INSULIN-RESISTANCE, HYPERTENSION AND MICROALBUMINURIA IN PATIENTS WITH TYPE-2 (NON-INSULIN-DEPENDENT) DIABETES-MELLITUS

We examined the impact of hypertension and microalbuminuria on insulin sensitivity in patients with Type 2 (non-insulin-dependent) diabetes mellitus using the euglycaemic insulin clamp technique in 52 Type 2 di abetic patients and in 19 healthy control subjects. Twenty-five diabet ic patients had hypertension and 19 had microalbuminuria. Hypertension per se was associated with a 27 % reduction in the rate of total gluc ose metabolism and a 40 % reduction in the rate of non-oxidative gluco se metabolism compared with normotensive Type 2 diabetic patients (bot h p < 0.001). Glucose metabolism was also impaired in normotensive mic roalbuminuric patients compared with normotensive normoalbuminuric pat ients (29.4 +/- 2.2 vs 40.5 +/- 2.8 mumol . kg lean body mass-1 . min- 1; p = 0.01 2), primarily due to a reduction in non-oxidative glucose metabolism (12.7 +/- 2.9 vs 21.1 +/- 2.6 mumol . kg lean body mass-1 . min-1; p = 0.06). In a factorial ANOVA design, however, only hyperten sion (p = 0.008) and the combination of hypertension and microalbuminu ria (p = 0.030) were significantly associated with the rate of glucose metabolism. The highest triglyceride and lowest HDL cholesterol conce ntrations were observed in Type 2 diabetic patients with both hyperten sion and microalbuminuria. Of note, glucose metabolism was indistingui shable from that in control subjects in Type 2 diabetic patients witho ut hypertension and microalbuminuria (40.5 +/- 2.8 vs 44.4 +/- 2.8 mum ol . kg lean body mass-1 . min-1). We conclude that insulin resistance in Type 2 diabetes is predominantly associated with either hypertensi on or microalbuminuria or with both.