Abstract | BACKGROUND AND OBJECTIVES:
Insulin resistance is a complication of advanced CKD. Insulin resistance is less well characterized in earlier stages of CKD. The response of the pancreatic β cell, effects on glucose tolerance, and risk of diabetes are not clear. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: RESULTS: Mean age was 72.5 years (range, 65-98 years). Mean eGFR was 72.2 (SD 17.1) ml/min per 1.73 m(2). After adjustment, each 10 ml/min per 1.73 m(2) lower eGFR was associated with a 2.2% higher fasting insulin concentration (95% confidence interval [CI], 1.4%, 2.9%; P<0.001) and a 1.1% lower insulin sensitivity index (95% CI, 0.03%, 2.2%; P=0.04). Surprisingly, eGFR was associated with an augmented β cell function index (P<0.001), lower 2-hour glucose concentration (P=0.002), and decreased risk of glucose intolerance (P=0.006). Over a median 12 years' follow-up, 437 participants (9.3%) developed diabetes. eGFR was not associated with the risk of incident diabetes. CONCLUSIONS: Among older adults, lower eGFR was associated with insulin resistance. However, with lower eGFR, β cell function was appropriately augmented and risks of impaired glucose tolerance and incident diabetes were not increased.
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Authors | Hien Pham, Cassianne Robinson-Cohen, Mary L Biggs, Joachim H Ix, Kenneth J Mukamal, Linda F Fried, Bryan Kestenbaum, David S Siscovick, Ian H de Boer |
Journal | Clinical journal of the American Society of Nephrology : CJASN
(Clin J Am Soc Nephrol)
Vol. 7
Issue 4
Pg. 588-94
(Apr 2012)
ISSN: 1555-905X [Electronic] United States |
PMID | 22383749
(Publication Type: Journal Article, Multicenter Study, Research Support, N.I.H., Extramural)
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Chemical References |
- Biomarkers
- Hypoglycemic Agents
- Insulin
- Creatinine
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Topics |
- Age Factors
- Aged
- Aged, 80 and over
- Biomarkers
(blood)
- Chronic Disease
- Creatinine
(blood)
- Diabetes Mellitus
(blood, diagnosis, drug therapy, epidemiology, physiopathology)
- Female
- Glomerular Filtration Rate
- Glucose Tolerance Test
- Health Surveys
- Humans
- Hypoglycemic Agents
(therapeutic use)
- Incidence
- Insulin
(blood)
- Insulin Resistance
- Insulin-Secreting Cells
(drug effects, metabolism)
- Kidney
(physiopathology)
- Kidney Diseases
(blood, diagnosis, epidemiology, physiopathology)
- Linear Models
- Male
- Proportional Hazards Models
- Risk Assessment
- Risk Factors
- United States
(epidemiology)
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