Insulin Resistance, Hypertension and Microalbuminuria in Patients With Type 2 (Non-Insulin-Dependent) Diabetes Mellitus

Diabetologia. 1993 Jul;36(7):642-7. doi: 10.1007/BF00404074.

Abstract

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 diabetic patients and in 19 healthy control subjects. Twenty-five diabetic patients had hypertension and 19 had microalbuminuria. Hypertension per se was associated with a 27% reduction in the rate of total glucose metabolism and a 40% reduction in the rate of non-oxidative glucose metabolism compared with normotensive Type 2 diabetic patients (both p < 0.001). Glucose metabolism was also impaired in normotensive microalbuminuric patients compared with normotensive normoalbuminuric patients (29.4 +/- 2.2 vs 40.5 +/- 2.8 mumol.kg lean body mass-1.min-1; p = 0.012), 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 hypertension (p = 0.008) and the combination of hypertension and microalbuminuria (p = 0.030) were significantly associated with the rate of glucose metabolism. The highest triglyceride and lowest HDL cholesterol concentrations were observed in Type 2 diabetic patients with both hypertension and microalbuminuria. Of note, glucose metabolism was indistinguishable from that in control subjects in Type 2 diabetic patients without hypertension and microalbuminuria (40.5 +/- 2.8 vs 44.4 +/- 2.8 mumol.kg lean body mass-1.min-1). We conclude that insulin resistance in Type 2 diabetes is predominantly associated with either hypertension or microalbuminuria or with both.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Albuminuria*
  • Blood Glucose / analysis
  • Blood Pressure
  • Body Mass Index
  • C-Peptide / blood
  • Cholesterol / blood
  • Cholesterol, HDL / blood
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / physiopathology*
  • Diabetes Mellitus, Type 2 / urine
  • Diabetic Angiopathies / blood
  • Diabetic Angiopathies / physiopathology*
  • Diabetic Angiopathies / urine
  • Fasting
  • Fatty Acids, Nonesterified / blood
  • Glucagon
  • Glucose / metabolism
  • Glycated Hemoglobin A / analysis
  • Humans
  • Hypertension / blood
  • Hypertension / physiopathology*
  • Hypertension / urine
  • Insulin / blood
  • Insulin Resistance*
  • Lipids / blood*
  • Liver / metabolism
  • Middle Aged
  • Reference Values
  • Triglycerides / blood

Substances

  • Blood Glucose
  • C-Peptide
  • Cholesterol, HDL
  • Fatty Acids, Nonesterified
  • Glycated Hemoglobin A
  • Insulin
  • Lipids
  • Triglycerides
  • Glucagon
  • Cholesterol
  • Glucose