Title of Thesis

Relationship of Microalbuminuria in Patients of Type 2 Diabetes with Insulin Resistance and Gender Difference in this Association

Abstract

Insulin resistance i s considered as a fundamental component of the pathogenesis of type 2 diabetes. People have suggested the possibility that treating and modifying insulin resistance in patients of type 2 diabetes would improve urine albumin excretion. This study was planned with an objective to investigate the relationship of insulin resistance with microalbuminuria in patients of type 2 diabetes mellitus and observe any difference between men and women in this association, in Pakistani population. This study was carried out and Diabetes clinic of Combined Military Hospital, Malir Cantt, from April 2007 to August 2007. One hundred and fifty five patients of type 2 diabetes mellitus were included in the study that had either microalbuminuria or normoalbuminuria. Body mass index, waist circumference and blood pressure were recorded. Fasting venous blood sample was collected for plasma glucose (FPG), serum insulin, total and HDL cholesterol, triglycerides, creatinine and HbA1c. Urine albumin excretion was determined using urine albumin to creatinine ratio. Insulin resistance was calculated from fasting plasma glucose and serum insulin levels, using homeostatic model assessment of insulin resistance (HOMA-IR). Microalbuminuria was found to be significantly correlated with HOMA-IR (r = 0.33, p = < 0.0001), serum insulin (r = 0.28, p = < 0.001), body mass index (r = 0.18, p = 0.02) and waist circumference (r = 0.21, p = 0.008). This correlation was more significant in women (n = 85, r =  0.48, p = < 0.0001) as compared to men (n = 70, r = 0.14, p = 0.12). The correlation between HOMA-IR and urine albumin excretion remained highly significant (p = 0.001) after controlling for gender, age, duration of diabetes, waist circumference, hypertension, triglycerides and HbA1c. 6 HOMA-IR was also significantly correlated with waistcircumference (r = 0.24, p = 0.001), BMI (r = 0.16, p = 0.02), triglycerides (r = 0.22, p = 0.003), HDL cholesterol (r = 0.18, p = 0.01), HbA1c (r = 0.35, p = < 0.0001), FPG (r = 0.44, p = < 0.0001) and metabolic syndrome (r = 0.18, p = 0.01) The study concludes that urine albumin excretion in patients of type 2 diabetes is strongly associated with insulin resistance and related cardiovascular risk factors. This association appears to be stronger in women than men, in our population.

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