Insulin resistance precedes the appearance of albuminuria in non-diabetic subjects: 6 years follow up study

Microalbuminuria is a marker of increased risk of cardiovascular mortality in type 1 and type 2 diabetes, and in non-diabetic subjects. Little is know n about the association between prospective changes of microalbuminuria and the risk factors of atherosclerosis, or gene polymorphism in non-diabetic subjects. We conducted a 6-year prospective study of risk factors for progr ession of albuminuria in non-diabetic subjects. The participants were 116 n on-diabetic subjects who consecutively underwent medical examinations for J apanese-Americans living in Hawaii. In the baseline examination in 1992, no rmoalbuminuria was found in all subjects. After 6 years, 101 subjects remai ned normoalbuminuria (non-progressors). 15 subjects changing fr om normoalb uminuria to microalbuminuria or proteinuria and were defined as progressors . In progressors, compared with non-progressors, the fasting insulin level and HOMA-R were significantly higher at 3 years follow-up, and the systolic and diastolic pressure and Sigma insulin level were significantly higher a t 6 years follow-up. Insulin resistance appeared earlier than the appearanc e of hypertension and albuminuria. In progressors, there was no significant correlation with angiotensin-converting enzyme (ACE) genotype or angiotens inogen (AGT) genotype compared with non-progressors. Therefore, the appeara nce of insulin resistance should be regarded as a remarkable mediator of al buminuria. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.