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[IP] Kidney Disease in People With Type 1 Diabetes

Just read this article this morning.  With the recent discussions on kidney
disease on IP I thought tthis would be of interest to the group

Denise Guerin

Type 1 48 years

Kidney Disease in People With Type 1 Diabetes Is Related to How Well Insulin
Works, Say University of Pittsburgh Researchers

Source: University of Pittsburgh Graduate School of Public Health


Insulin resistance, a condition commonly associated with the development of
type 2 diabetes, is likely a major cause of kidney disease, or nephropathy, in
people with type 1 diabetes, according to study results published by
University of Pittsburgh Graduate School of Public Health (GSPH) researchers
in the September 2002 issue of Kidney International, a journal of the
International Society of Nephrology.

"Kidney disease is a major lethal complication for people with diabetes,
particularly those with type 1 diabetes, and until now there has been no clear
explanation for its cause beyond blood sugar itself," said principal
investigator Trevor Orchard, M.D., professor and acting chair, department of
epidemiology, GSPH. "We now suspect that reducing or preventing insulin
resistance, possibly through exercise, weight loss and drugs, may help people
with type 1 diabetes avoid nephropathy."

The study analyzed data from the Pittsburgh Epidemiology of Diabetes
Complication Study (PEDCS), a 10-year prospective investigation based on a
cohort of adults with type 1, or childhood-onset, diabetes. Of the 658
subjects in PEDCS, 485 did not have nephropathy at baseline and were followed
for the current study.

Fifty-six of the 485 subjects developed nephropathy during either the first
five years of follow-up, or during years 6-10. Researchers found that in all
cases, strong relationships existed between nephropathy and insulin resistance
throughout follow up, unlike other risk factors such as blood pressure and
blood fats, which only predicted nephropathy in the short term.

To measure insulin resistance, investigators used a novel calculation based on
waist-to-hip ratio, hypertension status and long-term blood sugar levels.

"Although our measure of insulin resistance is an estimate based on
easier-to-measure factors, it is strongly correlated with the gold standard -
euglycemic clamp studies - and clearly stands out as the leading predictor of
kidney disease in this study," said Dr. Orchard.

Other risk factors in those that developed nephropathy included elevated LDL
("bad") cholesterol, triglycerides, white blood cell count (a marker of
inflammation) and blood pressure.

"The good news is that not all people with type 1 diabetes are insulin
resistant, and for them the risk of kidney disease now appears to be low," Dr.
Orchard said. "Even for someone with type 1 diabetes who is genetically
predisposed to insulin resistance, the secret to avoiding nephropathy may well
be to prevent insulin resistance through lifestyle changes such as proper
diet, exercise, smoking cessation and perhaps medication.

"Another intriguing finding from this study is that since insulin resistance
also predicts heart disease," Dr. Orchard continued, "it may explain the
longstanding observation that in type 1 diabetes, kidney disease predicts
heart disease. In other words, insulin resistance may be the 'common ground'
for both complications."

Investigators also examined genetic markers of risk and found that three
markers linked to blood pressure and blood fats also predicted kidney

Insulin resistance results when insulin fails to enable cells to admit
glucose, necessary for cells' energy production. Glucose then builds up in the
blood, and additional insulin is required.

Up to 40 percent of people with type 1 diabetes develop kidney disease, in
which the kidneys' tiny blood vessels are damaged and unable to filter wastes
and excess water from the blood. Untreated, nephropathy leads to end stage
renal disease (ESRD), in which the kidneys' entire filtration system closes
down and the kidneys fail to function. A patient with ESRD requires dialysis
or a kidney transplant to live.

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