Dietary sodium restriction impairs insulin sensitivity in noninsulin-dependent diabetes mellitus.
Dietary sodium restriction has a variety of effects on metabolism, including activation of the renin-angiotensin system. Angiotensin II has complex metabolic and cardiovascular effects, and these may be relevant to the effects of both nonpharmacological and pharmacological interventions in noninsulin-dependent diabetes mellitus (NIDDM). We have assessed the effect of dietary sodium restriction on insulin sensitivity and endogenous glucose production in eight normotensive patients with diet-controlled NIDDM who underwent hyperinsulinemic clamp studies in a randomized, double-blind, placebo-controlled cross-over protocol after two 4-day periods on sodium replete (160 mmol/day) and sodium deplete (40 mmol/day) diets. Mean +/- SD 24-h urinary sodium was 197 +/- 76.0 mmol (replete) and 67 +/- 19.5 mmol (deplete), P = 0.03. Insulin sensitivity was 42.0 +/- 11.3 mumol/kg.min (replete) and 37.0 +/- 11.6 mumol/kg.min (deplete), P = 0.04 (a reduction of 12%). Blood pressure was 130 +/- 21/78 +/- 11 mmHg (replete) and 128 +/- 12/73 +/- 10 mmHg (deplete). Dietary sodium restriction may result in a decrease in peripheral insulin sensitivity in normotensive patients with NIDDM, possibly via an elevation in prevailing angiotensin II concentrations.
Petrie
J R
JR
Department of Medicine and Therapeutics, West Glasgow Hospitals University NHS Trust, United Kingdom. jrp1s@clinmed.gla.ac.uk
Morris
A D
AD
Minamisawa
K
K
Hilditch
T E
TE
Elliott
H L
HL
Small
M
M
McConnell
J
J
D000368:Aged; D000450:Aldosterone / Q000097:blood; D000804:Angiotensin II / Q000097:blood; D018592:Cross-Over Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000178:diet therapy*; D004039:Diet, Sodium-Restricted; D004311:Double-Blind Method; D004573:Electrolytes / Q000097:blood; D005260:Female; D005947:Glucose / Q000096:biosynthesis; D015309:Glucose Clamp Technique; D006801:Humans; D007328:Insulin / Q000097:blood / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D010919:Placebos; D012083:Renin / Q000097:blood; D014280:Triglycerides / Q000097:blood
D004573:Electrolytes; D007328:Insulin; D010919:Placebos; D014280:Triglycerides; D000804:Angiotensin II; D000450:Aldosterone; D012083:Renin; D005947:Glucose