Higher Blood Urea Nitrogen and Urinary Calcium: New Risk Factors for Diabetes Mellitus in Primary Aldosteronism Patients

Abstract

The aim of the study was to investigate the prevalence and risk factors of diabetes mellitus (DM) in primary aldosteronism (PA) patients.Methods: This case-control study enrolled 259 PA patients in West China Hospital, China from January 2016 to January 2019. Patients were divided into three groups: PA group, PA + impaired fasting glucose (IFG)/impaired glucose tolerance (IGT) group and PA + DM group. Clinical characteristics (like age and sex) and laboratory variables (like plasma aldosterone concentration and plasma renin activity) were compared between three groups. Univariate and multivariate logistic regression analyses were performed to determine risk factors for DM in PA patients. The association of random blood glucose with the above-mentioned factors were also investigated by Pearson correlation analyses. Nomogram model was developed to predict the probability of DM in PA patients.Results: 49 (18.9%) patients were diagnosed with DM and 22 (8.5%) with IFG/IGT in 259 PA patients. Apart from older age, male, higher body mass index, higher triglycerides and lower cholesterol, we found that higher blood urea nitrogen (BUN) and higher 24 h urinary calcium (Ca) might be potential new risk factors for dysglycemia. The nomogram model for DM in PA patients had a good predictive accuracy, with the area under the curve of receiver operating characteristic of 0.839 (95% CI 0.784-0.893).Conclusions: PA patients were more likely to have DM compared with general population. Apart from older age, overweight and dyslipidemia, higher BUN and excessive excretion of urinary Ca may also be the new potential risk factors for DM in PA patients.

<p>Association of Serum Uric Acid, Urea Nitrogen, and Urine Specific Gravity Levels at 16–18 Weeks of Gestation with the Risk of Gestational Diabetes Mellitus</p>

“… 37 Meanwhile, patients with primary aldosteronism were reported to be more likely to have DM due to increased UN levels resulting from impaired renal function, relative to the general population. 38 A study in China by Feng et al that included 13,448 eligible pregnant women, of which 2,793 had GDM, reported that elevated UN levels in early pregnancy were positively and dose-responsively correlated with an increased risk of GDM. 22 However, we detected no association between UN and GDM in either our total population or age-stratified subgroups.…”

Alteration of Gut Microbiota Relates to Metabolic Disorders in Primary Aldosteronism Patients

“…Previous studies regarded hypokalemia as a risk factor for DM. They thought that hypokalemia may decrease insulin secretion and induce insulin resistance, followed by dysbiosis of glucose metabolism (36). We found that Romboutisa and Bacteroides were more abundant in PA patients than in primary hypertension patients.…”

Mechanism exploration of Gouqi-wentang formula against type 2 diabetes mellitus by phytochemistry and network pharmacology-based analysis and biological validation

“…Of which Insulin resistance, a condition where cells become resistant to the effects of insulin and is often found in obesity, T2DM, non-alcoholic fatty liver disease, etc. [ 49 – 51 ]; for PPAR signaling pathway, which plays significantly in inflammation, insulin sensitivity, lipid metabolism, as well as the expression of hepatic enzymes regulating glucose homeostasis [ 52 , 53 ]; for FoxO signaling pathway, which controls important physiological events, including apoptosis, glucose metabolism, oxidative stress resistance, by converting the external stimuli of insulin, growth factors, cytokines, and oxidative stress into cell-specific biological responses by regulating the transcriptional activity of target genes [ 54 , 55 ]; for Fc epsilon RI signaling pathway, which contributes to inflammatory responses by regulating mediators and cytokines [ 56 , 57 ]; there are also pathways that influence diabetes primarily by regulating metabolism, such as cAMP signaling pathway [ 58 ], AMPK signaling pathway [ 59 ], Starch and sucrose metabolism [ 60 ], Carbohydrate digestion and absorption [ 61 ], Aldosterone-regulated sodium reabsorption [ 62 ], Adipocytokine signaling pathway [ 63 ]; and other T2DM directly related pathways like Insulin signaling pathway, and Type II diabetes mellitus, are involved. In addition, combined with literature search, the corresponding symptoms of these pathways were synthesized to construct the "herbs-targets-pathways- symptoms" network, which represents a global view of GQWTF in treating T2DM, with their pathways that functions and related possible symptomatic improvement.…”