The role of microalbuminuria and insulin resistance as significant risk factors for white matter lesions in Japanese type 2 diabetic patients.
OBJECTIVE
The presence of white matter lesions (WML) is an important prognostic factor for the development of stroke. Microalbuminuria, which is associated with diabetes, has been flagged as a novel predictor for cerebrovascular events. This preliminary study was therefore designed to test the hypothesis that the presence of WML correlates with microalbuminuria and insulin resistance in patients with type 2 diabetic mellitus (DM) not receiving insulin treatment.


METHODS
Based on brain magnetic resonance imaging (MRI) findings, 90 type 2 diabetic patients were divided into two groups: a WML-positive group (57+/-8 years, mean+/-SD, n=34) and a WML-negative group (57+/-6 years, n=56). The level of blood glucose was assessed by fasting plasma glucose (FPG), fasting immunoreactive insulin (F-IRI), homeostasis model assessment (HOMA) index, and hemoglobin A(1c) (HbA1c).


RESULTS
The body mass index was higher in the WML-positive group than in the WML-negative group (p<0.01). Plasma levels of triglycerides were higher while high-density lipoprotein cholesterol (HDL-C) was lower in the WML-positive group than in the WML-negative group (p<0.05 and p<0.0001, respectively). Fasting plasma glucose (p<0.005), insulin concentrations (p<0.0001), HOMA index (p<0.0001), and urinary albumin excretion (p<0.0001) levels were higher in the WML-positive group than in the WML-negative group. Multivariate logistic analysis revealed that WML was independently predicted by the microalbuminuria and insulin resistance (p<0.005, p<0.0005, respectively).


CONCLUSIONS
The results of this preliminary study indicate that the presence of WML was associated with the microalbuminuria and insulin resistance in these Japanese patients with type 2 DM; larger cohort studies are warranted to confirm these findings.
Anan
Futoshi
F
Department of Cardiology, Oita Red Cross Hospital, Oita, Japan. anan-f@med.oita-u.ac.jp
Masaki
Takayuki
T
Iwao
Tetsu
T
Eto
Takeshi
T
Shimomura
Tsuyoshi
T
Umeno
Yoshikazu
Y
Eshima
Nobuoki
N
Saikawa
Tetsunori
T
Yoshimatsu
Hironobu
H
D000368:Aged; D000419:Albuminuria / Q000097:blood; D001927:Brain Diseases / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000652:urine; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007333:Insulin Resistance / Q000502:physiology*; D007564:Japan; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors; D020521:Stroke / Q000209:etiology