Insulin resistance, diabetic kidney disease, and all-cause mortality in individuals with type 2 diabetes: a prospective cohort study
Abstract Background It is unclear whether insulin resistance (IR) contributes to excess mortality in patients with type 2 diabetes independent of diabetic kidney disease (DKD), which is strongly associated with IR and is a major risk factor for cardiovascular disease (CVD), the main cause of death i...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-03-01
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| Series: | BMC Medicine |
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| Online Access: | https://doi.org/10.1186/s12916-021-01936-3 |
| _version_ | 1819119910695993344 |
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| author | Giuseppe Penno Anna Solini Emanuela Orsi Enzo Bonora Cecilia Fondelli Roberto Trevisan Monica Vedovato Franco Cavalot Gianpaolo Zerbini Olga Lamacchia Antonio Nicolucci Giuseppe Pugliese for the Renal Insufficiency And Cardiovascular Events (RIACE) Study Group |
| author_facet | Giuseppe Penno Anna Solini Emanuela Orsi Enzo Bonora Cecilia Fondelli Roberto Trevisan Monica Vedovato Franco Cavalot Gianpaolo Zerbini Olga Lamacchia Antonio Nicolucci Giuseppe Pugliese for the Renal Insufficiency And Cardiovascular Events (RIACE) Study Group |
| author_sort | Giuseppe Penno |
| collection | DOAJ |
| description | Abstract Background It is unclear whether insulin resistance (IR) contributes to excess mortality in patients with type 2 diabetes independent of diabetic kidney disease (DKD), which is strongly associated with IR and is a major risk factor for cardiovascular disease (CVD), the main cause of death in these individuals. We tested this hypothesis in patients with type 2 diabetes from the Renal Insufficiency And Cardiovascular Events Italian Multicentre Study. Methods This observational, prospective, cohort study enrolled 15,773 patients with type 2 diabetes attending 19 Italian Diabetes Clinics in 2006–2008. Insulin sensitivity was assessed as estimated glucose disposal rate (eGDR), which was validated against the euglycaemic-hyperinsulinemic clamp technique. Vital status on October 31, 2015, was retrieved for 15,656 patients (99.3%). Participants were stratified by eGDR tertiles from T1 (≥ 5.35 mg/kg/min) to T3 (≤ 4.14 mg/kg/min, highest IR). Results CVD risk profile was worse in T2 and T3 vs T1. eGDR tertiles were independently associated with micro- and macroalbuminuria and the albuminuric DKD phenotypes (albuminuria with preserved or reduced estimated glomerular filtration rate [eGFR]) as well as with eGFR categories or the nonalbuminuric DKD phenotype. Over a 7.4-year follow-up, unadjusted death rates and mortality risks increased progressively across eGDR tertiles, but remained significantly elevated after adjustment only in T3 vs T1 (age- and gender- adjusted death rate, 22.35 vs 16.74 per 1000 person-years, p < 0.0001, and hazard ratio [HR] adjusted for multiple confounders including DKD, 1.140 [95% confidence interval [CI], 1.049–1.238], p = 0.002). However, eGDR was independently associated with mortality in participants with no DKD (adjusted HR, 1.214 [95% CI, 1.072–1.375], p = 0.002) and in those with nonalbuminuric DKD (1.276 [1.034–1.575], p = 0.023), but not in those with the albuminuric DKD phenotypes. Moreover, the association was stronger in males and in younger individuals and was observed in those without but not with prior CVD, though interaction was significant only for age. Conclusions The proxy of insulin sensitivity eGDR predicts all-cause mortality in type 2 diabetes, independent of confounders including DKD. However, the impact of IR in individuals with albuminuric DKD may be mediated by its relationship with albuminuria. Trial registration ClinicalTrials.gov , NCT00715481, retrospectively registered 15 July 2008. |
| first_indexed | 2024-12-22T06:12:17Z |
| format | Article |
| id | doaj.art-03bb3a4725a245589490e67ff3fbb619 |
| institution | Directory Open Access Journal |
| issn | 1741-7015 |
| language | English |
| last_indexed | 2024-12-22T06:12:17Z |
| publishDate | 2021-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Medicine |
| spelling | doaj.art-03bb3a4725a245589490e67ff3fbb6192022-12-21T18:36:11ZengBMCBMC Medicine1741-70152021-03-0119111310.1186/s12916-021-01936-3Insulin resistance, diabetic kidney disease, and all-cause mortality in individuals with type 2 diabetes: a prospective cohort studyGiuseppe Penno0Anna Solini1Emanuela Orsi2Enzo Bonora3Cecilia Fondelli4Roberto Trevisan5Monica Vedovato6Franco Cavalot7Gianpaolo Zerbini8Olga Lamacchia9Antonio Nicolucci10Giuseppe Pugliese11for the Renal Insufficiency And Cardiovascular Events (RIACE) Study GroupDepartment of Clinical and Experimental Medicine, University of PisaDepartment of Surgical, Medical, Molecular and Critical Area Pathology, University of PisaDiabetes Unit, IRCCS “Cà Granda - Ospedale Maggiore Policlinico” FoundationDivision of Endocrinology, Diabetes and Metabolism, University and Hospital Trust of VeronaDiabetes Unit, University of SienaEndocrinology and Diabetes Unit, Azienda Ospedaliera Papa Giovanni XXIIIDepartment of Clinical and Experimental Medicine, University of PaduaDepartment of Clinical and Biological Sciences, University of TurinComplications of Diabetes Unit, Division of Metabolic and Cardiovascular Sciences, San Raffaele Scientific InstituteDepartment of Medical Sciences, University of FoggiaCentre for Outcomes Research and Clinical Epidemiology (CORESEARCH)Department of Clinical and Molecular Medicine, “La Sapienza” UniversityAbstract Background It is unclear whether insulin resistance (IR) contributes to excess mortality in patients with type 2 diabetes independent of diabetic kidney disease (DKD), which is strongly associated with IR and is a major risk factor for cardiovascular disease (CVD), the main cause of death in these individuals. We tested this hypothesis in patients with type 2 diabetes from the Renal Insufficiency And Cardiovascular Events Italian Multicentre Study. Methods This observational, prospective, cohort study enrolled 15,773 patients with type 2 diabetes attending 19 Italian Diabetes Clinics in 2006–2008. Insulin sensitivity was assessed as estimated glucose disposal rate (eGDR), which was validated against the euglycaemic-hyperinsulinemic clamp technique. Vital status on October 31, 2015, was retrieved for 15,656 patients (99.3%). Participants were stratified by eGDR tertiles from T1 (≥ 5.35 mg/kg/min) to T3 (≤ 4.14 mg/kg/min, highest IR). Results CVD risk profile was worse in T2 and T3 vs T1. eGDR tertiles were independently associated with micro- and macroalbuminuria and the albuminuric DKD phenotypes (albuminuria with preserved or reduced estimated glomerular filtration rate [eGFR]) as well as with eGFR categories or the nonalbuminuric DKD phenotype. Over a 7.4-year follow-up, unadjusted death rates and mortality risks increased progressively across eGDR tertiles, but remained significantly elevated after adjustment only in T3 vs T1 (age- and gender- adjusted death rate, 22.35 vs 16.74 per 1000 person-years, p < 0.0001, and hazard ratio [HR] adjusted for multiple confounders including DKD, 1.140 [95% confidence interval [CI], 1.049–1.238], p = 0.002). However, eGDR was independently associated with mortality in participants with no DKD (adjusted HR, 1.214 [95% CI, 1.072–1.375], p = 0.002) and in those with nonalbuminuric DKD (1.276 [1.034–1.575], p = 0.023), but not in those with the albuminuric DKD phenotypes. Moreover, the association was stronger in males and in younger individuals and was observed in those without but not with prior CVD, though interaction was significant only for age. Conclusions The proxy of insulin sensitivity eGDR predicts all-cause mortality in type 2 diabetes, independent of confounders including DKD. However, the impact of IR in individuals with albuminuric DKD may be mediated by its relationship with albuminuria. Trial registration ClinicalTrials.gov , NCT00715481, retrospectively registered 15 July 2008.https://doi.org/10.1186/s12916-021-01936-3Type 2 diabetesEstimated glucose disposal rateAll-cause mortalityDiabetic kidney diseaseAlbuminuriaGlomerular filtration rate |
| spellingShingle | Giuseppe Penno Anna Solini Emanuela Orsi Enzo Bonora Cecilia Fondelli Roberto Trevisan Monica Vedovato Franco Cavalot Gianpaolo Zerbini Olga Lamacchia Antonio Nicolucci Giuseppe Pugliese for the Renal Insufficiency And Cardiovascular Events (RIACE) Study Group Insulin resistance, diabetic kidney disease, and all-cause mortality in individuals with type 2 diabetes: a prospective cohort study BMC Medicine Type 2 diabetes Estimated glucose disposal rate All-cause mortality Diabetic kidney disease Albuminuria Glomerular filtration rate |
| title | Insulin resistance, diabetic kidney disease, and all-cause mortality in individuals with type 2 diabetes: a prospective cohort study |
| title_full | Insulin resistance, diabetic kidney disease, and all-cause mortality in individuals with type 2 diabetes: a prospective cohort study |
| title_fullStr | Insulin resistance, diabetic kidney disease, and all-cause mortality in individuals with type 2 diabetes: a prospective cohort study |
| title_full_unstemmed | Insulin resistance, diabetic kidney disease, and all-cause mortality in individuals with type 2 diabetes: a prospective cohort study |
| title_short | Insulin resistance, diabetic kidney disease, and all-cause mortality in individuals with type 2 diabetes: a prospective cohort study |
| title_sort | insulin resistance diabetic kidney disease and all cause mortality in individuals with type 2 diabetes a prospective cohort study |
| topic | Type 2 diabetes Estimated glucose disposal rate All-cause mortality Diabetic kidney disease Albuminuria Glomerular filtration rate |
| url | https://doi.org/10.1186/s12916-021-01936-3 |
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