ภาวะการดื้อต่ออินสูลินกับระยะของการดำเนินโรคไตจากเบาหวานชนิดที่ 2

บทคัดย่อ

Background: Diabetic nephropathy (DN) is one of the most serious complications of diabetes mellitus due to highmorbidity and mortality. In type 2 diabetic patients resistance to the action of insulin has been documented butonly a few studies have evaluated the risk of diabetic subjects with insulin resistance for developing DN. In thisstudy we assessed insulin resistance in different stage of DN. Methods: This is a cross-sectional study of 230 patients  with type 2 diabetes. Patients were divided into three groups according to levels of urinary albumin-tocreatinine ratio (ACR) and urine protein: normoalbuminuria (ACR <30mg/g) incipient nephropathy (ACR 30-299mg/g)  and overt nephropathy (ACR ³ 300 mg/g and/or persistent proteinuria). Insulin resistance was evaluated byhomeostasis  model assessment (HOMA-IR). Results: There was a trend to ward a higher HOMA-IR in overt andincipient nephropathy,but failed to reach statistic significance. Compared with the first quartile of HOMA-IR the fourth quartile of HOMA-IR was associated with a significantly higher risk of overt nephropathy: crude odds ratio(OR) 4.14; 95% CI 1.69-10.11 and adjusted OR 5.79; 95% CI 1.72-19.52. In contrast HOMA-IR quartiles were not significantly associated with the development of incipient nephropathy. Known duration of diabetes (adjusted OR 1.09; 95%CI 1.05-1.14) history of hypertension (adjusted OR 2.83; 95% CI 1.24-6.47) diabetic retinopathy (adjusted OR 6.48; 95%CI 3.01-13.96) and urinary albumin-to-creatinine ratio (adjusted OR 1.29; 95% CI 1.14-1.47) were also associated withdevelopment of diabetic nephropathy. Conclusion: In addition to known risk factors of DN high insulin resistance was independently associated with development of overt nephropathy in type 2 diabetes,but not incipientnephropathy.