Amy K Mottl1, Jasmin Divers2, Dana Dabelea3, David M Maahs4, Lawrence Dolan5, David Pettitt6, Santica Marcovina7, Giuseppina Imperatore8, Catherine Pihoker9, Michael Mauer10,11, Elizabeth J Mayer-Davis12,13. 1. UNC Division of Nephrology and Hypertension, University of North Carolina School of Medicine, Chapel Hill, NC, USA. amy_mottl@med.unc.edu. 2. Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA. 3. Department of Epidemiology, School of Public Health, University of Colorado Denver, Aurora, CO, USA. 4. Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, CO, USA. 5. Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA. 6. , Santa Barbara, CA, USA. 7. Northwest Lipid Metabolism and Diabetes Research Laboratories, Department of Medicine, University of Washington, Seattle, WA, USA. 8. Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA. 9. Department of Pediatrics, University of Washington, Seattle, WA, USA. 10. Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA. 11. Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA. 12. Department of Nutrition, University of North Carolina School of Public Health, Chapel Hill, NC, USA. 13. Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
Abstract
BACKGROUND: Insulin resistance is associated with microalbuminuria among youth with diabetes mellitus. We sought to determine the dose-response effect of insulin sensitivity (IS) on the magnitude of albuminuria and whether there is a threshold below which urine albumin excretion increases. METHODS: These analyses included participants from the SEARCH for Diabetes in Youth Study with incident diabetes who completed a baseline study visit (n = 2988). We estimated IS using a validated equation incorporating waist circumference, HbA1C, and fasting serum triglycerides. Multivariate regression analyses were performed to assess the effect of IS on urine albumin creatinine ratio (UACR), stratified by diabetes type. The IS threshold was then determined using segmented regressions within each diabetes type and incorporated into the multivariate model. RESULTS: There was an association between IS and UACR in type 2 diabetes only (beta = -0.39; p < 0.001). There was strong statistical evidence for a threshold effect of IS score on UACR in the group of youth with type 2 (beta = 0.40; p < 0.001) but not type 1 diabetes (p = 0.3). CONCLUSIONS: In cross-sectional analyses, there is a negative association between IS and UACR in youth with type 2 but not type 1 diabetes, and this association likely includes a threshold effect of IS on UACR.
BACKGROUND: Insulin resistance is associated with microalbuminuria among youth with diabetes mellitus. We sought to determine the dose-response effect of insulin sensitivity (IS) on the magnitude of albuminuria and whether there is a threshold below which urine albumin excretion increases. METHODS: These analyses included participants from the SEARCH for Diabetes in Youth Study with incident diabetes who completed a baseline study visit (n = 2988). We estimated IS using a validated equation incorporating waist circumference, HbA1C, and fasting serum triglycerides. Multivariate regression analyses were performed to assess the effect of IS on urine albumin creatinine ratio (UACR), stratified by diabetes type. The IS threshold was then determined using segmented regressions within each diabetes type and incorporated into the multivariate model. RESULTS: There was an association between IS and UACR in type 2 diabetes only (beta = -0.39; p < 0.001). There was strong statistical evidence for a threshold effect of IS score on UACR in the group of youth with type 2 (beta = 0.40; p < 0.001) but not type 1 diabetes (p = 0.3). CONCLUSIONS: In cross-sectional analyses, there is a negative association between IS and UACR in youth with type 2 but not type 1 diabetes, and this association likely includes a threshold effect of IS on UACR.
Entities:
Keywords:
Insulin resistance; Metabolic syndrome; Microalbuminuria; Nephropathy; Urine:albumin creatinine ratio
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