Dr. Ron’s Research Review – August 3, 2016

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This week’s research review focuses on insulin resistance testing.

Estimates based on fasting insulin concentration may not adequately capture insulin resistance because they largely reflect hepatic defects. Static tests assess insulin sensitivity in the fasting state, in which insulin sensitivity is largely determined by the ability of insulin to regulate hepatic glucose production, thereby reflecting primarily hepatic insulin resistance.
Dynamic tests assess insulin sensitivity when the body is challenged with glucose or insulin. In this setting, glucose is primarily disposed of in skeletal muscle, and results largely reflect peripheral insulin resistance.
The kidney plays a major role in the metabolism of insulin. It removes an estimated 30–80% of insulin in the systemic circulation. The kidney also clears C-peptide. (Pham et al., 2011)

Dr. Ron


 

Articles

Measurement of insulin resistance in chronic kidney disease.
            (Pham et al., 2011) Download
PURPOSE OF REVIEW:  Insulin resistance is a known complication of end-stage renal disease that also appears to be present in earlier stages of chronic kidney disease (CKD). It is a risk factor for cardiovascular disease and an important potential therapeutic target in this population. Measurement of insulin resistance is reviewed in the context of known pathophysiologic abnormalities in CKD. RECENT FINDINGS:  Insulin resistance in CKD is due to a high prevalence of known risk factors (e.g. obesity) and to unique metabolic abnormalities. The site of insulin resistance in CKD is localized to skeletal muscle. Estimates based on fasting insulin concentration may not adequately capture insulin resistance in CKD because they largely reflect hepatic defects and because CKD impairs insulin catabolism. A variety of dynamic tests are available to directly measure insulin-mediated glucose uptake. SUMMARY:  Insulin resistance may be an important therapeutic target in CKD. Complementary methods are available to assess insulin resistance, and each method has unique advantages, disadvantages, and levels of complexity. These characteristics, and the likelihood that CKD alters the performance of some insulin resistance measurements, must be considered when designing and interpreting clinical studies.

 

References

Pham, H, KM Utzschneider, and IH de Boer (2011), ‘Measurement of insulin resistance in chronic kidney disease.’, Curr Opin Nephrol Hypertens, 20 (6), 640-46. PubMed: 21885970