The Effect Of Insulin Resistance On Renal Function In Patients With Early Type 2 Diabetic Nephropathy

Objective: To investigate the effect of insulin resistance on renal function and its risk factors in patients with early type 2 diabetic nephropathy.Methods: 199 individuals with T2 DM in total admitted to the Endocrinology Department Qinghai University Affiliated Hospital from January 2018 to May 2018 were retrospectively collected.Part 1: all patients were divided into IR group and non IR group according to the existence of insulin resistance(IR).The dividing line of IR was HOMA-IR index 2.5,that is,non IR group(HOMA-IR < 2.5)and IR group(HOMAIR ≥ 2.5),The general data(age,gender,waist circumference,BMI,diabetes years),renal function and blood lipid were collected between the two groups,and the relationship between IR and renal function and the risk factors of IR were statistically analyzed;Part 2: according to the microalbuminuria,the individuals with microalbuminuria ≥ 30 mg / L were regarded as albuminuria group and the individuals with microalbuminuria < 30 mg / L were regarded as normal group.The clinical,biochemical indexes and HOMA-IR index were compared between the two groups,and the risk factors of proteinuria were analyzed.Results:Part one(1)There were significant distinctions in SUA and 24-hour urine protein between the two groups.SUA in IR group(305.95 ± 76.63)was remarkably higher than that in non IR group(281.89 ± 78.67),the distinction was statistically significant(P = 0.030);24-hour urine protein in non IR Group [0.04(0.02,0.07)] was remarkably lower than that in IR Group [0.05(0.03,0.09)],The difference was statistically significant(P = 0.012);(2)There were conspicuous distinctions in BMI,triglyceride,HDL-C,ACEI / ARB medication history between the two groups.IR group was remarkably higher(P < 0.05).There was no significant distinction in gender,age,waist circumference,e GFR and blood pressure.(P>0.05);(3)regression analysis showed that the decrease of HDL-C was a risk factor for IR;(4)HOMA-IR show positive relationship with SUA and 24-hour urine protein,and negatively relationship with HDL-C(P < 0.05);Part two:(1)There were significant differences in waist circumference and ACEI /ARB medication history between albuminuria group and normal group(P < 0.05),but there were no significant differences in gender,age,HOMA-IR and blood lipid index between those two groups(P > 0.05).(2)Correlation analysis showed that waist circumference was positively correlated with microalbuminuria(P < 0.05).Conclusions:1.T2 DM patients with IR are more likely to have renal damage,mainly manifested as increased urine protein and SUA;2.HOMA-IR shows positive relationship with SUA and 24-hour urine protein,and negatively relationship with HDL-C.3.The decrease of HDL-C will increase the risk of IR;4.Waist circumference is positively correlated with microalbuminuria.