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      Validation of Simple Indices to Assess Insulin Sensitivity and Pancreatic Beta-Cell Function in Patients with Renal Dysfunction

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          Background/Aims: Insulin resistance and hyperinsulinemia has been reported in patients with chronic renal failure. However, usefulness and validation of new indices for assessment to insulin sensitivity and pancreatic beta-cell function were unknown. Methods: We evaluated insulin sensitivity and pancreatic beta-cell function in 61 normal glucose tolerant (NGT) and 60 diabetic (DM) subjects; both groups were subdivided as normal renal function (NRF; C<sub>cr</sub> ≥ 70 ml/min) and impaired renal function (IRF; C<sub>cr</sub> <70 ml/min). Insulin sensitivity were assessed by homeostasis model assessment of insulin resistance (HOMA-IR) and plasma glucose and insulin concentrations obtained at fasting or during a 75-gram oral glucose tolerance test (insulin sensitivity index), and pancreatic beta-cell function were assessed by insulinogenic index, first-phase insulin secretion index, and area under the response curve for plasma insulin (insulin-AUC<sub>0–180</sub>). Results: There was no evidence of insulin resistance in NGT-IRF group. No differences in both insulinogenic index and first-phase insulin secretion index between NGT-NRF and NGT-IRF, but these were significantly decreased in DM-NRF and DM-IRF. There were inverse linear correlations between the insulin sensitivity index and insulin-AUC<sub>0–180</sub> in patients with NGT and DM, respectively. These correlations were similarly robust in NRF subjects and IRF subjects. Conclusions: New indices for assessment of insulin sensitivity and pancreatic beta-cell function calculated from plasma glucose and plasma insulin concentrations after OGTT are applicable for clinical use even in patients with renal dysfunction.

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          Insulin resistance and hyperinsulinaemia in mild to moderate progressive chronic renal failure and its association with aerobic work capacity.

          Tissue sensitivity to insulin and aerobic work capacity was measured in patients with mild to moderate progressive chronic renal failure. Twenty-nine non-diabetic patients with a glomerular filtration rate of 25 ml.min-1.1.73 m-2 (11-43) (median, range) and 15 sex, age, and body mass index matched control subjects with normal renal function were studied. Fasting blood glucose was comparable and in the non-diabetic range in the two groups as was the oral glucose tolerance test. Patients demonstrated hyperinsulinaemia both during fasting (p < 0.01) and during the test (p < 0.02). The tissue sensitivity to insulin, expressed by the amount of glucose infused during the last 60 min of a 120-min hyperinsulinaemia euglycaemic clamp (M-value) and the M/I ratio, was significantly lower in the patients than in the control subjects (M-value 404 +/- 118 vs 494 +/- 85 mg glucose/kg body weight, p < 0.02) (M/I ratio 1.77 +/- 0.71 vs 2.57 +/- 0.70 (mg/(kgBW.min) per pmol/l.100, p < 0.001). The maximal aerobic work capacity was significantly lower in the patients than in the control subjects (24 +/- 8 vs 32 +/- 11 ml O2/(kg body weight.min), p < 0.02) and positively correlated to the M-value and the M/I ratio in both groups. In conclusion, not only patients with end-stage chronic renal failure but also those with mild to moderate progressive chronic renal failure are insulin resistant and hyperinsulinaemic. The tissue sensitivity to insulin is correlated to the maximal aerobic work capacity suggesting that these patients might benefit from physical training programmes.

            Author and article information

            S. Karger AG
            September 2002
            26 September 2002
            : 92
            : 3
            : 713-715
            First Department of Internal Medicine, Nara Medical University, Nara, Japan
            64072 Nephron 2002;92:713–715
            © 2002 S. Karger AG, Basel

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            Figures: 1, Tables: 1, References: 10, Pages: 3
            Self URI (application/pdf): https://www.karger.com/Article/Pdf/64072
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