Research on Insulin Resistance and Chronic Kidney Disease in Patients with Type 1 Diabetes Mellitus

Background and Aims: The purpose of the study was to determine the prevalence of CKD in T1DM
and the correlation with insulin resistance (IR) in patients with CKD.
Materials and Methods: The study was conducted over a period of three years (2010–2013) and
included patients with DM registered in the Clinical Centre of Diabetes, Nutrition and Metabolic
Diseases of Dolj county. The study design was an epidemiological, transversal, noninterventional
type. Finally, the study group included 200 subjects with type 1 DM. Insulin resistance (IR) was
estimated by eGDR. The subjects with eGDR ≤7.5 mg/kg/min were considered with insulin resistance.
Results: CKD was found in 44% of the patients. Analyzing statistically the presence of CKD, we
found highly significant differences between patients with CKD and those without CKD regarding age
and sex of the patients, the duration of diabetes, glycosylated hemoglobin (HbA1c), the estimated
glucose disposal rate (eGDR), and the presence of hypertension, dyslipidemia, and hyperuricemia. In
patients with CKD, age and diabetes duration are significantly higher than in those who do not have
this complication. CKD is more frequent in males than in females (50.9% men versus 34.5% women,
= 0.022). From the elements of metabolic syndrome, high blood pressure, hyperuricemia, and
dyslipidemia are significantly increased in diabetic patients with CKD. eGDR value (expressed as
mg⋅kg−1⋅min−1) is lower in patients with CKD than in those without CKD (15.92 versus 6.42, < 0.001)
indicating the fact that patients with CKD show higher insulin resistance than those without CKD.
Conclusions: This study has shown that insulin resistance is associated with an increased risk of
CKD, but, due to the cross-sectional design, the causal relationship cannot be assessed. However,
the existence of this causality and the treatment benefit of insulin resistance in type 1 diabetes are
issues for further discussion. In conclusion, our study has shown that insulin resistance is a constant
factor associated with CKD in type 1 DM and it may be useful in the future for CKD screening.