الفهرس 
INSULIN RESISTANCE AND PREDIABETESOnly 14 pages are availabe for public view
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Abstract
Systemic insulin resistance is a decreased glucose disposal rate in humans in response to defined concentrations of insulin. Systemic insulin resistance can result from impaired insulin action in metabolically active organs and tissues, including skeletal muscle, the liver, and adipose tissue. The degree to which systemic insulin resistance is due to impaired insulin action in skeletal muscle, liver, or adipose tissue may vary among individuals (Hall et al., 2020).
“Prediabetes” refers to IFG, IGT or an A1C of 6.0% to 6.4%, each of which places individuals at high risk of developing diabetes and its complications. Not all people with pre-diabetes will develop diabetes, but the majority will. In fact, up to 70% of those with pre-diabetes may acquire the disease over their lifetime. Furthermore, even when overt diabetes is delayed or prevented, both micro- and macrovascular disease appears more prevalent in those with pre-diabetes compared to their normoglycemic peers (Punthakee et al., 2018).
Obesity and overweight are defined as abnormal or excessive fat accumulation that presents a risk to health. The body mass index (BMI) is a simple index of weight-for-height that is commonly used to classify underweight, overweight and obesity. It is defined as the weight in kilograms divided by the square of the height in metres (kg/m2). A person with a BMI of 25 Kg/m2 or more is considered by WHO to be overweight, while obesity is defined as having a BMI of 30 Kg/m2 or more. Overweight and obesity are potent risk factors for cardiovascular diseases, type 2 diabetes and are major contributors to premature deaths (WHO, 2019).
Chronic kidney disease (CKD) is defined as the presence of kidney damage or an estimated glomerular filtration rate (eGFR) less than 60 ml/min/1.73 mt2. CKD is a major health problem because of its association with a high cardiovascular risk, and most CKD patients progress to end-stage renal disease (ESRD), requiring dialysis or transplantation. Diabetes mellitus is one of the most important risk factors in the development of CKD, around 30%–50% of ESRD patients worldwide come from a diabetic origin (Ruiz-Ortega et al., 2020).
In human diabetic nephropathy (DN), Nephrin mRNA was reduced in renal biopsy samples of T2DM patients compared to healthy controls by 62%. Also a reduction in Nephrin protein levels has been reported in diabetic patients with microalbuminuria and nephrotic syndrome. Nephrin expression is a marker of normal podocyte and the loss of podocytes correlating closely with disease progression. It remains unclear whether reduction of nephrin in DN is second to loss of podocyte number or reduction of nephrin expression per podocyte (Li and He, 2015).
This cross sectional observational study was conducted on 90 persons, their age ranged from 30 to70 years old from the outpatient clinic of Dar El-Shefa hospital between December 2019 till may 2020. The study was explained to all persons and, and an informed consent was obtained from them before starting the study. Subjects were be divided in to three groups, groupI (30 obese non pre diabetic patients), group II ( 30 obese pre diabetic patients) and group III ( 30 healthy control).
All patients were subjected to full history taking, full clinical examination and laboratory assessment of nephrin level in urine, fasting insulin [to calculate HOMA-IR], Hb A1C, 2HPP, fasting blood glucose, lipid profile [total cholesterol, HDL, LDL, TG], Estimated GFR, albumin/create ratio in urine and urine analysis.
Any nephrological disorder (obstructive, glomerular, tubular), Pregnant females, Smokers, Urinary tract infections, Late stage of heart failure, Late stage of liver disease, Age less than thirty or more than 75 were excluded from the study.
Our results show that there is highly statistical significant difference between the three studied groups regarding nephrin being higher in group II (obese prediabetic patients) followed by group I (obese non prediabetic patients) then group III (control group). Drawing attention to the possibility to use urinary nephrin as a marker of nephropathy in obese prediabetic patients, helping us for early detection of nephropathy, to prevent progression and improving prognosis.