Lambie, MR ORCID: https://orcid.org/0000-0002-6285-5368, Bonomini, M, Davies, SJ ORCID: https://orcid.org/0000-0001-5127-4755, Accili, D, Arduini, A and Zammit, V (2021) Insulin resistance in cardiovascular disease, uremia, and peritoneal dialysis. Trends in Endocrinology and Metabolism, 32 (9). 721 - 730.

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Lambie et al TEM March 2021 Revised by AA_MB_ML_SD.docx - Accepted Version
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Abstract

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.

Item Type: Article
Additional Information: The final version of this accepted manuscript is available directly from the publishers. Please refer to any relevant terms of reference.
Uncontrolled Keywords: insulin resistance; peritoneal dialysis; diabetes; cardiovascular disease; uremia
Subjects: R Medicine > R Medicine (General)
R Medicine > RC Internal medicine > RC666 Diseases of the circulatory (Cardiovascular) system
Divisions: Faculty of Medicine and Health Sciences > School of Pharmacy and Bioengineering
Related URLs:
Depositing User: Symplectic
Date Deposited: 16 Sep 2021 08:38
Last Modified: 16 Sep 2021 08:38
URI: https://eprints.keele.ac.uk/id/eprint/10024

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