03276nas a2200541 4500008004100000022001400041245008700055210006900142260001300211300001100224490000600235520180000241653001602041653000902057653002202066653001502088653002002103653001502123653002202138653001102160653003102171653002702202653001902229653001102248653002402259653001402283653001202297653002302309653002802332653001102360653002002371653001802391653000902409653003202418653002002450653001702470653001802487100001502505700003002520700001902550700001902569700002402588700002002612700002202632700002402654700002002678856003602698 2012 eng d a1555-905X00aChronic kidney disease, insulin resistance, and incident diabetes in older adults.0 aChronic kidney disease insulin resistance and incident diabetes c2012 Apr a588-940 v73 a
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: The Cardiovascular Health Study included 4680 adults without baseline diabetes. The Chronic Kidney Disease Epidemiology Collaboration creatinine equation was used to obtain the estimated GFR (eGFR). Insulin resistance was evaluated as fasting insulin concentration. The insulin sensitivity index, β cell function, and glucose tolerance were assessed by oral glucose tolerance testing. Incident diabetes was defined as fasting glucose ≥126 mg/dl, nonfasting glucose ≥200 mg/dl, or use of glucose-lowering medications.
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.
10aAge Factors10aAged10aAged, 80 and over10aBiomarkers10aChronic Disease10aCreatinine10aDiabetes Mellitus10aFemale10aGlomerular Filtration Rate10aGlucose Tolerance Test10aHealth Surveys10aHumans10aHypoglycemic Agents10aIncidence10aInsulin10aInsulin Resistance10aInsulin-Secreting Cells10aKidney10aKidney Diseases10aLinear Models10aMale10aProportional Hazards Models10aRisk Assessment10aRisk Factors10aUnited States1 aPham, Hien1 aRobinson-Cohen, Cassianne1 aBiggs, Mary, L1 aIx, Joachim, H1 aMukamal, Kenneth, J1 aFried, Linda, F1 aKestenbaum, Bryan1 aSiscovick, David, S1 ade Boer, Ian, H uhttps://chs-nhlbi.org/node/1368