INSULIN-RESISTANCE IN INSULIN-DEPENDENT DIABETIC-PATIENTS WITH MICROALBUMINURIA

In insulin-dependent diabetes, microalbuminuria increases the risk of cardiovascular and renal disease. By means of a euglycaemic hyperinsul inaemic clamp method, we measured total-body glucose utilisation rate and studied the interaction of this measure of insulin sensitivity wit h known risk factors for cardiovascular disease in 14 diabetic patient s with microalbuminuria and 14 with normal albumin excretion (median a lbumin excretion rate [AER] 56.2 [range 39.2-80.6] vs 8.8 [7.4-10.7] m ug per min). The two groups were of similar age, duration of diabetes, and body-mass index. Total-body glucose disposal rate was significant ly lower in the patients with microalbuminuria than in those without ( mean 7.86 [SD 1.40] vs 9.04 [0.90] mg/kg per min; p<0.05). There were also significant differences between the groups in the daily insulin d ose needed for equivalent glucose control (0.76 [0.20] vs 0.65 [0.10] U/kg, p<0.05), mean systolic blood pressure over 24 h ambulatory monit oring (134 [7] vs 127 [7] mm Hg; p<0.05), and various plasma lipid con centrations, contributing to a more atherogenic profile in the microal buminuric group. Total-body glucose disposal rate was inversely correl ated with body-mass index and log10 AER. The insulin sensitivity of th e microalbuminuric group remained impaired after adjustment for blood pressure and body-mass index. Impaired insulin sensitivity is a featur e of insulin-dependent diabetic patients with microalbuminuria, which adds, with other factors, to the increased risks of renal and cardiova scular disease in these patients.