy risk stratification in T2D; leaves open whether targeting insulin resistance alters microalbuminuria incidence.
OBJECTIVE: An association between insulin resistance and microalbuminuria in type 2 diabetes has often been found in cross-sectional studies. We aimed to reassess this relationship in a prospective Taiwanese cohort of type 2 diabetic subjects. RESEARCH DESIGN AND METHODS: We enrolled 738 normoalbuminuric type 2 diabetic subjects, aged 56.6 ± 9.0 years, between 2003 and 2005 and followed them through the end of 2009. Average follow-up time was 5.2 ± 0.8 years. We used urine albumin-to-creatinine ratio to define microalbuminuria and the homeostasis model assessment of insulin resistance (HOMA-IR) to assess insulin resistance. The incidence rate ratio and Cox proportional hazards model were used to evaluate the association between HOMA-IR and development of microalbuminuria. RESULTS: We found incidences of microalbuminuria of 64.8, 83.5, 93.3, and 99.0 per 1,000 person-years for the lowest to highest quartiles of HOMA-IR. Compared with those in the lowest quartile of HOMA-IR, the incidence rate ratios for those in the 2nd, 3rd, and highest quartiles were 1.28 (95% CI 0.88-1.87), 1.44 (0.99-2.08), and 1.52 (1.06-2.20), respectively (trend test: P < 0.001). By comparison with those in the lowest quartile, the adjusted hazard ratios were 1.37 (0.93-2.02), 1.66 (1.12-2.47), and 1.76 (1.20-2.59) for those in the 2nd, 3rd, and highest HOMA-IR quartiles, respectively. CONCLUSIONS: According to the dose-response effects of HOMA-IR shown in this prospective study, we conclude that insulin resistance could significantly predict development of microalbuminuria in type 2 diabetic patients.
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Hsu et al. (2011) conducted a cohort in Type 2 diabetes (n=738). Insulin resistance (HOMA-IR) vs. Lowest quartile of HOMA-IR was evaluated on Development of microalbuminuria (HR 1.76, 95% CI 1.20-2.59, p=<0.001). Higher insulin resistance (highest vs lowest HOMA-IR quartile) significantly predicted the development of microalbuminuria in type 2 diabetic patients (adjusted HR 1.76; 95% CI 1.20-2.59).
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