Attenuation of vasopressin-induced antidiuresis in poorly controlled type 2 diabetes

Amar Agha, Diarmuid Smith, Francis Finucane, Mark Sherlock, Andrew Morris, Peter Baylis, Christopher J. Thompson*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Renal resistance to vasopressin has been demonstrated in type 1 diabetes and in type 2 diabetes with nephropathy. However, renal response to vasopressin in type 2 diabetes without nephropathy has not been studied. We studied 10 subjects with poorly controlled type 2 diabetes (PCDS; Hb A1c >9%), 10 subjects with well-controlled type 2 diabetes (WCDS; Hb A ic <7%), and 10 matched nondiabetic control subjects (NDCS) during a euglycemic 8-h water deprivation test. None of the subjects had nephropathy. Water deprivation caused similar rises in plasma vasopressin concentrations in all three groups, but the rise in urine osmolality in PCDS (280.3 ± 49.7 to 594.4 ± 88.5 mosmol/kgH2O) was lower than in WCDS (360.7 ± 142.8 to 794.1 ± 77.3 mosmol/kgH2O, P < 0.001) or NDCS (336.0 ± 123.3 to 786.5 ± 63.3 mosmol/kgH2O, P = 0.019). Total urine output was higher in the PCDS than in WCDS and NDCS (P < 0.05). Linear regression analysis showed that, in PCDS, the osmotic thresholds for thirst (291.9 ± 4.6 mosmol/kgH2O) and vasopressin release (291.1 ± 2.9 mosmol/kgH2O) were higher compared with WCDS (286.6 ± 1.8 and 286.0 ± 3.6 mosmol/kgH2O, respectively) and NDCS (286.0 ± 2.4 and 284.1 ± 4.7 mosmol/kgH2O, respectively) (between groups P < 0.001 for both variables). Under conditions of euglycemia, PCDS have impaired renal response to vasopressin and elevated osmotic threshold for thirst and vasopressin release in response to dehydration. Under conditions of chronic hyperglycemia, these abnormalities may significantly contribute to the development of dehydration in PCDS.

Original languageEnglish
JournalAJP - Endocrinology and Metabolism
Volume287
Issue number6 50-6
DOIs
Publication statusPublished - 1 Dec 2004

Keywords

  • osmoregulation

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