Elevation of the renal threshold for glucose is associated with insulin resistance and higher glycated hemoglobin levels.

Abstract

AIMS/INTRODUCTION:

The renal threshold for glucose (RTg) corresponds to a blood glucose level of ~180 mg/dL; however, in hospitals, patients are often encountered who are hyperglycemic, but urine glucose test strip-negative, who remain negative for urine glucose even at blood glucose concentrations >180 mg/dL, implying a high RTg value. In this study, we aimed to identify factors determining high RTg in Japanese patients with type 2 diabetes mellitus.

MATERIALS AND METHODS:

We estimated RTg (eRTg) using urinalysis data from 67 type 2 diabetes mellitus patients for whom the glucose infusion rate (GIR) was determined by hyperinsulinemic-euglycemic clamp. After allocating patients to two groups according to their baseline eRTg (<180 mg/dL or ≥180 mg/dL), we identified the factors affecting eRTg using simple and multiple linear regression analyses.

RESULTS:

GIR, glycated hemoglobin (HbA1c), insulin use and dyslipidemia differed significantly between the groups. In simple regression analysis, GIR, HbA1c, body muscle-to-fat ratio and insulin use were significantly correlated with eRTg; and in multiple regression analysis, GIR and HbA1c remained independent negative and positive determinants, respectively, with the contribution of GIR being substantial. In receiver operating characteristic curve analysis, when GIR <5.7 was used as the insulin resistance threshold, the cut-off value of eRTg was 189 mg/dL (P = 0.0001). Furthermore, in receiver operating characteristic analysis using eRTg ≥189 mg/dL, the cut-off value for HbA1c was 8.0% (P = 0.0006).

CONCLUSIONS:

High eRTg is associated with low GIR and high HbA1c, with GIR making a substantial contribution.

• Authors: Kunio Hieshima, Seigo Sugiyama, Akira Yoshida, Noboru Kurinami, Tomoko Suzuki, Hiroko Ijima, Fumio Miyamoto, Keizo Kajiwara, Katsunori Jinnouchi, Tomio Jinnouchi, Hideaki Jinnouchi
• Journal: Journal of diabetes investigation (J Diabetes Investig) Vol. 11 Issue 3 Pg. 617-625 (May 2020) ISSN: 2040-1124 [Electronic] Japan
• PMID: 31770476 (Publication Type: Journal Article)
• Copyright: © 2019 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd.

Chemical References

• Blood Glucose
• Glycated Hemoglobin A
• hemoglobin A1c protein, human
• Glucose

Topics

• Aged
• Asian People
• Blood Glucose
• Diabetes Mellitus, Type 2 (complications, diagnosis, metabolism)
• Female
• Glucose (metabolism)
• Glucose Clamp Technique
• Glycated Hemoglobin (analysis)
• Glycosuria (complications, urine)
• Humans
• Hyperglycemia (complications, urine)
• Insulin Resistance
• Japan
• Male
• Middle Aged
• ROC Curve
• Retrospective Studies