There is contradictory information relating to insulin sensitivity in NIDDM patients with microalbuminuria. The numerous clinical and epidemiological investigations have revealed a greater insulin resistance in these patients. However on the ground of the Nielsen and co-workers observations it has been ascertained that the level of insulin sensitivity is similar in exactly selected NIDDM patients with normo- and microalbuminuria. It suggests, that the increased cardiovascular morbidity and mortality among microalbuminuric NIDDM patients may not primarily be a consequence of more pronounced levels of hyperinsulinemia or insulin resistance. The influence of environmental factors may aggravate resident insulin resistance, elevate albuminuria, and may cause itself an increased cardiovascular risk.
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