Analysis of the difference in the risk of chronic renal failure in the classification of type 2 diabetes according to insulin resistance and beta cell function

초록

Background This study aimed to determine whether the patterns of diabetic complications differed when patients with type 2 diabetes mellitus (T2DM) were classified according to insulin sensitivity and beta-cell function. Methods This observational study included 10,693 patients with T2DM who underwent concurrent testing for fasting glucose, fasting insulin, and one or more diabetic complications. Higher insulin resistance and beta-cell dysfunction were defined on the basis of the median values of the homeostasis model assessment for insulin resistance and beta-cell function. Results We categorized the patients into four groups according to insulin sensitivity and beta-cell function. Compared with the control group (low insulin resistance and preserved beta-cell function), the “only beta-cell dysfunction” group had no increased risk of specific diabetic complications but had a decreased risk of chronic renal failure (adjusted odds ratios [aOR] = 0.697, 95% confidence intervals [CI] = 0.506?0.961). The “only insulin resistance” group had an increased prevalence of carotid artery plaque formation (aOR = 1.228, 95% CI = 1.020?1.478) and hepatic steatosis (aOR = 1.707, 95% CI = 1.398?2.083). The “insulin resistance and beta-cell dysfunction” group had a significantly higher prevalence of neuropathy (aOR = 1.491, 95% CI = 1.163?1.910) and hepatic steatosis (aOR = 1.549, 95% CI = 1.230?1.950). After a median of nine years of follow-up, this group distinction did not lead to a difference in risk of new diabetic retinopathy, chronic kidney disease, or carotid plaque development. Conclusion The patterns of complications differ when patients with T2DM are classified according to insulin resistance and beta-cell dysfunction. However, there were no differences in the risk of developing new complications.