Insulin Sensitivity Predicts Kidney Health in Adolescent Diabetes

MedicalResearch.com Interview with:
Petter Bjornstad, M.D.
Children’s Hospital Colorado
University of Colorado Denver
Aurora, CO 80045

Medical Research: What are the main findings of the study?

Dr. Bjornstad: Type 2 diabetes is the most common cause of end-stage renal disease in the Western world. It is therefore of paramount importance to develop a better understanding of the determinants of diabetic nephropathy risk and progression, to improve outcome in adolescents with type 2 diabetes.

We report high rates of microalbuminuria and renal hyperfiltration in adolescents with type 2 diabetes, which forecast early renal morbidity and mortality. In our observational study, insulin sensitivity measured by hyperinsulinemic-euglycemic clamp studies, rather than adiposity, blood pressure, lipid and glycemic control was associated with markers of renal health (albumin-to-creatinine ratio and estimated glomerular filtration rate).

Medical Research: Were any of the findings unexpected?

Dr. Bjornstad: An unexpected finding was that insulin sensitivity appeared to be a stronger determinant of renal health in adolescents with type 2 diabetes than the more conventional risk factors including blood pressure, glucose and lipids.

Medical Research: What should clinicians and patients take away from your report?

Dr. Bjornstad: It is difficult to imply causality with observational studies, but our findings suggest an important association between insulin sensitivity and renal health in adolescents with type 2 diabetes. Although there is a need for confirmatory studies, these observations emphasize the importance of optimizing insulin sensitivity in adolescents with type 2 diabetes to improve renal outcomes.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Bjornstad:  There is a need for longitudinal studies to investigate the relationships between insulin sensitivity, incident diabetic nephropathy and progression of diabetic nephropathy over time. Furthermore, the translation of insulin sensitivity as a therapeutic target into clinical practice requires investment in adequately powered clinical trials will capture important renal long-term outcomes.

Citation:

Insulin Sensitivity Is an Important Determinant of Renal Health in Adolescents With Type 2 Diabetes

Petter Bjornstad, David M. Maahs, David Z. Cherney, Melanie Cree-Green, Amy West, Laura Pyle, and Kristen J. Nadeau

Diabetes Care published ahead of print July 28, 2014, doi:10.2337/dc14-1331 1935-5548

 

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