1
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Mutter S, Parente EB, Januszewski AS, Simonsen JR, Harjutsalo V, Groop PH, Jenkins AJ, Thorn LM. Insulin sensitivity estimates and their longitudinal association with coronary artery disease in type 1 diabetes. Does it matter? Cardiovasc Diabetol 2024; 23:152. [PMID: 38702680 PMCID: PMC11069169 DOI: 10.1186/s12933-024-02234-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 04/11/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Insulin resistance and chronic kidney disease are both associated with increased coronary artery disease risk. Many formulae estimating glucose disposal rate in type 1 diabetes infer insulin sensitivity from clinical data. We compare associations and performance relative to traditional risk factors and kidney disease severity between three formulae estimating the glucose disposal rate and coronary artery disease in people with type 1 diabetes. METHODS The baseline glucose disposal rate was estimated by three (Williams, Duca, and Januszewski) formulae in FinnDiane Study participants and related to subsequent incidence of coronary artery disease, by baseline kidney status. RESULTS In 3517 adults with type 1 diabetes, during median (IQR) 19.3 (14.6, 21.4) years, 539 (15.3%) experienced a coronary artery disease event, with higher rates with worsening baseline kidney status. Correlations between the three formulae estimating the glucose disposal rate were weak, but the lowest quartile of each formula was associated with higher incidence of coronary artery disease. Importantly, only the glucose disposal rate estimation by Williams showed a linear association with coronary artery disease risk in all analyses. Of the three formulae, Williams was the strongest predictor of coronary artery disease. Only age and diabetes duration were stronger predictors. The strength of associations between estimated glucose disposal rate and CAD incidence varied by formula and kidney status. CONCLUSIONS In type 1 diabetes, estimated glucose disposal rates are associated with subsequent coronary artery disease, modulated by kidney disease severity. Future research is merited regarding the clinical usefulness of estimating the glucose disposal rate as a coronary artery disease risk factor and potential therapeutic target.
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Affiliation(s)
- Stefan Mutter
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Haartmaninkatu 8, 00290, Helsinki, Finland
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, 00290, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Haartmaninkatu 8, 00290, Helsinki, Finland
| | - Erika B Parente
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Haartmaninkatu 8, 00290, Helsinki, Finland
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, 00290, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Haartmaninkatu 8, 00290, Helsinki, Finland
| | - Andrzej S Januszewski
- Sydney Pharmacy School, University of Sydney, A15, Science Rd, Camperdown, NSW, 2050, Australia
- NHMRC Clinical Trials Centre, University of Sydney, K25, Parramatta Rd, Camperdown, NSW, 2050, Australia
| | - Johan R Simonsen
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Haartmaninkatu 8, 00290, Helsinki, Finland
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, 00290, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Haartmaninkatu 8, 00290, Helsinki, Finland
| | - Valma Harjutsalo
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Haartmaninkatu 8, 00290, Helsinki, Finland
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, 00290, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Haartmaninkatu 8, 00290, Helsinki, Finland
| | - Per-Henrik Groop
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Haartmaninkatu 8, 00290, Helsinki, Finland.
- Department of Nephrology, University of Helsinki and Helsinki University Hospital, Haartmaninkatu 4, 00290, Helsinki, Finland.
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Haartmaninkatu 8, 00290, Helsinki, Finland.
- Department of Diabetes, Central Clinical School, Monash University, The Alfred Centre, 99 Commercial Rd, Melbourne, VIC, 3004, Australia.
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, VIC, 3004, Australia.
| | - Alicia J Jenkins
- NHMRC Clinical Trials Centre, University of Sydney, K25, Parramatta Rd, Camperdown, NSW, 2050, Australia
- Baker Heart and Diabetes Institute, 75 Commercial Rd, Melbourne, VIC, 3004, Australia
| | - Lena M Thorn
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, Biomedicum Helsinki, Haartmaninkatu 8, 00290, Helsinki, Finland
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Haartmaninkatu 8, 00290, Helsinki, Finland
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Biomedicum 2, Tukholmankatu 8, 00290, Helsinki, Finland
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2
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Cheng Y, Chen Y, Li K, Liu S, Pang C, Gao L, Xie J, Wenjing LV, Yu H, Deng B. How inflammation dictates diabetic peripheral neuropathy: An enlightening review. CNS Neurosci Ther 2024; 30:e14477. [PMID: 37795833 PMCID: PMC11017439 DOI: 10.1111/cns.14477] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/28/2023] [Accepted: 09/08/2023] [Indexed: 10/06/2023] Open
Abstract
BACKGROUND Diabetic peripheral neuropathy (DPN) constitutes a debilitating complication associated with diabetes. Although, the past decade has seen rapid developments in understanding the complex etiology of DPN, there are no approved therapies that can halt the development of DPN, or target the damaged nerve. Therefore, clarifying the pathogenesis of DPN and finding effective treatment are the crucial issues for the clinical management of DPN. AIMS This review is aiming to summary the current knowledge on the pathogenesis of DPN, especially the mechanism and application of inflammatory response. METHODS We systematically summarized the latest studies on the pathogenesis and therapeutic strategies of diabetic neuropathy in PubMed. RESULTS In this seminal review, the underappreciated role of immune activation in the progression of DPN is scrutinized. Novel insights into the inflammatory regulatory mechanisms of DPN have been unearthed, illuminating potential therapeutic strategies of notable clinical significance. Additionally, a nuanced examination of DPN's complex etiology, including aberrations in glycemic control and insulin signaling pathways, is presented. Crucially, an emphasis has been placed on translating these novel understandings into tangible clinical interventions to ameliorate patient outcomes. CONCLUSIONS This review is distinguished by synthesizing cutting-edge mechanisms linking inflammation to DPN and identifying innovative, inflammation-targeted therapeutic approaches.
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Affiliation(s)
- Yifan Cheng
- Center for Rehabilitation Medicine, Department of Neurology, Zhejiang Provincial People's HospitalAffiliated People's Hospital, Hangzhou Medical CollegeHangzhouChina
| | - Yinuo Chen
- Department of NeurologyFirst Affiliated Hospital of Wenzhou Medical UniversityWenzhouZhejiang ProvinceChina
- First School of Clinical MedicineWenzhou Medical UniversityWenzhouZhejiang ProvinceChina
| | - Kezheng Li
- Department of NeurologyFirst Affiliated Hospital of Wenzhou Medical UniversityWenzhouZhejiang ProvinceChina
- First School of Clinical MedicineWenzhou Medical UniversityWenzhouZhejiang ProvinceChina
| | - Shuwei Liu
- First School of Clinical MedicineWenzhou Medical UniversityWenzhouZhejiang ProvinceChina
| | - Chunyang Pang
- Department of NeurologyFirst Affiliated Hospital of Wenzhou Medical UniversityWenzhouZhejiang ProvinceChina
| | - Lingfei Gao
- Department of NeurologyFirst Affiliated Hospital of Wenzhou Medical UniversityWenzhouZhejiang ProvinceChina
| | - Jiali Xie
- Department of Neurology, Shanghai East HospitalTongji UniversityShanghaiP.R. China
| | - L. V. Wenjing
- Department of GeriatricsThe Affiliated Hospital of Qingdao UniversityQingdaoShandong ProvinceChina
| | - Huan Yu
- Department of PediatricsSecond Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical UniversityWenzhouChina
| | - Binbin Deng
- Department of NeurologyFirst Affiliated Hospital of Wenzhou Medical UniversityWenzhouZhejiang ProvinceChina
- First School of Clinical MedicineWenzhou Medical UniversityWenzhouZhejiang ProvinceChina
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3
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Suarez R, Villarreal C, Nahuelpán Y, Jara C, Oyarzún C, Alarcón S, Díaz-Encarnación MM, Guillén-Gómez E, Quezada C, San Martín R. Defective insulin-stimulated equilibrative nucleoside transporter-2 activity and altered subcellular transporter distribution drive the loss of adenosine homeostasis in diabetic kidney disease progression. Biochim Biophys Acta Mol Basis Dis 2024; 1870:166890. [PMID: 37734469 DOI: 10.1016/j.bbadis.2023.166890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 08/23/2023] [Accepted: 09/16/2023] [Indexed: 09/23/2023]
Abstract
AIM Progression of diabetic nephropathy (DN) is linked to the dysregulated increase of adenosine and altered signaling properties. A major contribution to the maintenance of physiological extracellular adenosine levels relies on cellular uptake activity through plasma membrane nucleoside transporters. Because kidney cells are responsive to insulin, this study aims to determine how DN affects insulin regulation of the equilibrative nucleoside transporter-2 (ENT2). METHODS Human Podocytes and rat glomeruli were used to study ENT2 regulation. The effects of diabetes and insulin on ENT2 mediated transport activity were determined measuring the fraction of total adenosine uptake in sodium-free medium which is inhibitable by hypoxanthine. Alterations in ENT2 subcellular distribution were assessed in the kidney of people affected with DN and diabetic rats. The consequences of impaired ENT2 activity on the kidney were evaluated using dipyridamole in an animal model. RESULTS Insulin upregulates ENT2 uptake activity by increasing the Vmax, thus counteracting decreased adenosine uptake due to high d-glucose and achieving extracellular adenosine homeostasis. Insulin promoted ENT2 translocation to the plasma membrane dependent on PI3-kinase/Akt signaling and actin cytoskeleton integrity. However, in diabetic rats, the insulin-mediated induction of ENT2 activity was lost. Additionally, reduced Akt activation in response to insulin correlated with decreased ENT2 distribution at the plasma membrane. Kidney tissues from diabetic rats and human DN biopsies showed ENT2 redistribution to an intracellular pattern, evidencing dysfunctional adenosine uptake. Through ENT inhibition, we evidenced increased proteinuria and induced alpha-smooth muscle actin as a result of profibrotic activation of cells in the kidney. CONCLUSION Deficient insulin regulation of ENT2 activity contributes to chronically high adenosine levels and glomerular alterations that underline diabetic kidney disease progression.
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Affiliation(s)
- Raibel Suarez
- Institute of Biochemistry and Microbiology, Science Faculty, Universidad Austral de Chile, Valdivia, Chile
| | - Carolina Villarreal
- Institute of Biochemistry and Microbiology, Science Faculty, Universidad Austral de Chile, Valdivia, Chile
| | - Yessica Nahuelpán
- Institute of Biochemistry and Microbiology, Science Faculty, Universidad Austral de Chile, Valdivia, Chile
| | - Claudia Jara
- Institute of Biochemistry and Microbiology, Science Faculty, Universidad Austral de Chile, Valdivia, Chile
| | - Carlos Oyarzún
- Institute of Biochemistry and Microbiology, Science Faculty, Universidad Austral de Chile, Valdivia, Chile
| | - Sebastián Alarcón
- Institute of Biochemistry and Microbiology, Science Faculty, Universidad Austral de Chile, Valdivia, Chile
| | - Montserrat M Díaz-Encarnación
- Nephrology Service Fundació Puigvert, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Elena Guillén-Gómez
- Nephrology Service Fundació Puigvert, Biomedical Research Institute Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Claudia Quezada
- Institute of Biochemistry and Microbiology, Science Faculty, Universidad Austral de Chile, Valdivia, Chile; Millennium Institute on Immunology and Immunotherapy, Valdivia, Chile
| | - Rody San Martín
- Institute of Biochemistry and Microbiology, Science Faculty, Universidad Austral de Chile, Valdivia, Chile.
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Khadilkar A, Oza C, Mondkar SA. Insulin Resistance in Adolescents and Youth With Type 1 Diabetes: A Review of Problems and Solutions. Clin Med Insights Endocrinol Diabetes 2023; 16:11795514231206730. [PMID: 37901890 PMCID: PMC10604500 DOI: 10.1177/11795514231206730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 09/21/2023] [Indexed: 10/31/2023] Open
Abstract
Though insulin resistance (IR) was previously considered a feature of only type 2 Diabetes (T2DM), its development in type 1 Diabetes (T1DM) is not an uncommon occurrence, the causes of which are multifactorial (gender, pubertal status, diabetes duration, ethnicity, genetics, adiposity, glycemic control, chronic inflammation). Despite improvements in glucose, blood pressure and lipid profile, vascular complications (coronary artery disease and nephropathy) continue to remain common causes of morbidity and mortality in T1DM. Aggressive glycemic control reduces but does not eliminate the risk of IR. IR accelerates the development of micro and macrovascular complications, many of which can be potentially reversed if diagnosed and managed early. Lack of endogenous insulin production makes estimation of insulin sensitivity in T1DM difficult. As hyperinsulinemic-euglycemic clamp studies are cumbersome and invasive, the use of prediction equations for calculating estimated insulin sensitivity may prove to be useful. Along with intensive insulin therapy, dietary modifications and increasing physical activity, the role of Metformin in managing IR in T1DM is becoming increasingly popular. Metformin adjunct therapy in T1DM has been shown to improve insulin sensitivity, glycemic control, lipid profile, body composition, vascular smooth muscle function, thereby reducing the risk of vascular complications, as well as reversal of early vascular dysfunction. However, further studies to assess long-term efficacy and safety of Metformin use in adolescents and youth with T1DM are needed. This review aims at revisiting the pathophysiology of IR in T1DM and techniques of identifying those at risk so as to put into action various strategies for management of the same.
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Affiliation(s)
- Anuradha Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
- Interdisciplinary School of Health Sciences, Savitribai Phule University, Pune, Maharashtra, India
| | - Chirantap Oza
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
| | - Shruti A Mondkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, India
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5
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Karamanakos G, Kokkinos A, Dalamaga M, Liatis S. Highlighting the Role of Obesity and Insulin Resistance in Type 1 Diabetes and Its Associated Cardiometabolic Complications. Curr Obes Rep 2022; 11:180-202. [PMID: 35931912 DOI: 10.1007/s13679-022-00477-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW This narrative review appraises research data on the potentially harmful effect of obesity and insulin resistance (IR) co-existence with type 1 diabetes mellitus (T1DM)-related cardiovascular (CVD) complications and evaluates possible therapeutic options. RECENT FINDINGS Obesity and IR have increasingly been emerging in patients with T1DM. Genetic, epigenetic factors, and subcutaneous insulin administration are implicated in the pathogenesis of this coexistence. Accumulating evidence implies that the concomitant presence of obesity and IR is an independent predictor of worse CVD outcomes. The prevalence of obesity and IR has increased in patients with T1DM. This increase can be partly attributed to general population trends but, additionally, to iatrogenic weight gain caused by insulin treatment. This association might be the missing link explaining the excess CVD burden observed in patients with T1DM despite optimal glycemic control. Data on newer agents for type 2 diabetes mellitus (T2DM) treatment are unraveling novel ways to challenge this aggravating coexistence.
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Affiliation(s)
- Georgios Karamanakos
- First Department of Propaedeutic Internal Medicine, Medical School, National Kapodistrian University of Athens, Laiko General Hospital, 17 Agiou Thoma Street, Athens, 11527, Greece.
| | - Alexander Kokkinos
- First Department of Propaedeutic Internal Medicine, Medical School, National Kapodistrian University of Athens, Laiko General Hospital, 17 Agiou Thoma Street, Athens, 11527, Greece
| | - Maria Dalamaga
- Department of Biological Chemistry, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Stavros Liatis
- First Department of Propaedeutic Internal Medicine, Medical School, National Kapodistrian University of Athens, Laiko General Hospital, 17 Agiou Thoma Street, Athens, 11527, Greece
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6
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Adeva-Andany MM, Fernández-Fernández C, Funcasta-Calderón R, Ameneiros-Rodríguez E, Adeva-Contreras L, Castro-Quintela E. Insulin Resistance is Associated with Clinical Manifestations of Diabetic Kidney Disease (Glomerular Hyperfiltration, Albuminuria, and Kidney Function Decline). Curr Diabetes Rev 2022; 18:e171121197998. [PMID: 34789129 DOI: 10.2174/1573399818666211117122604] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/13/2021] [Accepted: 09/15/2021] [Indexed: 11/22/2022]
Abstract
Clinical features of diabetic kidney disease include glomerular hyperfiltration, albuminuria, and kidney function decline towards End-Stage Kidney Disease (ESKD). There are presently neither specific markers of kidney involvement in patients with diabetes nor strong predictors of rapid progression to ESKD. Serum-creatinine-based equations used to estimate glomerular filtration rate are notoriously unreliable in patients with diabetes. Early kidney function decline, reduced glomerular filtration rate, and proteinuria contribute to identifying diabetic patients at higher risk for rapid kidney function decline. Unlike proteinuria, the elevation of urinary albumin excretion in the range of microalbuminuria is frequently transient in patients with diabetes and does not always predict progression towards ESKD. Although the rate of progression of kidney function decline is usually accelerated in the presence of proteinuria, histological lesions of diabetes and ESKD may occur with normal urinary albumin excretion. No substantial reduction in the rate of ESKD associated with diabetes has been observed during the last decades despite intensified glycemic control and reno-protective strategies, indicating that existing therapies do not target underlying pathogenic mechanisms of kidney function decline. Very long-term effects of sodium-glucose transporters- 2 inhibitors and glucagon-like peptide-1 analogs remain to be defined. In patients with diabetes, glucagon secretion is typically elevated and induces insulin resistance. Insulin resistance is consistently and strongly associated with clinical manifestations of diabetic kidney disease, suggesting that reduced insulin sensitivity participates in the pathogenesis of the disease and may represent a therapeutic objective. Amelioration of insulin sensitivity in patients with diabetes is associated with cardioprotective and kidney-protective effects.
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Affiliation(s)
- María M Adeva-Andany
- Nephrology Division, Hospital General Juan Cardona, c/ Pardo Bazán s/n, 15406 Ferrol, Spain
| | | | | | | | | | - Elvira Castro-Quintela
- Nephrology Division, Hospital General Juan Cardona, c/ Pardo Bazán s/n, 15406 Ferrol, Spain
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7
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Ricciardi CA, Gnudi L. Kidney disease in diabetes: From mechanisms to clinical presentation and treatment strategies. Metabolism 2021; 124:154890. [PMID: 34560098 DOI: 10.1016/j.metabol.2021.154890] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/08/2021] [Accepted: 09/16/2021] [Indexed: 12/24/2022]
Abstract
Metabolic and haemodynamic perturbations and their interaction drive the development of diabetic kidney disease (DKD) and its progression towards end stage renal disease (ESRD). Increased mitochondrial oxidative stress has been proposed as the central mechanism in the pathophysiology of DKD, but other mechanisms have been implicated. In parallel to increased oxidative stress, inflammation, cell apoptosis and tissue fibrosis drive the relentless progressive loss of kidney function affecting both the glomerular filtration barrier and the renal tubulointerstitium. Alteration of glomerular capillary autoregulation is at the basis of glomerular hypertension, an important pathogenetic mechanism for DKD. Clinical presentation of DKD can vary. Its classical presentation, often seen in patients with type 1 diabetes (T1DM), features hyperfiltration and albuminuria followed by progressive fall in renal function. Patients can often also present with atypical features characterised by progressive reduction in renal function without albuminuria, others in conjunction with non-diabetes related pathologies making the diagnosis, at times, challenging. Metabolic, lipid and blood pressure control with lifestyle interventions are crucial in reducing the progressive renal function decline seen in DKD. The prevention and management of DKD (and parallel cardiovascular disease) is a huge global challenge and therapies that target haemodynamic perturbations, such as inhibitors of the renin-angiotensin-aldosterone system (RAAS) and SGLT2 inhibitors, have been most successful.
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Affiliation(s)
| | - Luigi Gnudi
- School of Cardiovascular Medicine & Science, King's College London, London, UK.
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8
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Zhang JH, Yang HZ, Su H, Song J, Bai Y, Deng L, Feng CP, Guo HX, Wang Y, Gao X, Gu Y, Zhen Z, Lu Y. Berberine and Ginsenoside Rb1 Ameliorate Depression-Like Behavior in Diabetic Rats. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2021; 49:1195-1213. [PMID: 34049474 DOI: 10.1142/s0192415x21500579] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Rhizoma coptidis (Huang-lian) and Asian ginseng have been widely used in the treatment of diabetes and other concurrent diseases with apparent effects. This study investigated the effects of the active ingredients of R. coptidis and ginseng, berberine and ginsenoside Rb1, on depression-like behavior in a rat diabetes model. The animal model was established via a high-fat diet and intraperitoneal injection of streptozotocin, while the animal's depression-like behavior was induced via chronic unpredictable mild stress. These experimental rats were divided into four groups: control, depression-like behavior (DLB), metformin plus fluoxetine hydrochloride (M+FH), and berberine plus ginsenoside Rb1 (B+GRb1) groups. Glucose metabolism and insulin resistance were evaluated by oral glucose test and glucose clamp study. Depression-like behavior was evaluated via behavioral analyses, including forced swim, sucrose preference, elevated plus maze, and open-field tests. HE and Nissl staining, plasma cortisol expression of adrenocorticotropic hormone, and brain-derived neurotrophic factor (BDNF) levels were assayed to explore the mechanisms of action. Compared with the control, rats in the DLB group had a significant increase in the levels of blood glucose and depression-like behavior. The B+GRb1 group significantly improved glucose metabolism and insulin resistance, reduced depression-like behavior, downregulated levels of plasma cortisol and adrenocorticotropic hormone under stress, and upregulated BDNF protein expression compared to the DLB rats. HE and Nissl staining data revealed that B+GRb1 protected neurons from pathological and morphological changes. Thus, berberine and ginsenoside Rb1 not only improved glucose metabolism in diabetic rats but also ameliorated their depression-like behavior under chronic unpredictable stress. Mechanistically, studied data with plasma hormonal levels and brain neuronal pathological/morphological changes supported the observed effects. The combination of berberine and ginsenoside Rb1 may have a clinical value in the management of diabetic patients with depression.
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Affiliation(s)
| | - Hui-Zeng Yang
- Tianjin Anding Hospital, Tianjian 300022, P. R. China
| | - Hao Su
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, P. R. China
| | - Jun Song
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, P. R. China
| | - Yu Bai
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, P. R. China
| | - Lan Deng
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, P. R. China
| | - Chun-Peng Feng
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, P. R. China
| | - Hong-Xia Guo
- Langfang Normal University, Langfang 065000, P. R. China
| | - Yi Wang
- Tianjin Anding Hospital, Tianjian 300022, P. R. China
| | - Xin Gao
- Tianjin Anding Hospital, Tianjian 300022, P. R. China
| | - Yan Gu
- Tianjin Third Central Hospital, Tianjian 300170, P. R. China
| | - Zhong Zhen
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, P. R. China
| | - Yao Lu
- Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, P. R. China
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9
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Wagner R, Heni M, Tabák AG, Machann J, Schick F, Randrianarisoa E, Hrabě de Angelis M, Birkenfeld AL, Stefan N, Peter A, Häring HU, Fritsche A. Pathophysiology-based subphenotyping of individuals at elevated risk for type 2 diabetes. Nat Med 2021; 27:49-57. [PMID: 33398163 DOI: 10.1038/s41591-020-1116-9] [Citation(s) in RCA: 177] [Impact Index Per Article: 59.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 10/01/2020] [Indexed: 12/13/2022]
Abstract
The state of intermediate hyperglycemia is indicative of elevated risk of developing type 2 diabetes1. However, the current definition of prediabetes neither reflects subphenotypes of pathophysiology of type 2 diabetes nor is predictive of future metabolic trajectories. We used partitioning on variables derived from oral glucose tolerance tests, MRI-measured body fat distribution, liver fat content and genetic risk in a cohort of extensively phenotyped individuals who are at increased risk for type 2 diabetes2,3 to identify six distinct clusters of subphenotypes. Three of the identified subphenotypes have increased glycemia (clusters 3, 5 and 6), but only individuals in clusters 5 and 3 have imminent diabetes risks. By contrast, those in cluster 6 have moderate risk of type 2 diabetes, but an increased risk of kidney disease and all-cause mortality. Findings were replicated in an independent cohort using simple anthropomorphic and glycemic constructs4. This proof-of-concept study demonstrates that pathophysiological heterogeneity exists before diagnosis of type 2 diabetes and highlights a group of individuals who have an increased risk of complications without rapid progression to overt type 2 diabetes.
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Affiliation(s)
- Robert Wagner
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany.
- German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany.
- Department of Internal Medicine, Division of Diabetology, Endocrinology and Nephrology, Eberhard-Karls University Tübingen, Tübingen, Germany.
| | - Martin Heni
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
- Department of Internal Medicine, Division of Diabetology, Endocrinology and Nephrology, Eberhard-Karls University Tübingen, Tübingen, Germany
- Institute for Clinical Chemistry and Pathobiochemistry, Department for Diagnostic Laboratory Medicine, University Hospital of Tübingen, Tübingen, Germany
| | - Adam G Tabák
- Department of Epidemiology and Public Health, University College London, London, UK
- Department of Internal Medicine and Oncology, Semmelweis University Faculty of Medicine, Budapest, Hungary
- Department of Public Health, Semmelweis University Faculty of Medicine, Budapest, Hungary
| | - Jürgen Machann
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
- University Department of Radiology, Section on Experimental Radiology, Eberhard-Karls University Tübingen, Tübingen, Germany
| | - Fritz Schick
- German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
- University Department of Radiology, Section on Experimental Radiology, Eberhard-Karls University Tübingen, Tübingen, Germany
| | - Elko Randrianarisoa
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
| | - Martin Hrabě de Angelis
- German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
- Institute of Experimental Genetics and German Mouse Clinic, Helmholtz Zentrum München, Neuherberg, Germany
- Chair of Experimental Genetics, TUM School of Life Sciences (SoLS), Technische Universität München, Freising, Germany
| | - Andreas L Birkenfeld
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
- Department of Internal Medicine, Division of Diabetology, Endocrinology and Nephrology, Eberhard-Karls University Tübingen, Tübingen, Germany
| | - Norbert Stefan
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
- Department of Internal Medicine, Division of Diabetology, Endocrinology and Nephrology, Eberhard-Karls University Tübingen, Tübingen, Germany
- Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | - Andreas Peter
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
- Institute for Clinical Chemistry and Pathobiochemistry, Department for Diagnostic Laboratory Medicine, University Hospital of Tübingen, Tübingen, Germany
| | - Hans-Ulrich Häring
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
| | - Andreas Fritsche
- Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich at the University of Tübingen, Tübingen, Germany
- German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
- Department of Internal Medicine, Division of Diabetology, Endocrinology and Nephrology, Eberhard-Karls University Tübingen, Tübingen, Germany
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10
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Pina AF, Borges DO, Meneses MJ, Branco P, Birne R, Vilasi A, Macedo MP. Insulin: Trigger and Target of Renal Functions. Front Cell Dev Biol 2020; 8:519. [PMID: 32850773 PMCID: PMC7403206 DOI: 10.3389/fcell.2020.00519] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 06/02/2020] [Indexed: 12/16/2022] Open
Abstract
Kidney function in metabolism is often underestimated. Although the word “clearance” is associated to “degradation”, at nephron level, proper balance between what is truly degraded and what is redirected to de novo utilization is crucial for the maintenance of electrolytic and acid–basic balance and energy conservation. Insulin is probably one of the best examples of how diverse and heterogeneous kidney response can be. Kidney has a primary role in the degradation of insulin released in the bloodstream, but it is also incredibly susceptible to insulin action throughout the nephron. Fluctuations in insulin levels during fast and fed state add another layer of complexity in the understanding of kidney fine-tuning. This review aims at revisiting renal insulin actions and clearance and to address the association of kidney dysmetabolism with hyperinsulinemia and insulin resistance, both highly prevalent phenomena in modern society.
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Affiliation(s)
- Ana F Pina
- Centro de Estudos de Doenças Crónicas, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.,ProRegeM Ph.D. Programme, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.,Department of Medical Sciences, University of Aveiro, Aveiro, Portugal
| | - Diego O Borges
- Centro de Estudos de Doenças Crónicas, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.,Molecular Biosciences Ph.D. Programme, Instituto de Tecnologia Química e Biológica António Xavier, Universidade Nova de Lisboa, Oeiras, Portugal
| | - Maria João Meneses
- Centro de Estudos de Doenças Crónicas, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.,ProRegeM Ph.D. Programme, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Patrícia Branco
- Department of Nephrology, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.,Portuguese Diabetes Association - Education and Research Center (APDP-ERC), Lisbon, Portugal
| | - Rita Birne
- Department of Nephrology, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.,Portuguese Diabetes Association - Education and Research Center (APDP-ERC), Lisbon, Portugal
| | - Antonio Vilasi
- Institute of Clinical Physiology - National Research Council, Reggio Calabria Unit1, Reggio Calabria, Italy
| | - Maria Paula Macedo
- Centro de Estudos de Doenças Crónicas, NOVA Medical School/Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.,Department of Medical Sciences, University of Aveiro, Aveiro, Portugal.,Portuguese Diabetes Association - Education and Research Center (APDP-ERC), Lisbon, Portugal
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11
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Lehtonen S. SHIPping out diabetes-Metformin, an old friend among new SHIP2 inhibitors. Acta Physiol (Oxf) 2020; 228:e13349. [PMID: 31342643 PMCID: PMC6916339 DOI: 10.1111/apha.13349] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 07/15/2019] [Accepted: 07/19/2019] [Indexed: 02/06/2023]
Abstract
SHIP2 (Src homology 2 domain‐containing inositol 5′‐phosphatase 2) belongs to the family of 5′‐phosphatases. It regulates the phosphoinositide 3‐kinase (PI3K)‐mediated insulin signalling cascade by dephosphorylating the 5′‐position of PtdIns(3,4,5)P3 to generate PtdIns(3,4)P2, suppressing the activity of the pathway. SHIP2 mouse models and genetic studies in human propose that increased expression or activity of SHIP2 contributes to the pathogenesis of the metabolic syndrome, hypertension and type 2 diabetes. This has raised great interest to identify SHIP2 inhibitors that could be used to design new treatments for metabolic diseases. This review summarizes the central mechanisms associated with the development of diabetic kidney disease, including the role of insulin resistance, and then moves on to describe the function of SHIP2 as a regulator of metabolism in mouse models. Finally, the identification of SHIP2 inhibitors and their effects on metabolic processes in vitro and in vivo are outlined. One of the newly identified SHIP2 inhibitors is metformin, the first‐line medication prescribed to patients with type 2 diabetes, further boosting the attraction of SHIP2 as a treatment target to ameliorate metabolic disorders.
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Affiliation(s)
- Sanna Lehtonen
- Department of Pathology and Research Program for Clinical and Molecular Metabolism, Faculty of Medicine University of Helsinki Helsinki Finland
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12
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Khawandanah J. Double or hybrid diabetes: A systematic review on disease prevalence, characteristics and risk factors. Nutr Diabetes 2019; 9:33. [PMID: 31685799 PMCID: PMC6828774 DOI: 10.1038/s41387-019-0101-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 10/09/2019] [Accepted: 10/11/2019] [Indexed: 12/13/2022] Open
Abstract
Diabetes mellitus is a worldwide epidemic affecting the health of millions of people. While type 1 diabetes (T1D) is caused by autoimmune destruction of the insulin-producing beta cells of the pancreas, type 2 diabetes (T2D) results from a combination of insulin resistance and beta cell insulin secretory defect. Clear definition and diagnosis of these two types of diabetes has been increasing more and more difficult, leading to the inclusion of a new category, namely double or hybrid diabetes (DD) that demonstrates symptoms of both T1D and T2D via the accelerator hypothesis. In this review, we discuss the worldwide prevalence of DD, its main physiological characteristics, including beta-cell autoimmunity, insulin resistance, and cardiovascular disease, the main risk factors of developing DD, mainly genetics, obesity and lifestyle choices, as well as potential treatments, such as insulin titration, metformin and behavioural modifications. Increasing awareness of DD among the general population and primary care practitioners is necessary for successfully treating this complex, hybrid disease in the future.
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Affiliation(s)
- Jomana Khawandanah
- Clinical Nutrition Department, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah, Saudi Arabia.
- Section for Nutrition Research, Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, United Kingdom.
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13
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Mitrofanova A, Sosa MA, Fornoni A. Lipid mediators of insulin signaling in diabetic kidney disease. Am J Physiol Renal Physiol 2019; 317:F1241-F1252. [PMID: 31545927 PMCID: PMC6879940 DOI: 10.1152/ajprenal.00379.2019] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/19/2019] [Accepted: 09/19/2019] [Indexed: 12/30/2022] Open
Abstract
Diabetic kidney disease (DKD) affects ∼40% of patients with diabetes and is associated with high mortality rates. Among different cellular targets in DKD, podocytes, highly specialized epithelial cells of the glomerular filtration barrier, are injured in the early stages of DKD. Both clinical and experimental data support the role of preserved insulin signaling as a major contributor to podocyte function and survival. However, little is known about the key modulators of podocyte insulin signaling. This review summarizes the novel knowledge that intracellular lipids such as cholesterol and sphingolipids are major determinants of podocyte insulin signaling. In particular, the implications of these lipids on DKD development, progression, and treatment will be addressed.
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Affiliation(s)
- Alla Mitrofanova
- Katz Family Division of Nephrology and Hypertension, Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida
- Peggy and Harold Katz Family Drug Discovery Center, Miller School of Medicine, University of Miami, Miami, Florida
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, Florida
| | - Marie Anne Sosa
- Katz Family Division of Nephrology and Hypertension, Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida
| | - Alessia Fornoni
- Katz Family Division of Nephrology and Hypertension, Department of Medicine, Miller School of Medicine, University of Miami, Miami, Florida
- Peggy and Harold Katz Family Drug Discovery Center, Miller School of Medicine, University of Miami, Miami, Florida
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14
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Xu M, Jiang F, Li B, Zhang Z. 1α,25(OH) 2 D 3 alleviates high glucose-induced lipid accumulation in rat renal tubular epithelial cells by inhibiting SREBPs. J Cell Biochem 2019; 120:15211-15221. [PMID: 31020705 DOI: 10.1002/jcb.28786] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 01/10/2019] [Accepted: 01/14/2019] [Indexed: 01/29/2023]
Abstract
Lipid accumulation is a vital event in the progression of diabetic nephropathy. 1,25-Dihydroxyvitamin D3 (1α,25(OH)2 D3 ) is considered to have a protective effect on diabetic nephropathy. However, it remains unclear whether 1α,25(OH)2 D3 can inhibit lipid accumulation, and the potential mechanisms responsible for lipid metabolism are incompletely understood. In this study, we evaluated the effects of 1α,25(OH)2 D3 on lipid metabolism in high glucose-exposed rat renal tubular epithelial NRK-52E cells. Results indicated that high glucose-enhanced lipid accumulation in NRK-52E cells and 1α,25(OH)2 D3 can remarkably decrease high glucose-induced lipid accumulation. Western blot showed that 1α,25(OH)2 D3 alleviated high glucose-induced upregulation of sterol regulatory element-binding protein-1c (SREBP-1c) and SREBP2, along with their established target genes fatty acid synthase (FASN) and hydroxymethylglutaryl CoA reductases (HMGCR). Overall, these findings suggest that 1α,25(OH)2 D3 downregulated the expressions of SREBPs to inhibit high glucose-induced lipid accumulation, which provides new sights into the protective effects of 1α,25(OH)2 D3 on diabetic nephropathy.
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Affiliation(s)
- Miao Xu
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Disease, Department of Labor Hygiene and Environmental Health, School of Public Health, Soochow University, Suzhou, P R China
| | - Fei Jiang
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Disease, Department of Labor Hygiene and Environmental Health, School of Public Health, Soochow University, Suzhou, P R China
| | - Bingyan Li
- Department of Nutrition and Food Hygiene, School of Public Health, Soochow University, Suzhou, P R China
| | - Zengli Zhang
- Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Disease, Department of Labor Hygiene and Environmental Health, School of Public Health, Soochow University, Suzhou, P R China
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15
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Probing insulin sensitivity in diabetic kidney disease: is there a stronger role for functional imaging? Clin Sci (Lond) 2018; 132:1085-1095. [PMID: 29871909 DOI: 10.1042/cs20171490] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 04/25/2018] [Accepted: 05/09/2018] [Indexed: 11/17/2022]
Abstract
Clinical and experimental evidence support a cause-effect relationship between altered insulin signaling and development of kidney disease of metabolic and non-metabolic origin. However, the current criteria to measure and/or estimate the insulin resistance (IR) are available as research tool but are very difficult to implement in the clinical practice. Therefore, a better understanding of the key players contributing to IR may lead to the development of new non-invasive tools to assess organ-specific insulin sensitivity (IS). We will therefore first introduce the concept that IR and kidney disease may be causally linked as suggested by clinical and experimental studies. We will then, expand on the potential mechanisms leading to altered renal insulin signaling. After reviewing the limitation of currently available strategies to determine IR, this review article will focus on imaging techniques that could be utilized to determine renal IR and that could be tested to predict kidney disease development and progression.
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16
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Wasik AA, Lehtonen S. Glucose Transporters in Diabetic Kidney Disease-Friends or Foes? Front Endocrinol (Lausanne) 2018; 9:155. [PMID: 29686650 PMCID: PMC5900043 DOI: 10.3389/fendo.2018.00155] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 03/22/2018] [Indexed: 12/16/2022] Open
Abstract
Diabetic kidney disease (DKD) is a major microvascular complication of diabetes and a common cause of end-stage renal disease worldwide. DKD manifests as an increased urinary protein excretion (albuminuria). Multiple studies have shown that insulin resistance correlates with the development of albuminuria in non-diabetic and diabetic patients. There is also accumulating evidence that glomerular epithelial cells or podocytes are insulin sensitive and that insulin signaling in podocytes is essential for maintaining normal kidney function. At the cellular level, the mechanisms leading to the development of insulin resistance include mutations in the insulin receptor gene, impairments in the phosphoinositide 3-kinase (PI3K)/AKT signaling pathway, or perturbations in the trafficking of glucose transporters (GLUTs), which mediate the uptake of glucose into cells. Podocytes express several GLUTs, including GLUT1, GLUT2, GLUT3, GLUT4, and GLUT8. Of these, the most studied ones are GLUT1 and GLUT4, both shown to be insulin responsive in podocytes. In the basal state, GLUT4 is preferentially located in perinuclear and cytosolic vesicular structures and to a lesser extent at the plasma membrane. After insulin stimulation, GLUT4 is sorted into GLUT4-containing vesicles (GCVs) that translocate to the plasma membrane. GCV trafficking consists of several steps, including approaching of the GCVs to the plasma membrane, tethering, and docking, after which the lipid bilayers of the GCVs and the plasma membrane fuse, delivering GLUT4 to the cell surface for glucose uptake into the cell. Studies have revealed novel molecular regulators of the GLUT trafficking in podocytes and unraveled unexpected roles for GLUT1 and GLUT4 in the development of DKD, summarized in this review. These findings pave the way for better understanding of the mechanistic pathways associated with the development and progression of DKD and aid in the development of new treatments for this devastating disease.
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17
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Microalbuminuria as a simple predictor of incident diabetes over 8 years in the Korean Genome and Epidemiology Study (KoGES). Sci Rep 2017; 7:15445. [PMID: 29133894 PMCID: PMC5684338 DOI: 10.1038/s41598-017-15827-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 10/26/2017] [Indexed: 01/06/2023] Open
Abstract
Microalbuminuria (MAU) is a common subclinical disease and related with cardiovascular outcome both in diabetic and non-diabetic patients. However, there is rare data about the effect of MAU on the development of diabetes. Thus, we aimed to investigate whether MAU is associated with the development of incident diabetes. A total of 3385 subjects without diabetes (1503 men and 1882 women; mean age, 53 years) who participated in the Ansung–Ansan cohort study from 2001–2002 (baseline) to 2011–2012 (fifth follow-up visit) were followed for a mean of 8 years. The prevalence of MAU at baseline was 10.8% (365 patients), and the incidence of newly developed diabetes during the follow-up period was 15.3% (56 patients) in subjects with MAU. The hazard ratio (HR) for development of diabetes was 1.43 (95% confidence interval (CI) 1.07–1.91, p-value 0.016), independent of traditional risk factors for diabetes including pre-diabetes, age, obesity, and family history. The impact of MAU on diabetes was also significant in the non-pre-diabetic population (HR 2.08, 95% CI 1.07–4.03, p-value 0.031). In conclusion, our results show that incident MAU is associated with future development of diabetes and could be an early marker for diabetes, even in the non-prediabetic population.
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18
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Alarcón S, Garrido W, Vega G, Cappelli C, Suárez R, Oyarzún C, Quezada C, San Martín R. Deficient Insulin-mediated Upregulation of the Equilibrative Nucleoside Transporter 2 Contributes to Chronically Increased Adenosine in Diabetic Glomerulopathy. Sci Rep 2017; 7:9439. [PMID: 28842605 PMCID: PMC5572683 DOI: 10.1038/s41598-017-09783-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 07/28/2017] [Indexed: 12/21/2022] Open
Abstract
Deficient insulin signaling is a key event mediating diabetic glomerulopathy. Additionally, diabetic kidney disease has been related to increased levels of adenosine. Therefore, we tested a link between insulin deficiency and dysregulated activity of the equilibrative nucleoside transporters (ENTs) responsible for controlling extracellular levels of adenosine. In ex vivo glomeruli, high D-glucose decreased nucleoside uptake mediated by ENT1 and ENT2 transporters, resulting in augmented extracellular levels of adenosine. This condition was reversed by exposure to insulin. Particularly, insulin through insulin receptor/PI3K pathway markedly upregulated ENT2 uptake activity to restores the extracellular basal level of adenosine. Using primary cultured rat podocytes as a cellular model, we found insulin was able to increase ENT2 maximal velocity of transport. Also, PI3K activity was necessary to maintain ENT2 protein levels in the long term. In glomeruli of streptozotocin-induced diabetic rats, insulin deficiency leads to decreased activity of ENT2 and chronically increased extracellular levels of adenosine. Treatment of diabetic rats with adenosine deaminase attenuated both the glomerular loss of nephrin and proteinuria. In conclusion, we evidenced ENT2 as a target of insulin signaling and sensitive to dysregulation in diabetes, leading to chronically increased extracellular adenosine levels and thereby setting conditions conducive to kidney injury.
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Affiliation(s)
- Sebastián Alarcón
- Institute of Biochemistry and Microbiology, Science Faculty, Universidad Austral de Chile, Valdivia, Chile
| | - Wallys Garrido
- Institute of Biochemistry and Microbiology, Science Faculty, Universidad Austral de Chile, Valdivia, Chile
| | - Génesis Vega
- Institute of Biochemistry and Microbiology, Science Faculty, Universidad Austral de Chile, Valdivia, Chile
| | - Claudio Cappelli
- Institute of Biochemistry and Microbiology, Science Faculty, Universidad Austral de Chile, Valdivia, Chile
| | - Raibel Suárez
- Institute of Biochemistry and Microbiology, Science Faculty, Universidad Austral de Chile, Valdivia, Chile
| | - Carlos Oyarzún
- Institute of Biochemistry and Microbiology, Science Faculty, Universidad Austral de Chile, Valdivia, Chile
| | - Claudia Quezada
- Institute of Biochemistry and Microbiology, Science Faculty, Universidad Austral de Chile, Valdivia, Chile
| | - Rody San Martín
- Institute of Biochemistry and Microbiology, Science Faculty, Universidad Austral de Chile, Valdivia, Chile.
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19
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Cleland S. Double diabetes: the cardiovascular implications of combining type 1 with type 2 diabetes. PRACTICAL DIABETES 2017. [DOI: 10.1002/pdi.2120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Steve Cleland
- Queen Elizabeth University Hospital and Gartnavel General Hospital; Glasgow UK
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20
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Orchard TJ, Costacou T. Cardiovascular complications of type 1 diabetes: update on the renal link. Acta Diabetol 2017; 54:325-334. [PMID: 27995339 DOI: 10.1007/s00592-016-0949-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 11/25/2016] [Indexed: 12/22/2022]
Abstract
AIMS Despite recent findings of increased life expectancy among individuals with type 1 diabetes, mortality remains greatly increased compared to the general population. As this is largely the result of cardiovascular and renal complications, we aimed to review recent findings surrounding these diseases in type 1 diabetes. METHODS We reviewed published findings concerning the cardiovascular complications of type 1 diabetes, with a particular focus on links with renal disease. RESULTS The cardiovascular and renal complications of type 1 diabetes share many features including insulin resistance, oxidative damage, and genetic associations with the Haptoglobin genotype, and both are strongly affected by glycemic control. CONCLUSIONS Although current knowledge on predictors of type 1 diabetes cardiovascular and renal complications has increased, further investigation is required to understand the mechanisms leading to cardio-renal complications in this population.
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Affiliation(s)
- Trevor J Orchard
- Department of Epidemiology, Diabetes and Lipid Research Clinic, University of Pittsburgh, 3512 Fifth Avenue, Pittsburgh, PA, 15213, USA
| | - Tina Costacou
- Department of Epidemiology, Diabetes and Lipid Research Clinic, University of Pittsburgh, 3512 Fifth Avenue, Pittsburgh, PA, 15213, USA.
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21
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Wasik AA, Dumont V, Tienari J, Nyman TA, Fogarty CL, Forsblom C, Lehto M, Lehtonen E, Groop PH, Lehtonen S. Septin 7 reduces nonmuscle myosin IIA activity in the SNAP23 complex and hinders GLUT4 storage vesicle docking and fusion. Exp Cell Res 2016; 350:336-348. [PMID: 28011197 PMCID: PMC5243148 DOI: 10.1016/j.yexcr.2016.12.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 12/10/2016] [Accepted: 12/17/2016] [Indexed: 12/28/2022]
Abstract
Glomerular epithelial cells, podocytes, are insulin responsive and can develop insulin resistance. Here, we demonstrate that the small GTPase septin 7 forms a complex with nonmuscle myosin heavy chain IIA (NMHC-IIA; encoded by MYH9), a component of the nonmuscle myosin IIA (NM-IIA) hexameric complex. We observed that knockdown of NMHC-IIA decreases insulin-stimulated glucose uptake into podocytes. Both septin 7 and NM-IIA associate with SNAP23, a SNARE protein involved in GLUT4 storage vesicle (GSV) docking and fusion with the plasma membrane. We observed that insulin decreases the level of septin 7 and increases the activity of NM-IIA in the SNAP23 complex, as visualized by increased phosphorylation of myosin regulatory light chain. Also knockdown of septin 7 increases the activity of NM-IIA in the complex. The activity of NM-IIA is increased in diabetic rat glomeruli and cultured human podocytes exposed to macroalbuminuric sera from patients with type 1 diabetes. Collectively, the data suggest that the activity of NM-IIA in the SNAP23 complex plays a key role in insulin-stimulated glucose uptake into podocytes. Furthermore, we observed that septin 7 reduces the activity of NM-IIA in the SNAP23 complex and thereby hinders GSV docking and fusion with the plasma membrane. Septin 7, nonmuscle myosin heavy chain IIA (NMHC-IIA) and SNAP23 form a complex. Knockdown of septin 7 increases NM-IIA activity in the SNAP23 complex. Insulin decreases septin 7 level and increases NM-IIA activity in the SNAP23 complex. Septin 7 hinders GSV docking/fusion by reducing NM-IIA activity in the SNAP23 complex.
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Affiliation(s)
- Anita A Wasik
- Department of Pathology, University of Helsinki, 00014 Helsinki, Finland
| | - Vincent Dumont
- Department of Pathology, University of Helsinki, 00014 Helsinki, Finland
| | - Jukka Tienari
- Department of Pathology, University of Helsinki and Helsinki University Hospital, 00290 Helsinki, 05850 Hyvinkää, Finland
| | - Tuula A Nyman
- Institute of Biotechnology, University of Helsinki, 00014 Helsinki, Finland
| | - Christopher L Fogarty
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, 00290 Helsinki, Finland; Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, 000290 Helsinki, Finland; Diabetes&Obesity Research Program, Research Program´s Unit, 00014 University of Helsinki, Finland
| | - Carol Forsblom
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, 00290 Helsinki, Finland; Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, 000290 Helsinki, Finland; Diabetes&Obesity Research Program, Research Program´s Unit, 00014 University of Helsinki, Finland
| | - Markku Lehto
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, 00290 Helsinki, Finland; Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, 000290 Helsinki, Finland; Diabetes&Obesity Research Program, Research Program´s Unit, 00014 University of Helsinki, Finland
| | - Eero Lehtonen
- Department of Pathology, University of Helsinki, 00014 Helsinki, Finland; Laboratory Animal Centre, University of Helsinki, 00014 Helsinki, Finland
| | - Per-Henrik Groop
- Folkhälsan Institute of Genetics, Folkhälsan Research Center, 00290 Helsinki, Finland; Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, 000290 Helsinki, Finland; Diabetes&Obesity Research Program, Research Program´s Unit, 00014 University of Helsinki, Finland; Baker IDI Heart & Diabetes Institute, 3004 Melbourne, Australia
| | - Sanna Lehtonen
- Department of Pathology, University of Helsinki, 00014 Helsinki, Finland.
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22
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Lizotte F, Denhez B, Guay A, Gévry N, Côté AM, Geraldes P. Persistent Insulin Resistance in Podocytes Caused by Epigenetic Changes of SHP-1 in Diabetes. Diabetes 2016; 65:3705-3717. [PMID: 27585521 DOI: 10.2337/db16-0254] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 08/26/2016] [Indexed: 11/13/2022]
Abstract
Poor glycemic control profoundly affects protein expression and the cell signaling action that contributes to glycemic memory and irreversible progression of diabetic nephropathy (DN). We demonstrate that SHP-1 is elevated in podocytes of diabetic mice, causing insulin unresponsiveness and DN. Thus, sustained SHP-1 expression caused by hyperglycemia despite systemic glucose normalization could contribute to the glycemic memory effect in DN. Microalbuminuria, glomerular filtration rate, mesangial cell expansion, and collagen type IV and transforming growth factor-β expression were significantly increased in diabetic Ins2+/C96Y mice compared with nondiabetic Ins2+/+ mice and remained elevated despite glucose normalization with insulin implants. A persistent increase of SHP-1 expression in podocytes despite normalization of systemic glucose levels was associated with sustained inhibition of the insulin signaling pathways. In cultured podocytes, high glucose levels increased mRNA, protein expression, and phosphatase activity of SHP-1, which remained elevated despite glucose concentration returning to normal, causing persistent insulin receptor-β inhibition. Histone posttranslational modification analysis showed that the promoter region of SHP-1 was enriched with H3K4me1 and H3K9/14ac in diabetic glomeruli and podocytes, which remained elevated despite glucose level normalization. Hyperglycemia induces SHP-1 promoter epigenetic modifications, causing its persistent expression and activity and leading to insulin resistance, podocyte dysfunction, and DN.
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MESH Headings
- Animals
- Cell Line
- Diabetes Mellitus, Experimental/genetics
- Diabetes Mellitus, Experimental/metabolism
- Diabetic Nephropathies/genetics
- Diabetic Nephropathies/metabolism
- Epigenesis, Genetic/genetics
- Glomerular Filtration Rate/physiology
- Hyperglycemia/genetics
- Hyperglycemia/metabolism
- Immunohistochemistry
- Insulin Resistance/genetics
- Insulin Resistance/physiology
- Kidney Glomerulus/metabolism
- Male
- Mice
- Mice, Inbred C57BL
- Microscopy, Electron, Transmission
- Podocytes/metabolism
- Promoter Regions, Genetic/genetics
- Protein Tyrosine Phosphatase, Non-Receptor Type 6/genetics
- Receptor, Insulin/genetics
- Receptor, Insulin/metabolism
- Signal Transduction/genetics
- Signal Transduction/physiology
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Affiliation(s)
- Farah Lizotte
- Research Center of CHU de Sherbrooke and Department of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
- Division of Endocrinology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Benoit Denhez
- Research Center of CHU de Sherbrooke and Department of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
- Division of Endocrinology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Andréanne Guay
- Research Center of CHU de Sherbrooke and Department of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
- Division of Endocrinology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Nicolas Gévry
- Department of Biology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Anne Marie Côté
- Research Center of CHU de Sherbrooke and Department of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
- Department of Nephrology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Pedro Geraldes
- Research Center of CHU de Sherbrooke and Department of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
- Division of Endocrinology, Université de Sherbrooke, Sherbrooke, QC, Canada
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Keel S, Itsiopoulos C, Koklanis K, Vukicevic M, Cameron F, Brazionis L. Prevalence and risk factors for diabetic retinopathy in a hospital-based population of Australian children and adolescents with type 1 diabetes. J Pediatr Endocrinol Metab 2016; 29:1135-1142. [PMID: 27658136 DOI: 10.1515/jpem-2016-0231] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 08/04/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND The aim of this study was to investigate the prevalence of, and traditional and emerging risk factors associated with, retinopathy in a hospital-based population of Australian children and adolescents with type 1 diabetes. METHODS This was a cross-sectional study of 483 children and adolescents with type 1 diabetes. Medical files were audited to collect all relevant clinical data. Diabetic retinopathy was assessed from colour retinal images by an ophthalmologist. RESULTS Diabetic retinopathy was observed in 11 (2.3%) participants. Logistic regression revealed that the principal components analysis derived risk profile of: higher serum creatinine, older age, higher systolic blood pressures, higher body mass index, abnormal estimated glomerular filtration rate (eGFR) (<59 mL/min), lower high density lipoproteins (HDL) cholesterol, higher serum sodium, longer duration of diabetes and narrower retinal arteriolar calibre was associated with diabetic retinopathy (ExpB=2.60, 95% CI 1.36/4.96, p=0.004). CONCLUSIONS These results support the concept that the pathogenesis of diabetic retinopathy is likely due to the combined influence of various risk factors, many already identified.
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24
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Ragot S, Saulnier PJ, Velho G, Gand E, de Hauteclocque A, Slaoui Y, Potier L, Sosner P, Halimi JM, Zaoui P, Rigalleau V, Fumeron F, Roussel R, Marre M, Hadjadj S. Dynamic Changes in Renal Function Are Associated With Major Cardiovascular Events in Patients With Type 2 Diabetes. Diabetes Care 2016; 39:1259-66. [PMID: 27222502 DOI: 10.2337/dc15-2607] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 04/18/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The pattern of renal function decline prior to cardiovascular (CV) events in type 2 diabetes is not well known. Our aim was to describe the association between renal function trajectories and the occurrence of a CV event. RESEARCH DESIGN AND METHODS We considered patients with type 2 diabetes from the SURDIAGENE (Survie, Diabete de type 2 et Genetique) study (discovery cohort) and the DIABHYCAR (Non-Insulin-Dependent Diabetes, Hypertension, Microalbuminuria or Proteinuria, Cardiovascular Events, and Ramipril) study (replication cohort). Global patterns of estimated glomerular filtration rate (eGFR) (Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI]) and serum creatinine (SCr) prior to a major CV event (MACE) or last update were determined using a linear mixed-effects model and annual individual slopes computed by simple linear regression. RESULTS In the 1,040 participants of the discovery cohort, establishment of global patterns including 22,227 SCr over 6.3 years of follow-up showed an annual eGFR decline and an annual SCr increase that were significantly greater in patients with MACE compared with patients without (-3.0 and -1.7 mL/min/1.73 m(2)/year and +10.7 and +4.0 μmol/L/year, respectively; P < 0.0001 for both). Median annual individual slopes were also significantly steeper in patients with MACE, and adjusted risk of MACE was 4.11 times higher (3.09-5.45) in patients with rapid decline in eGFR (change less than -5 mL/min/1.73 m(2)/year). Consideration of renal function trajectories provided significant additive information helping to explain the occurrence of MACE for both SCr and eGFR (PIDI < 0.0001 and P = 0.0005, respectively). These results were confirmed in the replication cohort. CONCLUSIONS Renal function decline was associated with a higher risk of MACE. The pattern of renal function decline, beyond baseline kidney function, is an independent factor of CV risk.
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Affiliation(s)
- Stéphanie Ragot
- INSERM CIC 1402, Poitiers, France Centre d'Investigation Clinique, CHU de Poitiers, Poitiers, France
| | - Pierre-Jean Saulnier
- INSERM CIC 1402, Poitiers, France Centre d'Investigation Clinique, CHU de Poitiers, Poitiers, France
| | - Gilberto Velho
- INSERM UMRS1138, Centre de Recherche des Cordeliers, Paris, France Département d'Endocrinologie, Diabétologie, et Nutrition, DHU FIRE, Hôpital Bichat, AP-HP, Paris, France
| | - Elise Gand
- Pôle DUNE, CHU de Poitiers, Poitiers, France
| | | | - Yousri Slaoui
- Laboratoire de Mathématiques et Applications, Université de Poitiers, Poitiers, France
| | - Louis Potier
- INSERM UMRS1138, Centre de Recherche des Cordeliers, Paris, France Département d'Endocrinologie, Diabétologie, et Nutrition, DHU FIRE, Hôpital Bichat, AP-HP, Paris, France
| | - Philippe Sosner
- Complexe Médico-Sportif Mon Stade, Paris, France Laboratoire MOVE (EA 6314), Université de Poitiers, Poitiers, France
| | - Jean-Michel Halimi
- Service Néphrologie Immunologie Clinique, CHU de Tours, Tours, France Cellules Dendritiques, Immunomodulation, et Greffes (EA 4245), Université François Rabelais, Tours, France
| | - Philippe Zaoui
- Service Néphrologie, Dialyse, et Transplantation, CHU de Grenoble, Grenoble, France Faculté de Médecine, Université Joseph Fournier, Grenoble, France
| | - Vincent Rigalleau
- Service Nutrition-Diabétologie, CHU Haut-Lévêque, Pessac, France Faculté de Médecine, Université Victor Segalen, Bordeaux, France
| | - Frederic Fumeron
- INSERM UMRS1138, Centre de Recherche des Cordeliers, Paris, France Département d'Endocrinologie, Diabétologie, et Nutrition, DHU FIRE, Hôpital Bichat, AP-HP, Paris, France
| | - Ronan Roussel
- INSERM UMRS1138, Centre de Recherche des Cordeliers, Paris, France Département d'Endocrinologie, Diabétologie, et Nutrition, DHU FIRE, Hôpital Bichat, AP-HP, Paris, France
| | - Michel Marre
- INSERM UMRS1138, Centre de Recherche des Cordeliers, Paris, France Département d'Endocrinologie, Diabétologie, et Nutrition, DHU FIRE, Hôpital Bichat, AP-HP, Paris, France
| | - Samy Hadjadj
- INSERM CIC 1402, Poitiers, France UFR Médecine Pharmacie, Université de Poitiers, Poitiers, France Centre d'Investigation Clinique, CHU de Poitiers, Poitiers, France INSERM U1082 IRTOMIT, Poitiers, France
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25
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Mottl AK, Divers J, Dabelea D, Maahs DM, Dolan L, Pettitt D, Marcovina S, Imperatore G, Pihoker C, Mauer M, Mayer-Davis EJ. The dose-response effect of insulin sensitivity on albuminuria in children according to diabetes type. Pediatr Nephrol 2016; 31:933-40. [PMID: 26754041 PMCID: PMC4841707 DOI: 10.1007/s00467-015-3276-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 10/25/2015] [Accepted: 10/26/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Insulin resistance is associated with microalbuminuria among youth with diabetes mellitus. We sought to determine the dose-response effect of insulin sensitivity (IS) on the magnitude of albuminuria and whether there is a threshold below which urine albumin excretion increases. METHODS These analyses included participants from the SEARCH for Diabetes in Youth Study with incident diabetes who completed a baseline study visit (n = 2988). We estimated IS using a validated equation incorporating waist circumference, HbA1C, and fasting serum triglycerides. Multivariate regression analyses were performed to assess the effect of IS on urine albumin creatinine ratio (UACR), stratified by diabetes type. The IS threshold was then determined using segmented regressions within each diabetes type and incorporated into the multivariate model. RESULTS There was an association between IS and UACR in type 2 diabetes only (beta = -0.39; p < 0.001). There was strong statistical evidence for a threshold effect of IS score on UACR in the group of youth with type 2 (beta = 0.40; p < 0.001) but not type 1 diabetes (p = 0.3). CONCLUSIONS In cross-sectional analyses, there is a negative association between IS and UACR in youth with type 2 but not type 1 diabetes, and this association likely includes a threshold effect of IS on UACR.
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Affiliation(s)
- Amy K Mottl
- UNC Division of Nephrology and Hypertension, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
| | - Jasmin Divers
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Dana Dabelea
- Department of Epidemiology, School of Public Health, University of Colorado Denver, Aurora, CO, USA
| | - David M Maahs
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, CO, USA
| | - Lawrence Dolan
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - Santica Marcovina
- Northwest Lipid Metabolism and Diabetes Research Laboratories, Department of Medicine, University of Washington, Seattle, WA, USA
| | - Giuseppina Imperatore
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Catherine Pihoker
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Michael Mauer
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Elizabeth J Mayer-Davis
- Department of Nutrition, University of North Carolina School of Public Health, Chapel Hill, NC, USA
- Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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Laimer M, Melmer A, Mader JK, Schütz-Fuhrmann I, Engels HR, Götz G, Pfeifer M, Hermann JM, Stettler C, Holl RW. Variability of Basal Rate Profiles in Insulin Pump Therapy and Association with Complications in Type 1 Diabetes Mellitus. PLoS One 2016; 11:e0150604. [PMID: 26938444 PMCID: PMC4777503 DOI: 10.1371/journal.pone.0150604] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 02/17/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Traditionally, basal rate profiles in continuous subcutaneous insulin infusion therapy are individually adapted to cover expected insulin requirements. However, whether this approach is indeed superior to a more constant BR profile has not been assessed so far. This study analysed the associations between variability of BR profiles and acute and chronic complications in adult type 1 diabetes mellitus. MATERIALS AND METHODS BR profiles of 3118 female and 2427 male patients from the "Diabetes-Patienten-Verlaufsdokumentation" registry from Germany and Austria were analysed. Acute and chronic complications were recorded 6 months prior and after the most recently documented basal rate. The "variability index" was calculated as variation of basal rate intervals in percent and describes the excursions of the basal rate intervals from the median basal rate. RESULTS The variability Index correlated positively with severe hypoglycemia (r = .06; p<0.001), hypoglycemic coma (r = .05; p = 0.002), and microalbuminuria (r = 0.05; p = 0.006). In addition, a higher variability index was associated with higher frequency of diabetic ketoacidosis (r = .04; p = 0.029) in male adult patients. Logistic regression analysis adjusted for age, gender, duration of disease and total basal insulin confirmed significant correlations of the variability index with severe hypoglycemia (β = 0.013; p<0.001) and diabetic ketoacidosis (β = 0.012; p = 0.017). CONCLUSIONS Basal rate profiles with higher variability are associated with an increased frequency of acute complications in adults with type 1 diabetes.
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Affiliation(s)
- Markus Laimer
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Bern, Bern, Switzerland
- Department of Internal Medicine I, Medical University of Innsbruck, Innsbruck, Austria
- * E-mail:
| | - Andreas Melmer
- Department of Internal Medicine I, Medical University of Innsbruck, Innsbruck, Austria
| | - Julia K. Mader
- Department of Endocrinology and Metabolism, Medical University of Graz, Graz, Austria
| | - Ingrid Schütz-Fuhrmann
- Medical Department of Metabolic Disease and Nephrology, Hospital Hitzing, Vienna, Austria
| | | | - Gabriele Götz
- Diabetes Centre Nürtingen, Clinics Esslingen, Baden-Württemberg, Germany
| | - Martin Pfeifer
- Department of Internal Medicine, Hospital Tettnang, Baden-Württemberg, Germany
| | - Julia M. Hermann
- Institute of Epidemiology and Medical Biometry, ZIBMT, German Center for Diabetes Research (DZD), University of Ulm, Ulm, Germany
| | - Christoph Stettler
- Department of Endocrinology, Diabetology and Clinical Nutrition, University Hospital Bern, Bern, Switzerland
| | - Reinhard W. Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, German Center for Diabetes Research (DZD), University of Ulm, Ulm, Germany
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Wherrett DK, Chiang JL, Delamater AM, DiMeglio LA, Gitelman SE, Gottlieb PA, Herold KC, Lovell DJ, Orchard TJ, Ryan CM, Schatz DA, Wendler DS, Greenbaum CJ. Defining pathways for development of disease-modifying therapies in children with type 1 diabetes: a consensus report. Diabetes Care 2015; 38:1975-85. [PMID: 26404927 PMCID: PMC4876737 DOI: 10.2337/dc15-1429] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Emerging data suggest that type 1 diabetes is a more aggressive disease in children than in adults, with important differences in pathophysiology and clinical course. Therefore, the efficacy of disease-modifying therapies may be different in the two populations. Understanding the developmental and regulatory pathways for type 1 diabetes-modifying therapies in children will enable industry, academia, funders, advocacy groups, and regulators to translate new science to clinical care. This consensus report characterizes the fundamental differences in type 1 diabetes between children and adults and proposes a thoughtful approach to better understand the development and regulatory pathways for type 1 diabetes therapies.
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Affiliation(s)
- Diane K Wherrett
- Department of Pediatrics, University of Toronto, Toronto, Canada
| | | | | | | | - Stephen E Gitelman
- Department of Pediatrics, University of California, San Francisco, San Francisco, CA
| | - Peter A Gottlieb
- Departments of Medicine and Pediatrics, University of Colorado, Denver, CO
| | - Kevan C Herold
- Department of Immunobiology, Yale University, New Haven, CT
| | - Daniel J Lovell
- Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Trevor J Orchard
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA
| | | | - Desmond A Schatz
- Department of Pediatrics, University of Florida, Gainesville, FL
| | - David S Wendler
- Department of Bioethics, National Institutes of Health, Bethesda, MD
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Eboh C, Chowdhury TA. Management of diabetic renal disease. ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:154. [PMID: 26244141 DOI: 10.3978/j.issn.2305-5839.2015.06.25] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 06/26/2015] [Indexed: 12/15/2022]
Abstract
Diabetic nephropathy is the leading cause of end stage renal failure (ESRF) worldwide, representing over 50% of patients on renal replacement therapy in some parts of the world. The condition is common in people with type 1 and type 2 diabetes, although the incidence appears to be declining, especially in type 1 diabetes. More than 1 in 3 people with type 2 diabetes have impaired kidney function. Advances in our understanding of the pathogenesis and natural history of the condition have enabled us to consider earlier therapy aimed at renal preservation and reduction in cardiovascular morbidity. Microalbuminuria is now established as the earliest risk marker for nephropathy in type 1 diabetes and cardiovascular disease in type 2 diabetes. This review examines the current concepts in the pathogenesis and management of diabetic nephropathy.
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Affiliation(s)
- Cecil Eboh
- Department of Diabetes and Metabolism, the Royal London Hospital, London, UK
| | - Tahseen A Chowdhury
- Department of Diabetes and Metabolism, the Royal London Hospital, London, UK
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Insulin signaling: implications for podocyte biology in diabetic kidney disease. Curr Opin Nephrol Hypertens 2015; 24:104-10. [PMID: 25415617 DOI: 10.1097/mnh.0000000000000078] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW Several key elements of the insulin signaling cascade contribute to podocyte function and survival. While it was initially thought that the consequences of altered insulin signaling to podocyte function was strictly related to altered glucose uptake, it has become clear that upstream signaling events involved in cell survival, lipid metabolism or nutrient sensing and modulated by insulin are strong independent contributors to podocyte function. RECENT FINDINGS Akt2, the major isoform of Akt activated following cellular insulin stimulation, protects against the progression of renal disease in nephron-deficient mice, and podocyte-specific deletion of Akt2 results in a more rapid progression of experimental glomerular disease. In diabetes, podocyte mammalian target of rapamycin activation clearly contributes to podocyte injury and regulated autophagy. Furthermore, podocyte-specific glucose transporter type 4 (GLUT4) deficiency protects podocytes by preventing mammalian target of rapamycin signaling independently of glucose uptake. Finally, intracellular lipids have been recently recognized as major modulators of podocyte insulin signaling and as a new therapeutic target. SUMMARY The identification of new contributors to podocyte insulin signaling is of extreme translational value as it may lead to new drug development strategies for diabetic kidney disease, as well as for other proteinuric kidney diseases.
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30
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Park SK, Seo MH, Ryoo JH, Kim MG, Choi JM, Shin H, Choi YS, Hong HP. Urinary albumin excretion within the normal range predicts the development of diabetes in Korean men. Diabetes Res Clin Pract 2015; 109:427-33. [PMID: 26021977 DOI: 10.1016/j.diabres.2015.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 02/17/2015] [Accepted: 05/02/2015] [Indexed: 10/23/2022]
Abstract
AIMS Urine albumin creatinine ratio (UACR) is a reliable index of urinary albumin excretion. Elevated UACR is known to be associated with increased risk for diabetes complications. However there is only limited information about the predictability of UACR within normal range for diabetes. Therefore, this study was designed to investigate the association between UACR within the normal range and the development of diabetes. METHODS The 1410 non-diabetic Korean men with UACR within the normal range were identified in 2005 and followed-up until 2010. All subjects were classified into four categories according to their baseline level of UACR, from the lowest to the highest quartile. Cox proportional hazards analysis was used to evaluate the independent hazard ratios (HRs) for diabetes according to the UACR levels of their quartile group. RESULTS During follow-up, diabetes developed in 114 out of 1410 subjects (8.1%), and incidence of diabetes increased in proportion to the level of UACR (quartile 1; 4.5%, quartile 2; 7.9%, quartile 3: 8.8%, quartile 4: 11.1%, p = 0.002). The subjects with incident diabetes had a higher UACR than those without incident diabetes (6.6 ± 5.5 μg/mg v 5.3 ± 4.2 μg/mg, p=0.013). When quartile 1 was considered as the reference, HRs (95% confidential interval) for diabetes was higher in quartile 2 (1.04; 0.45-2.38), quartile 3 (1.09; 0.47-2.52) and quartile 4 (2.16; 1.02-4.57), even after adjusting for other potential confounders. CONCLUSIONS Elevated UACR, even within the normal range, could predict the future development of diabetes.
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Affiliation(s)
- Sung Keun Park
- Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea; Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - Mi Hae Seo
- Department of Internal Medicine, Gumi Hospital, Soon Chun Hyang University, School of Medicine, Gumi, South Korea
| | - Jae-Hong Ryoo
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, South Korea.
| | - Min-Gi Kim
- Department of Occupational and Environmental Medicine, Dongguk University, Gyeongju Hospital, Gyeongju, South Korea
| | - Joong-Myung Choi
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - Hocheol Shin
- Department of Family Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, School of medicine, Seoul, South Korea
| | - Yong-Sung Choi
- Department of Pediatrics, School of Medicine, Kyung Hee University, Seoul, South Korea
| | - Hyun Pyo Hong
- Department of Radiology, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, South Korea
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Jang CM, Hyun YY, Lee KB, Kim H. Insulin resistance is associated with the development of albuminuria in Korean subjects without diabetes. Endocrine 2015; 48:203-10. [PMID: 24676759 DOI: 10.1007/s12020-014-0242-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2014] [Accepted: 03/12/2014] [Indexed: 12/13/2022]
Abstract
Previous studies have shown that insulin resistance is associated with the development of albuminuria. However, most studies are done on a background of diabetes or metabolic syndrome and there is little data from general population. The aim of this study is to define the effect of insulin resistance on the development of albuminuria in healthy individuals without diabetes. We analyzed 60,047 participants without baseline diabetes or chronic kidney disease, who underwent at least two health maintenance visits at a 2-year interval between 2002 and 2009 at a tertiary hospital in Korea. We measured the incidence of albuminuria at the second examination and calculated the odds ratio for the development of albuminuria according to the quintile of the homeostasis model assessment of insulin resistance (HOMA-IR). After 2 years, 880 cases of incident albuminuria were observed. The cumulative incidences of albuminuria were 1.08, 1.50, 1.35, 1.47, and 1.92% for the 1st to 5th quintiles of HOMA-IR. On multivariate logistic analysis, the odds ratios for incident albuminuria compared to those in the 1st quintile were 1.38 (95% CI 1.10-1.73; P=0.006), 1.23 (95% CI 0.97-1.55; P=0.087), 1.32 (95% CI 1.04-1.67; P=0.020), and 1.66 (95% CI 1.31-2.09; P<0.001) in the 2nd, 3rd, 4th, and 5th quintiles, respectively. A high level of insulin resistance assessed with HOMA-IR was associated with the development of albuminuria in relatively healthy subjects without diabetes. Further research is needed to verify the role of insulin resistance in the development of albuminuria and renal injury.
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Affiliation(s)
- Cheol Min Jang
- Department of Internal Medicine, School of Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University, 29 Saemunan-ro, Jongro-Gu, Seoul, 110-746, Republic of Korea
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Bjornstad P, Maahs DM, Johnson RJ, Rewers M, Snell-Bergeon JK. Estimated insulin sensitivity predicts regression of albuminuria in Type 1 diabetes. Diabet Med 2015; 32:257-61. [PMID: 25303233 PMCID: PMC4301993 DOI: 10.1111/dme.12572] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/22/2014] [Indexed: 12/17/2022]
Abstract
AIM To test the hypothesis that greater baseline insulin sensitivity would predict regression of albuminuria over 6 years in adults with Type 1 diabetes. METHOD We enrolled 81 people aged 30-48 years with albuminuria at baseline in the present study and re-examined them 6 years later. Urinary albumin excretion rate was measured and albuminuria was defined as urinary albumin excretion rate ≥ 20 μg/min. Regression of albuminuria was defined as normoalbuminuria (urinary albumin excretion rate < 20 μg/min) at follow-up. Predictors of regression of albuminuria were examined in stepwise logistic regression. The variables age, diabetes duration, sex, serum uric acid, HbA1c , systolic blood pressure, LDL cholesterol, HDL cholesterol, BMI, baseline albumin excretion rate, estimated insulin sensitivity at baseline, change in estimated insulin sensitivity from baseline to follow-up and angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use were considered for inclusion in the model. RESULTS Estimated insulin sensitivity was significantly higher at both baseline (4.6 ± 1.2 vs 3.4 ± 1.7; P = 0.002) and follow-up (5.2 ± 1.9 vs. 3.5 ± 1.7; P < 0.0001) in people who had regression of albuminuria vs those who did not. HbA1c (odds ratio 0.4, 95% CI 0.2-0.8; P = 0.006), estimated insulin sensitivity (odds ratio 2.5, 95% CI 1.3-4.9; P = 0.006) at baseline and change in estimated insulin sensitivity from baseline to follow-up (odds ratio 2.7, 95% CI 1.4-5.3; P = 0.003) were independently associated with regression of albuminuria in a multivariable stepwise model. CONCLUSIONS In conclusion, over 6 years, higher baseline estimated insulin sensitivity and change in estimated insulin sensitivity independently predicted regression of albuminuria. Improving insulin sensitivity in people with Type 1 diabetes is a potential therapeutic target to increase rates of regression of albuminuria.
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Affiliation(s)
- P Bjornstad
- Department of Paediatrics, University of Colorado School of Medicine, Aurora, CO, USA
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Abstract
Diabetic vascular complications (DVCs) affecting several important organ systems of human body such as cardiovascular system contribute a major public health problem. Genetic factors contribute to the risk of diabetic nephropathy (DN). Genetics variants, structural variants (copy number variation) and epigenetic changes play important roles in the development of DN. Apart from nucleus genome, mitochondrial DNA (mtDNA) plays critical roles in regulation of development of DN. Epigenetic studies have indicated epigenetic changes in chromatin affecting gene transcription in response to environmental stimuli, which provided a large body of evidence of regulating development of diabetes mellitus. This review focused on the current knowledge of the genetic and epigenetic basis of DN. Ultimately, identification of genes or genetic loci, structural variants and epigenetic changes contributed to risk or protection of DN will benefit uncovering the complex mechanism underlying DN, with crucial implications for the development of personalized medicine to diabetes mellitus and its complications.
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Affiliation(s)
- Zi-Hui Tang
- Department of Endocrinology and Metabolism, Shanghai Tongji Hospital, Tongji University School of Medicine , Shanghai , China
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Karalliedde J, Gnudi L. Diabetes mellitus, a complex and heterogeneous disease, and the role of insulin resistance as a determinant of diabetic kidney disease. Nephrol Dial Transplant 2014; 31:206-13. [PMID: 25550448 DOI: 10.1093/ndt/gfu405] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 12/02/2014] [Indexed: 12/13/2022] Open
Abstract
Diabetes mellitus (DM) is increasingly recognized as a heterogeneous condition. The individualization of care and treatment necessitates an understanding of the individual patient's pathophysiology of DM that underpins their DM classification and clinical presentation. Classical type-2 diabetes mellitus is due to a combination of insulin resistance and an insulin secretory defect. Type-1 diabetes is characterized by a near-absolute deficiency of insulin secretion. More recently, advances in genetics and a better appreciation of the atypical features of DM has resulted in more categories of diabetes. In the context of kidney disease, patients with DM and microalbuminuria are more insulin resistant, and insulin resistance may be a pathway that results in accelerated progression of diabetic kidney disease. This review summarizes the updated classification of DM, including more rarer categories and their associated renal manifestations that need to be considered in patients who present with atypical features. The benefits and limitations of the tests utilized to make a diagnosis of DM are discussed. We also review the putative pathways and mechanisms by which insulin resistance drives the progression of diabetic kidney disease.
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Affiliation(s)
- Janaka Karalliedde
- Unit for Metabolic Medicine, Department of Diabetes and Endocrinology, Cardiovascular Division, School of Life Science & Medicine, King's College, London, UK
| | - Luigi Gnudi
- Unit for Metabolic Medicine, Department of Diabetes and Endocrinology, Cardiovascular Division, School of Life Science & Medicine, King's College, London, UK
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Bakry OA, Shoeib MAM, El Shafiee MK, Hassan A. Androgenetic alopecia, metabolic syndrome, and insulin resistance: Is there any association? A case-control study. Indian Dermatol Online J 2014; 5:276-81. [PMID: 25165643 PMCID: PMC4144211 DOI: 10.4103/2229-5178.137776] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
CONTEXT Although several previous studies have investigated the association of metabolic syndrome (MS) and insulin resistance (IR) with androgenetic alopecia (AGA), the results have been inconsistent. AIM We attempted to assess the presence of MS and IR in patients with AGA. This may help to detect if AGA can be considered as a clue for underlying serious systemic diseases. MATERIALS AND METHODS One hundred male patients with stages III-VII AGA, in Hamilton-Norwood classification, and 100 normal, gender- and age-matched control subjects were included. Anthropometric measures, blood pressure, fasting glucose, fasting insulin, high-density lipoprotein cholesterol, and triglycerides were measured for the all participants. The presence of MS and IR was evaluated. RESULTS There were statistically significant differences regarding mean values of body weight (P < 0.001), height (P = 0.002), waist circumference (P < 0.001), body mass index (P < 0.001), systolic (P < 0.001), and diastolic blood pressure (P < 0.001), fasting glucose (P < 0.001), triglycerides (P < 0.001), high-density lipoprotein cholesterol (P < 0.01), fasting insulin (P = 0.02) and homeostasis model assessment of insulin resistance (P < 0.001) between cases and controls. A statistically significant association was found between AGA and MS (P = 0.002) and between AGA and IR (P < 0.001). Multiple logistic regression analysis revealed that waist circumference (>102 cm) was the most significant risk factor for developing MS. It increased the risk of MS by 1.25-folds (95% CI = 1.10-1.42, P < 0.001). CONCLUSION Our results support the recommendation for assessing MS and IR in all young males with stage III or higher AGA. Early intervention is critical to reduce the risk and complications of cardiovascular disease and type 2 diabetes mellitus later in life.
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Affiliation(s)
- Ola Ahmed Bakry
- Departments of Dermatology, Andrology and STDs, Faculty of Medicine, Menoufiya University, Menoufiya, Egypt
| | | | | | - Ahmed Hassan
- Departments of Dermatology, Andrology and STDs, Faculty of Medicine, Menoufiya University, Menoufiya, Egypt
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Filippone EJ, Abubacker F, Farber JL. Posttransplantation normoglycemic diabetic nephropathy: the role of the allograft insulin resistance--a case report. Transplant Proc 2014; 46:2381-5. [PMID: 24984885 DOI: 10.1016/j.transproceed.2014.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 02/27/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND The pathogenesis of diabetic nephropathy is incompletely understood. Although the role of hyperglycemia is well-established, the participation of insulin resistance is increasingly appreciated. Podocytes are insulin responsive cells and require normal insulin signaling for sustained viability. CASE REPORT We have presented a renal transplant recipient with lupus nephritis who received a deceased donor kidney from a patient with diabetes mellitus (DM). The kidney functioned well initially. Within 2 years, however, nephrotic range proteinuria developed, and a biopsy revealed diabetic nephropathy that had clearly evolved in comparison with the implantation biopsy. The recipient was repeatedly normoglycemic with normal glycated hemoglobin and glucose tolerance, and she was found to be quite insulin sensitive on the basis of a low homeostasis model assessment of insulin resistance. CONCLUSIONS We argue that the nephropathy developed in the allograft owing to impaired insulin signaling from intrinsic donor-derived insulin resistance that was exacerbated by low insulin levels in the insulin-sensitive recipient. This case has implications for the most appropriate utilization of kidneys from donors with DM.
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Affiliation(s)
- E J Filippone
- Division of Nephrology, Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania.
| | - F Abubacker
- Division of Nephrology, Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - J L Farber
- Department of Pathology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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Filippone EJ, Gupta A, Farber JL. Normoglycemic diabetic nephropathy: the role of insulin resistance. CASE REPORTS IN NEPHROLOGY AND UROLOGY 2014; 4:137-43. [PMID: 25076962 PMCID: PMC4107385 DOI: 10.1159/000364901] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The pathophysiology of diabetic nephropathy (DN) is complex and incompletely understood. Whereas hyperglycemia is clearly important, the role of insulin resistance (IR) is increasingly recognized. We present the case of a normotensive non-smoking obese woman with nephrotic syndrome who was found to have DN by biopsy. All measures of glucose metabolism, including fasting glucose, glycosylated hemoglobin, and oral glucose tolerance testing, were repeatedly normal with little exception. IR was documented, however, based on the presence of the metabolic syndrome and an elevated homeostasis model assessment of IR. We posit that this IR is central to the pathogenesis of our patient's lesion, and this may explain other cases of DN with normoglycemia. The literature supporting this concept is discussed.
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Affiliation(s)
- Edward J Filippone
- Division of Nephrology, Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pa., USA
| | - Astha Gupta
- Division of Nephrology, Department of Medicine, Thomas Jefferson University Hospital, Philadelphia, Pa., USA
| | - John L Farber
- Department of Pathology, Thomas Jefferson University Hospital, Philadelphia, Pa., USA
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Fornoni A, Merscher S, Kopp JB. Lipid biology of the podocyte--new perspectives offer new opportunities. Nat Rev Nephrol 2014; 10:379-88. [PMID: 24861084 DOI: 10.1038/nrneph.2014.87] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
In the past 15 years, major advances have been made in understanding the role of lipids in podocyte biology. First, susceptibility to focal segmental glomerulosclerosis (FSGS) and glomerular disease is associated with an APOL1 sequence variant, is expressed in podocytes and encodes apolipoprotein L1, an important component of HDL. Second, acid sphingomyelinase-like phosphodiesterase 3b encoded by SMPDL3b has a role in the conversion of sphingomyelin to ceramide and its levels are reduced in renal biopsy samples from patients with recurrent FSGS. Furthermore, decreased SMPDL3b expression is associated with increased susceptibility of podocytes to injury after exposure to sera from these patients. Third, in many individuals with membranous nephropathy, autoantibodies against the phospholipase A2 (PLA2) receptor, which is expressed in podocytes, have been identified. Whether these autoantibodies affect the activity of PLA2, which liberates arachidonic acid from glycerophospholipids and modulates podocyte function, is unknown. Fourth, clinical and experimental evidence support a role for ATP-binding cassette sub-family A member 1-dependent cholesterol efflux, free fatty acids and glycerophospolipids in the pathogenesis of diabetic kidney disease. An improved understanding of lipid biology in podocytes might provide insights to develop therapeutic targets for primary and secondary glomerulopathies.
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Affiliation(s)
- Alessia Fornoni
- Peggy and Harold Katz Family Drug Discovery Center, Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, 1580 North West 10th Avenue, Miami, FL 33136, USA
| | - Sandra Merscher
- Peggy and Harold Katz Family Drug Discovery Center, Division of Nephrology and Hypertension, University of Miami Miller School of Medicine, 1580 North West 10th Avenue, Miami, FL 33136, USA
| | - Jeffrey B Kopp
- Kidney Disease Section, Kidney Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, NIH, 10 Center Drive, 3N116 Bethesda, MD 20892-1268, USA
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Brosius FC, Coward RJ. Podocytes, signaling pathways, and vascular factors in diabetic kidney disease. Adv Chronic Kidney Dis 2014; 21:304-10. [PMID: 24780459 DOI: 10.1053/j.ackd.2014.03.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 03/09/2014] [Accepted: 03/10/2014] [Indexed: 02/06/2023]
Abstract
Alterations and injury to glomerular podocytes play a key role in the initiation and progression of diabetic kidney disease (DKD). Multiple factors in diabetes cause abnormalities in podocyte signaling that lead to podocyte foot process effacement, hypertrophy, detachment, loss, and death. Alterations in insulin action and mammalian target of rapamycin activation have been well documented to lead to pathology. Reduced insulin action directly leads to albuminuria, increased glomerular matrix accumulation, thickening of the glomerular basement membrane, podocyte apoptosis, and glomerulosclerosis. In addition, podocytes generate factors that alter signaling in other glomerular cells. Prominent among these is vascular endothelial growth factor-A, which maintains glomerular endothelium viability but causes endothelial cell pathology when generated at too high a level. Finally, circulating vascular factors (eg, activated protein C) have a profound effect on podocyte stability and survival. This cytoprotective factor is critical for podocyte health, and its deficiency promotes podocyte injury and apoptosis. Thus, the podocyte sits in the center of a network of paracrine and hormonal signaling systems that in health keep the podocyte adaptable and viable, but in diabetes they can lead to pathologic changes, detachment, and death.
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Guzman J, Jauregui AN, Merscher-Gomez S, Maiguel D, Muresan C, Mitrofanova A, Diez-Sampedro A, Szust J, Yoo TH, Villarreal R, Pedigo C, Molano RD, Johnson K, Kahn B, Hartleben B, Huber TB, Saha J, Burke GW, Abel ED, Brosius FC, Fornoni A. Podocyte-specific GLUT4-deficient mice have fewer and larger podocytes and are protected from diabetic nephropathy. Diabetes 2014; 63:701-14. [PMID: 24101677 PMCID: PMC3900538 DOI: 10.2337/db13-0752] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Podocytes are a major component of the glomerular filtration barrier, and their ability to sense insulin is essential to prevent proteinuria. Here we identify the insulin downstream effector GLUT4 as a key modulator of podocyte function in diabetic nephropathy (DN). Mice with a podocyte-specific deletion of GLUT4 (G4 KO) did not develop albuminuria despite having larger and fewer podocytes than wild-type (WT) mice. Glomeruli from G4 KO mice were protected from diabetes-induced hypertrophy, mesangial expansion, and albuminuria and failed to activate the mammalian target of rapamycin (mTOR) pathway. In order to investigate whether the protection observed in G4 KO mice was due to the failure to activate mTOR, we used three independent in vivo experiments. G4 KO mice did not develop lipopolysaccharide-induced albuminuria, which requires mTOR activation. On the contrary, G4 KO mice as well as WT mice treated with the mTOR inhibitor rapamycin developed worse adriamycin-induced nephropathy than WT mice, consistent with the fact that adriamycin toxicity is augmented by mTOR inhibition. In summary, GLUT4 deficiency in podocytes affects podocyte nutrient sensing, results in fewer and larger cells, and protects mice from the development of DN. This is the first evidence that podocyte hypertrophy concomitant with podocytopenia may be associated with protection from proteinuria.
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Affiliation(s)
- Johanna Guzman
- Diabetes Research Institute, Miller School of Medicine, University of Miami, Miami, FL
- Department of Medicine, Division of Nephrology and Hypertension, Miller School of Medicine, University of Miami, Miami, FL
| | - Alexandra N. Jauregui
- Diabetes Research Institute, Miller School of Medicine, University of Miami, Miami, FL
| | - Sandra Merscher-Gomez
- Department of Medicine, Division of Nephrology and Hypertension, Miller School of Medicine, University of Miami, Miami, FL
| | - Dony Maiguel
- Diabetes Research Institute, Miller School of Medicine, University of Miami, Miami, FL
| | - Cristina Muresan
- Department of Medicine, Division of Nephrology and Hypertension, Miller School of Medicine, University of Miami, Miami, FL
| | - Alla Mitrofanova
- Department of Medicine, Division of Nephrology and Hypertension, Miller School of Medicine, University of Miami, Miami, FL
| | - Ana Diez-Sampedro
- Department of Physiology, Miller School of Medicine, University of Miami, Miami, FL
| | - Joel Szust
- Diabetes Research Institute, Miller School of Medicine, University of Miami, Miami, FL
| | - Tae-Hyun Yoo
- Department of Medicine, Division of Nephrology and Hypertension, Miller School of Medicine, University of Miami, Miami, FL
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, FL
| | - Rodrigo Villarreal
- Diabetes Research Institute, Miller School of Medicine, University of Miami, Miami, FL
- Department of Medicine, Division of Nephrology and Hypertension, Miller School of Medicine, University of Miami, Miami, FL
| | - Christopher Pedigo
- Department of Medicine, Division of Nephrology and Hypertension, Miller School of Medicine, University of Miami, Miami, FL
| | - R. Damaris Molano
- Diabetes Research Institute, Miller School of Medicine, University of Miami, Miami, FL
| | - Kevin Johnson
- Diabetes Research Institute, Miller School of Medicine, University of Miami, Miami, FL
| | - Barbara Kahn
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | | | - Tobias B. Huber
- Division of Nephrology, Freiburg University, Freiburg, Germany
| | - Jharna Saha
- Division of Nephrology, University of Michigan, Ann Arbor, MI
| | - George W. Burke
- Department of Surgery, Miller School of Medicine, University of Miami, Miami, FL
| | - E. Dale Abel
- Division of Endocrinology, Metabolism and Diabetes and Program in Molecular Medicine, University of Utah, Salt Lake City, UT
| | | | - Alessia Fornoni
- Diabetes Research Institute, Miller School of Medicine, University of Miami, Miami, FL
- Department of Medicine, Division of Nephrology and Hypertension, Miller School of Medicine, University of Miami, Miami, FL
- Corresponding author: Alessia Fornoni,
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Chillarón JJ, Flores Le-Roux JA, Benaiges D, Pedro-Botet J. Type 1 diabetes, metabolic syndrome and cardiovascular risk. Metabolism 2014; 63:181-7. [PMID: 24274980 DOI: 10.1016/j.metabol.2013.10.002] [Citation(s) in RCA: 118] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 10/16/2013] [Accepted: 10/16/2013] [Indexed: 11/24/2022]
Abstract
Patients with type 1 diabetes mellitus (T1DM) traditionally had a low body mass index and microangiopathic complications were common, while macroangiopathy and the metabolic syndrome were exceptional. The Diabetes Control and Complications Trial, published in 1993, demonstrated that therapy aimed at maintaining HbA1c levels as close to normal as feasible reduced the incidence of microangiopathy. Since then, the use of intensive insulin therapy to optimize metabolic control became generalized. Improved glycemic control resulted in a lower incidence of microangiopathy; however, its side effects included a higher rate of severe hypoglycemia and increased weight gain. Approximately 50% of patients with T1DM are currently obese or overweight, and between 8% and 40% meet the metabolic syndrome criteria. The components of the metabolic syndrome and insulin resistance have been linked to chronic T1DM complications, and cardiovascular disease is now the leading cause of death in these patients. Therefore, new therapeutic strategies are required in T1DM subjects, not only to intensively lower glycemia, but to control all associated metabolic syndrome traits.
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Affiliation(s)
- Juan J Chillarón
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona; Institut Municipal d´Investigacions Mèdiques; Departament de Medicina, Universitat Autònoma de Barcelona.
| | - Juana A Flores Le-Roux
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona; Institut Municipal d´Investigacions Mèdiques; Departament de Medicina, Universitat Autònoma de Barcelona
| | - David Benaiges
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona; Institut Municipal d´Investigacions Mèdiques; Departament de Medicina, Universitat Autònoma de Barcelona
| | - Juan Pedro-Botet
- Department of Endocrinology and Nutrition, Hospital del Mar, Barcelona; Institut Municipal d´Investigacions Mèdiques; Departament de Medicina, Universitat Autònoma de Barcelona
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Bjornstad P, Snell-Bergeon JK, Rewers M, Jalal D, Chonchol MB, Johnson RJ, Maahs DM. Early diabetic nephropathy: a complication of reduced insulin sensitivity in type 1 diabetes. Diabetes Care 2013; 36:3678-83. [PMID: 24026551 PMCID: PMC3816872 DOI: 10.2337/dc13-0631] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Diabetic nephropathy (DN) is a major cause of mortality in type 1 diabetes. Reduced insulin sensitivity is a well-documented component of type 1 diabetes. We hypothesized that baseline insulin sensitivity would predict development of DN over 6 years. RESEARCH DESIGN AND METHODS We assessed the relationship between insulin sensitivity at baseline and development of early phenotypes of DN-microalbuminuria (albumin-creatinine ratio [ACR] ≥30 mg/g) and rapid renal function decline (glomerular filtration rate [GFR] loss >3 mL/min/1.73 m2 per year)-with three Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations over 6 years. Subjects with diabetes (n = 449) and without diabetes (n = 565) in the Coronary Artery Calcification in Type 1 Diabetes study had an estimated insulin sensitivity index (ISI) at baseline and 6-year follow-up. RESULTS The ISI was lower in subjects with diabetes than in those without diabetes (P < 0.0001). A higher ISI at baseline predicted a lower odds of developing an ACR ≥30 mg/g (odds ratio 0.65 [95% CI 0.49-0.85], P = 0.003) univariately and after adjusting for HbA1c (0.69 [0.51-0.93], P = 0.01). A higher ISI at baseline conferred protection from a rapid decline of GFR as assessed by CKD-EPI cystatin C (0.77 [0.64-0.92], P = 0.004) and remained significant after adjusting for HbA1c and age (0.80 [0.67-0.97], P = 0.02). We found no relation between ISI and rapid GFR decline estimated by CKD-EPI creatinine (P = 0.38) or CKD-EPI combined cystatin C and creatinine (P = 0.50). CONCLUSIONS Over 6 years, a higher ISI independently predicts a lower odds of developing microalbuminuria and rapid GFR decline as estimated with cystatin C, suggesting a relationship between insulin sensitivity and early phenotypes of DN.
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Cleland SJ, Fisher BM, Colhoun HM, Sattar N, Petrie JR. Insulin resistance in type 1 diabetes: what is 'double diabetes' and what are the risks? Diabetologia 2013; 56:1462-70. [PMID: 23613085 PMCID: PMC3671104 DOI: 10.1007/s00125-013-2904-2] [Citation(s) in RCA: 148] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 02/25/2013] [Indexed: 12/16/2022]
Abstract
In this review, we explore the concept of 'double diabetes', a combination of type 1 diabetes with features of insulin resistance and type 2 diabetes. After considering whether double diabetes is a useful concept, we discuss potential mechanisms of increased insulin resistance in type 1 diabetes before examining the extent to which double diabetes might increase the risk of cardiovascular disease (CVD). We then go on to consider the proposal that weight gain from intensive insulin regimens may be associated with increased CV risk factors in some patients with type 1 diabetes, and explore the complex relationships between weight gain, insulin resistance, glycaemic control and CV outcome. Important comparisons and contrasts between type 1 diabetes and type 2 diabetes are highlighted in terms of hepatic fat, fat partitioning and lipid profile, and how these may differ between type 1 diabetic patients with and without double diabetes. In so doing, we hope this work will stimulate much-needed research in this area and an improvement in clinical practice.
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Affiliation(s)
- S J Cleland
- Department of Medicine, Royal Hampshire County Hospital, Romsey Road, Winchester, SO22 5DG, UK.
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MUSIL F, ŠMAHELOVÁ A, BLÁHA V, HYŠPLER R, TICHÁ A, LESNÁ J, ZADÁK Z, SOBOTKA L. Effect of Low Calorie Diet and Controlled Fasting on Insulin Sensitivity and Glucose Metabolism in Obese Patients With Type 1 Diabetes Mellitus. Physiol Res 2013; 62:267-76. [DOI: 10.33549/physiolres.932381] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Obesity in T1DM patients is associated with the components of metabolic syndrome. The influence of controlled fasting and low calorie diet (LCD) on insulin sensitivity and glucose metabolism was studied in 14 obese patients with type 1 diabetes mellitus (T1DM) (42.6±9.4 years, BMI 32.4±2.1 kg m−2). Insulin sensitivity in obese T1DM patients was measured using a hyperinsulinemic-euglycemic clamp before fasting, immediately after 7 days of fasting, and after 21 days of LCD. Glucose oxidation and non-oxidative glucose disposal were measured before and during the clamp by indirect calorimetry. In the control group of 13 of non-obese T1DM patients (36.9±13.9 years, BMI 22.6±2.1 kg m−2), only one hyperinsulinemic-euglycemic clamp was performed. Obese T1DM patients lost 6.1±1.1 kg after fasting and maintained reduction in body weight after 21 days of LCD. Fasting transiently reduced insulin-mediated glucose disposal in the clamp (from 9.69±1.48 to 6.78±1.21 mg min−1 kg−1, P<0.001). This was caused by reduced glucose oxidation after the fasting period (from 2.81±0.52 to 0.88±0.98 mg min−1 kg−1, P<0.001). We conclude that one week of fasting transiently decreased insulin-mediated glucose disposal in T1DM patients. This was caused by reduced glucose oxidation.
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Affiliation(s)
- F. MUSIL
- Department of Metabolic Care and Gerontology, Faculty of Medicine, Charles University and University Hospital, Hradec Králové, Czech Republic
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Drapeau N, Lizotte F, Denhez B, Guay A, Kennedy CR, Geraldes P. Expression of SHP-1 induced by hyperglycemia prevents insulin actions in podocytes. Am J Physiol Endocrinol Metab 2013; 304:E1188-98. [PMID: 23531619 DOI: 10.1152/ajpendo.00560.2012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Renal podocyte apoptosis is an early event of diabetic nephropathy progression. Insulin action is critical for podocyte survival. Previous studies demonstrated that Src homology-2 domain-containing phosphatase-1 (SHP-1) is elevated in renal cortex of type 1 diabetic mice; we hypothesized that hyperglycemia-induced SHP-1 expression may affect insulin actions in podocytes. Type 1 diabetic Akita mice (Ins2(+/C96Y)) developed elevated foot process effacement and podocyte apoptosis compared with control littermate mice (Ins2(+/+)). In contrast to Ins2(+/+) mice, insulin-stimulated protein kinase B (Akt) and extracellular signal-regulated kinase (ERK) phosphorylation were remarkably reduced in renal podocytes of Akita mice. This renal insulin resistance was associated with elevated SHP-1 expression in the glomeruli. Cultured podocytes exposed to high glucose concentration (HG; 25 mM) for 96 h exhibited high levels of apoptotic markers and caspase-3/7 enzymatic activity. HG exposure raised mRNA and protein levels of SHP-1 and reduced the insulin-signaling pathway in podocytes. Overexpression of dominant-negative SHP-1 in podocytes prevented HG effects and restored insulin actions. Elevated SHP-1 expression induced by high glucose levels was directly associated with insulin receptor-β in vitro and in vivo to prevent insulin-stimulated Akt and ERK phosphorylation. In conclusion, our results showed that high levels of SHP-1 expression in glomeruli cause insulin resistance and podocyte loss, thereby contributing to diabetic nephropathy.
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Affiliation(s)
- Nicolas Drapeau
- Clinical Research Center Étienne Le-Bel and Division of Endocrinology, Departments of Medicine, Université de Sherbrooke, Québec, Canada
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Zhang C, Lu X, Tan Y, Li B, Miao X, Jin L, Shi X, Zhang X, Miao L, Li X, Cai L. Diabetes-induced hepatic pathogenic damage, inflammation, oxidative stress, and insulin resistance was exacerbated in zinc deficient mouse model. PLoS One 2012; 7:e49257. [PMID: 23251339 PMCID: PMC3520990 DOI: 10.1371/journal.pone.0049257] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Accepted: 10/05/2012] [Indexed: 12/31/2022] Open
Abstract
Objectives Zinc (Zn) deficiency often occurs in the patients with diabetes. Effects of Zn deficiency on diabetes-induced hepatic injury were investigated. Methods Type 1 diabetes was induced in FVB mice with multiple low-dose streptozotocin. Hyperglycemic and age-matched control mice were treated with and without Zn chelator, N,N,N′,N′-tetrakis (2-pyridylemethyl) ethylenediamine (TPEN), at 5 mg/kg body-weight daily for 4 months. Hepatic injury was examined by serum alanine aminotransferase (ALT) level and liver histopathological and biochemical changes. Results Hepatic Zn deficiency (lower than control level, p<0.05) was seen in the mice with either diabetes or TPEN treatment and more evident in the mice with both diabetes and TPEN. Zn deficiency exacerbated hepatic injuries, shown by further increased serum ALT, hepatic lipid accumulation, inflammation, oxidative damage, and endoplasmic reticulum stress-related cell death in Diabetes/TPEN group compared to Diabetes alone. Diabetes/TPEN group also showed a significant decrease in nuclear factor-erythroid 2-related factor 2 (Nrf2) expression and transcription action along with significant increases in Akt negative regulators, decrease in Akt and GSK-3β phosphorylation, and increase in nuclear accumulation of Fyn (a Nrf2 negative regulator). In vitro study with HepG2 cells showed that apoptotic effect of TPEN at 0.5–1.0 µM could be completely prevented by simultaneous Zn supplementation at the dose range of 30–50 µM. Conclusions Zn is required for maintaining Akt activation by inhibiting the expression of Akt negative regulators; Akt activation can inhibit Fyn nuclear translocation to export nuclear Nrf2 to cytoplasm for degradation. Zn deficiency significantly enhanced diabetes-induced hepatic injury likely through down-regulation of Nrf2 function.
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Affiliation(s)
- Chi Zhang
- Ruian Center of the Chinese-American Research Institute for Diabetic Complications, The Third Affiliated Hospital of the Wenzhou Medical College, Wenzhou, Zhejiang, People's Republic of China
- The Chinese-American Research Institute for Diabetic Complications, The Wenzhou Medical College, Wenzhou, Zhejiang, People's Republic of China
- Kosair Children Hospital Research Institute, at the Department of Pediatrics of University of Louisville School of Medicine, Louisville, Kentucky, United States of America
| | - Xuemian Lu
- Ruian Center of the Chinese-American Research Institute for Diabetic Complications, The Third Affiliated Hospital of the Wenzhou Medical College, Wenzhou, Zhejiang, People's Republic of China
| | - Yi Tan
- The Chinese-American Research Institute for Diabetic Complications, The Wenzhou Medical College, Wenzhou, Zhejiang, People's Republic of China
- Kosair Children Hospital Research Institute, at the Department of Pediatrics of University of Louisville School of Medicine, Louisville, Kentucky, United States of America
| | - Bing Li
- Kosair Children Hospital Research Institute, at the Department of Pediatrics of University of Louisville School of Medicine, Louisville, Kentucky, United States of America
- The Second Hospital of Jilin University, Changchun, People's Republic of China
| | - Xiao Miao
- Kosair Children Hospital Research Institute, at the Department of Pediatrics of University of Louisville School of Medicine, Louisville, Kentucky, United States of America
- The Second Hospital of Jilin University, Changchun, People's Republic of China
| | - Litai Jin
- The Chinese-American Research Institute for Diabetic Complications, The Wenzhou Medical College, Wenzhou, Zhejiang, People's Republic of China
| | - Xue Shi
- Department of Chemistry, University of Louisville, Louisville, Kentucky, United States of America
| | - Xiang Zhang
- Department of Chemistry, University of Louisville, Louisville, Kentucky, United States of America
| | - Lining Miao
- The Second Hospital of Jilin University, Changchun, People's Republic of China
| | - Xiaokun Li
- The Chinese-American Research Institute for Diabetic Complications, The Wenzhou Medical College, Wenzhou, Zhejiang, People's Republic of China
- * E-mail: (XKL); (LC)
| | - Lu Cai
- Ruian Center of the Chinese-American Research Institute for Diabetic Complications, The Third Affiliated Hospital of the Wenzhou Medical College, Wenzhou, Zhejiang, People's Republic of China
- The Chinese-American Research Institute for Diabetic Complications, The Wenzhou Medical College, Wenzhou, Zhejiang, People's Republic of China
- Kosair Children Hospital Research Institute, at the Department of Pediatrics of University of Louisville School of Medicine, Louisville, Kentucky, United States of America
- Departments of Pharmacology and Toxicology, and Radiation Oncology, the University of Louisville, Louisville, Kentucky, United States of America
- * E-mail: (XKL); (LC)
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Collier A, Ghosh S, McGlynn B, Hollins G. Prostate cancer, androgen deprivation therapy, obesity, the metabolic syndrome, type 2 diabetes, and cardiovascular disease: a review. Am J Clin Oncol 2012; 35:504-9. [PMID: 21297430 DOI: 10.1097/coc.0b013e318201a406] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Prostate cancer is the most frequently diagnosed malignancy among UK men and accounts for 12% of male deaths. Androgen deprivation therapy (ADT) is commonly used as part of the treatment for prostate cancer. It is effective at suppressing prostate-specific antigen, stabilizing disease, alleviating symptoms in advanced disease, and potentially prolonging survival. However ADT, presumably at least in part owing to low testosterone levels is associated with insulin resistance, the development of metabolic syndrome plus increased overall and cardiovascular disease mortality. We have reviewed the relationship between prostate cancer, ADT, metabolic syndrome, type 2 diabetes, and cardiovascular disease. We have not reviewed other potential medical problems such as osteoporosis. We suggest that there should be a baseline assessment of patients' risk for cardiovascular disease before starting ADT. Consideration should be given to starting appropriate therapies including lifestyle advice, antihypertensive and lipid-lowering agents, insulin sensitizer, plus possibly aspirin. Having started ADT, the patients should have a regular (possibly annual) assessment of their cardiovascular risk factors.
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Affiliation(s)
- Andrew Collier
- Department of Diabetes, The Ayr Hospital, Ayr, Scotland.
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De Cosmo S, Menzaghi C, Prudente S, Trischitta V. Role of insulin resistance in kidney dysfunction: insights into the mechanism and epidemiological evidence. Nephrol Dial Transplant 2012; 28:29-36. [PMID: 23048172 DOI: 10.1093/ndt/gfs290] [Citation(s) in RCA: 122] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Several lines of evidence suggest a pathogenic role of insulin resistance on kidney dysfunction. Potential mechanisms are mostly due to the effect of single abnormalities related to insulin resistance and clustering into the metabolic syndrome. Hyperinsulinemia, which is inevitably associated to insulin resistance in non diabetic states, also appears to play a role on kidney function by inducing glomerular hyperfiltration and increased vascular permeability. More recently, adipocytokine which are linked to insulin resistance, low grade inflammation, endothelial dysfunction and vascular damage have been proposed as additional molecules able to modulate kidney function. In addition, recent evidences point also to a role of insulin resistance at the level of the podocyte, an important player in early phases of diabetic kidney damage, thus suggesting a new mechanism through which a reduction of insulin action can affect kidney function. In fact, mouse models not expressing the podocyte insulin receptor develop podocytes apoptosis, effacement of its foot processes along with thickening of the glomerular basement membrane, increased glomerulosclerosis and albuminuria. A great number of epidemiological studies have repeatedly reported the association between insulin resistance and kidney dysfunction in both non diabetic and diabetic subjects. Among these, studies addressing the impact of insulin resistance genes on kidney dysfunction have played the important role to help establish a cause-effect relationship between these two traits. Finally, numerous independent intervention studies have shown that a favourable modulation of insulin resistance has a positive effect also on urinary albumin and total protein excretion. In conclusion, several data of different nature consistently support the role of insulin resistance and related abnormalities on kidney dysfunction. Intervention trials designed to investigate whether treating insulin resistance ameliorates also hard renal end-points are both timely and needed.
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Affiliation(s)
- S De Cosmo
- Unit of Endocrinology, IRCSS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.
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Gnudi L. Podocytes and the struggle against glucose toxicity: new targets for treatment? Metabolism 2012; 61:1051-4. [PMID: 22386941 DOI: 10.1016/j.metabol.2012.01.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 01/12/2012] [Accepted: 01/17/2012] [Indexed: 10/28/2022]
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