Dutta Deep, Choudhuri Subhadip, Mondal Samim Ali, Mukherjee Satinath, Chowdhury Subhankar
Department of Endocrinology and Metabolism, Institute of Post Graduate Medical Education and Research (IPGMER) and Seth Sukhlal Karnani Memorial (SSKM) Hospital, Calcutta, India.
J Diabetes. 2014 Jul;6(4):316-22. doi: 10.1111/1753-0407.12112. Epub 2013 Dec 17.
The relationship between albumin : creatinine ratio (ACR), insulin resistance (IR), cytokines, dyslipidemia, and 25-hydroxy vitamin D (25-OHD) in individuals with prediabetes (IPD) was investigated to evaluate their role in predicting future risk of progression to diabetes.
The aforementioned parameters were evaluated in 147 IPD with persistent impaired fasting glucose and/or impaired glucose tolerance over two oral glucose tolerance tests, who were then followed up at 3-monthly intervals for progression to diabetes or reversal to normoglycemia.
Data were analyzed for 137 IPD with at least 1-year follow-up. Forty-three IPD reversed to normoglycemia (Group I), 69 continued with prediabetes (Group II), and 25 progressed to diabetes (Group III) over a mean follow-up period of 28.36 ± 8.19 months. Baseline fasting blood glucose levels (BGLs), 2-h post-glucose BGLs, and ACR were lowest in Group I and highest in Group III. Of the 137 IPD, 54.75% (n = 75) had microalbuminuria. The IPD in the lowest ACR quartile had the highest reversal to normoglycemia. Cox regression revealed that baseline IL-6 was predictive of progression to diabetes (P = 0.03) and ACR was an independent predictor of reversal to normoglycemia (P = 0.007). Kaplan-Meier analysis showed higher reversal to normoglycemia in IPD without microalbuminuria (P < 0.001).
An increased ACR is associated with higher creatinine, IR, and cytokine levels and lower 25-OHD levels in IPD. Microalbuminuria is associated with decreased reversal to normoglycemia and increased progression to diabetes. Low 25-OHD may be associated with increased progression to diabetes, perhaps via modulation of the ACR.
研究了糖尿病前期个体（IPD）中白蛋白与肌酐比值（ACR）、胰岛素抵抗（IR）、细胞因子、血脂异常和25-羟基维生素D（25-OHD）之间的关系，以评估它们在预测未来进展为糖尿病风险中的作用。
对147例在两次口服葡萄糖耐量试验中空腹血糖持续受损和/或葡萄糖耐量受损的IPD进行上述参数评估，然后每3个月随访一次，观察其进展为糖尿病或恢复正常血糖的情况。
对137例至少随访1年的IPD进行数据分析。在平均28.36±8.19个月的随访期内，43例IPD恢复正常血糖（第一组），69例继续处于糖尿病前期（第二组），25例进展为糖尿病（第三组）。第一组的基线空腹血糖水平（BGLs）、葡萄糖后2小时BGLs和ACR最低，第三组最高。137例IPD中，54.75%（n = 75）有微量白蛋白尿。ACR最低四分位数的IPD恢复正常血糖的比例最高。Cox回归显示，基线白细胞介素-6可预测进展为糖尿病（P = 0.03），ACR是恢复正常血糖的独立预测因子（P = 0.007）。Kaplan-Meier分析显示，无微量白蛋白尿的IPD恢复正常血糖的比例更高（P < 0.001）。
IPD中ACR升高与肌酐、IR和细胞因子水平升高以及25-OHD水平降低有关。微量白蛋白尿与恢复正常血糖的比例降低和进展为糖尿病的比例增加有关。低25-OHD可能与进展为糖尿病的比例增加有关，可能是通过调节ACR实现的。
