title: Adiponectin is positively associated with insulin resistance in subjects with type 2 diabetic nephropathy and effects of angiotensin II type 1 receptor blocker losartan.
abstract: BACKGROUND
  Plasma adiponectin concentration is inversely associated with renal function. There is little literature on adiponectin levels and regulation by anti-hypertensive medication with an angiotensin II type 1 receptor blocker (ARB), especially in subjects with type 2 diabetes in different stages of chronic kidney disease (CKD).
  
  
  METHODS
  Eighty subjects with type 2 diabetic nephropathy were randomly divided into two groups: losarten group (n = 41) and amlodipine group (n = 39). Fasting blood was drawn to determine HbA1c, insulin and adiponectin levels. Insulin resistance was calculated using fasting glucose and insulin, expressed as HOMA-IR. For assessment of the relationship between adiponectin and other parameters, Pearson sample correlation coefficients were used. After stratification, ARB losartan (100 mg daily) was administered for a period of 6 months.
  
  
  RESULTS
  There is a positive association between adiponectin and proteinuria, fasting insulin levels and HOMA-IR in both CKD stage 1-2 and stage 3-4. Baseline adiponectin levels were not related to baseline estimated glomerular filtration rate (eGFR). At baseline, the adiponectin concentration was high in all observed subjects, and after 3 and 6 months of treatment with losartan, adiponectin levels decreased in the losartan group as compared with the amlodipine group (P < 0.01). Also fasting insulin and HOMA-IR decreased during the 6-month follow-up compared with the control group (P < 0.01).
  
  
  CONCLUSIONS
  Our results demonstrate that serum adiponectin levels in type 2 diabetic nephropathy are strongly positively associated with fasting insulin levels and insulin resistance. Declines in fasting insulin and HOMA-IR by losartan are accompanied by decreased adiponectin levels, might offer potential protection in humans. The paradoxical phenomenon merits further ascertainment in future studies.
authors.affiliation: Hemodialysis Center, Bao Shan Branch of Shanghai No. 1 People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Li Li
authors.initials: LL
authors.lastname: Guo
authors.forename: Yu
authors.initials: Y
authors.lastname: Pan
authors.forename: Hui Min
authors.initials: HM
authors.lastname: Jin
mesh_terms: D052242:Adiponectin / Q000097:blood; D000328:Adult; D000368:Aged; D017311:Amlodipine / Q000627:therapeutic use; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use*; D001794:Blood Pressure; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000188:drug therapy* / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000097:blood* / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007328:Insulin / Q000008:administration & dosage; D007333:Insulin Resistance / Q000502:physiology*; D007676:Kidney Failure, Chronic / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology; D019808:Losartan / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011507:Proteinuria / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000188:drug therapy / Q000503:physiopathology; D012084:Renin-Angiotensin System / Q000187:drug effects / Q000502:physiology
chemical_list: C499918:ADIPOQ protein, human; D052242:Adiponectin; D047228:Angiotensin II Type 1 Receptor Blockers; D007328:Insulin; D017311:Amlodipine; D019808:Losartan