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Front. Physiol. | doi: 10.3389/fphys.2018.01666

Associations of insulin levels and insulin resistance with urine glucose excretion independent of blood glucose in Chinese adults with prediabetes and newly diagnosed diabetes

 Juan Chen1, Shanhu Qiu2, Haijian Guo3,  Wei Li4 and  Zilin Sun2*
  • 1School of Medicine, Southeast University, China
  • 2Department of Endocrinology, Zhongda Hospital, Southeast University, China
  • 3Jiangsu Provincial Center for Disease Control And Prevention, China
  • 4Southeast University, China

Several studies have demonstrated that renal glucose reabsorption is increased in patients with type 2 diabetes. However, the increased renal glucose reabsorption may contribute to the progression of hyperglycemia. Therefore, promoting urine glucose excretion (UGE) by suppression of renal glucose reabsorption is an attractive approach for the treatment of diabetes. Insulin resistance is identified as a major characteristic in the pathogenesis of type 2 diabetes. Thus, our aim was to evaluate the association of UGE with serum insulin levels and insulin resistance in subjects with glucose abnormalities, including prediabetes and newly diagnosed diabetes (NDD). The present study included 1129 subjects, 826 individuals with prediabetes and 303 individuals with NDD. Urine samples were collected within 2 h of oral glucose loading for the measurement of glucose. Fasting serum insulin was measured. Homeostatic model assessment of insulin resistance (HOMA-IR) was assessed. Multiple linear regression analysis and multivariate logistic regression analysis were performed to determine the association of UGE with insulin levels and HOMA-IR. A negative association between serum insulin levels and UGE was observed. The relationship still remained significant after adjustment for potential confounders, such as age, gender, blood pressure and glucose (β = -5.271, 95% CI: -9.775 to -0.767, p = 0.022). Furthermore, multivariable logistic regression model showed that increased insulin levels were associated with a decreased risk for high UGE (HUGE) after multivariable adjustment. In addition, similar correlation was also observed between HOMA-IR and UGE. HOMA-IR was negatively correlated with UGE after controlling for potential confounders. Moreover, an independent inverse relationship between HOMA-IR and the risk of HUGE was found (OR = 0.85, 95% CI: 0.78-0.93, p < 0.001). In conclusion, the insulin levels and HOMA-IR were negatively correlated with UGE after adjusting for potential confounders. Subjects with increased insulin levels or IR were at a decreased risk of HUGE independent of blood glucose. The study suggests that insulin may affect UGE through other ways, in addition to the direct blood glucose-lowering effect, thereby resulting in reduced UGE.

Keywords: Diabetes Mellitus, Glycosuria, urine glucose excretion, Insulin, Insulin Resistance

Received: 17 Sep 2018; Accepted: 05 Nov 2018.

Edited by:

George Grant, University of Aberdeen, United Kingdom

Reviewed by:

Vivek Bhalla, Stanford University, United States
Biagio Arcidiacono, Università degli studi Magna Græcia di Catanzaro, Italy  

Copyright: © 2018 Chen, Qiu, Guo, Li and Sun. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Prof. Zilin Sun, Department of Endocrinology, Zhongda Hospital, Southeast University, Nanjing, Jiangsu Province, China, sunzilin1963@126.com