title: Estimated insulin sensitivity predicts regression of albuminuria in Type 1 diabetes.
abstract: OBJECTIVE
  To test the hypothesis that greater baseline insulin sensitivity would predict regression of albuminuria over 6 years in adults with Type 1 diabetes.
  
  
  METHODS
  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.
authors.affiliation: Department of Paediatrics, University of Colorado School of Medicine, Aurora, CO, USA.
authors.forename: P
authors.initials: P
authors.lastname: Bjornstad
authors.forename: D M
authors.initials: DM
authors.lastname: Maahs
authors.forename: R J
authors.initials: RJ
authors.lastname: Johnson
authors.forename: M
authors.initials: M
authors.lastname: Rewers
authors.forename: J K
authors.initials: JK
authors.lastname: Snell-Bergeon
mesh_terms: D000328:Adult; D000419:Albuminuria / Q000150:complications / Q000453:epidemiology / Q000517:prevention & control*; D015331:Cohort Studies; D003120:Colorado / Q000453:epidemiology; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy; D003928:Diabetic Nephropathies / Q000453:epidemiology / Q000517:prevention & control*; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control*; D007333:Insulin Resistance; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human