Insulin resistance in cardiovascular disease, uremia, and peritoneal dialysis.

Autor: Lambie M; Faculty of Medicine and Health Sciences, Keele University, Keele ST5 5BG, UK., Bonomini M; Department of Medicine, G. d'Annunzio University, Chieti 66100, Italy., Davies SJ; Faculty of Medicine and Health Sciences, Keele University, Keele ST5 5BG, UK., Accili D; Columbia University College of Physicians and Surgeons, Department of Medicine, New York, NY 10032, USA., Arduini A; R&D Department, CoreQuest Sagl, Lugano CH6900, Switzerland., Zammit V; Translational & Experimental Medicine, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK. Electronic address: V.A.Zammit@warwick.ac.uk.
Jazyk: angličtina
Zdroj: Trends in endocrinology and metabolism: TEM [Trends Endocrinol Metab] 2021 Sep; Vol. 32 (9), pp. 721-730. Date of Electronic Publication: 2021 Jul 12.
DOI: 10.1016/j.tem.2021.06.001
Abstrakt: Diabetic nephropathy is highly correlated with the occurrence of other complications of type 1 diabetes (T1D) and type 2 diabetes (T2D) mellitus; for example, hypertension with cardiovascular disease (CVD) being the most frequent cause of death in patients with end-stage renal disease and undergoing renal dialysis. Hyperglycemia and insulin resistance (IR) are responsible for the micro- and macrovascular complications of diabetes through different mechanisms. In particular, IR plays a key role in the etiology of atherosclerosis in both diabetic and non-diabetic patients. IR - exacerbated by organ-level selectivity - is more important than glycemic control per se in determining cardiovascular outcomes. This may be exacerbated by the fact that IR is organ and pathway specific due to the only selective loss of sensitivity to insulin action of specific pathways/processes. Therefore, it is counterintuitive that the use of peritoneal dialysis (PD) in (frequently) diabetic renal disease patients should involve their exposure to high daily doses of glucose peritoneally. In view of the controversy about the causal association between glucose load and CVD in PD patients, we discuss the role that selective IR may play in the progression of CVD in diabetic renal end-stage patients. In discussing these associations, we propose that reducing glucose exposure in PD solutions may be beneficial especially if coupled with strategies that address IR directly, and the avoidance of excessive use of insulin treatment in T2D.
Competing Interests: Declaration of interests A.A. is an employee of Iperboreal Pharma srl, Italy. M.L. has received speaker’s honoraria from Baxter Healthcare and Fresenius Medical Care and an unrestricted research grant in 2013 from Baxter Healthcare. S.J.D. is an Advisory Board Member for Baxter Healthcare and Ellen Medical.
(Copyright © 2021 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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