Association between exogenous insulin autoimmune syndrome and diabetic kidney disease

doi:10.3969/j.issn.1004-583X.2025.11.005

Abstract

Abstract:

Objective To evaluate the association between exogenous insulin autoimmune syndrome (EIAS) and renal dysfunction in patients with diabetes mellitus. Methods We consecutively enrolled patients with diabetes mellitus admitted to the Department of Endocrinology between June 2023 and March 2024 who underwent insulin autoantibody (IAA) testing. Participants were stratified into an EIAS group (IAA-positive) and a control group (IAA-negative). Clinical characteristics and urine albumin-to-creatinine ratio (ACR) were compared between groups. Patients were further categorized by albuminuria severity (ACR threshold of 30 mg/g). Univariable and multivariable logistic regression models were used to assess the relationship between EIAS and elevated ACR. Results Among 115 eligible patients, 36 (31.3%) met the diagnostic criteria for EIAS. Compared with controls, EIAS patients exhibited distinct clinical profiles: Older age, longer diabetes duration, higher daily insulin requirements, and preferential use of insulin aspart or premixed human insulin formulations (all P<0.05). EIAS patients exhibited lower fasting plasma glucose and HbA1c but higher fasting and 2-h postprandial insulin concentrations and an elevated HOMA IR (all P<0.05). In univariable logistic regression, EIAS was significantly associated with elevated ACR (OR=2.70; 95%CI: 1.20-6.60; P=0.016). However, after adjustment for age, diabetes duration, insulin dose, estimated glomerular filtration rate (eGFR), fasting glucose, fasting insulin, and HbA1c, this association was attenuated and lost statistical significance (adjusted OR=2.89; 95%CI: 0.95-8.79; P=0.062). Conclusion Diabetes mellitus patients with concomitant EIAS are more likely to experience marked glycemic variability, increased insulin resistance, and more advanced renal impairment. Clinicians should therefore be vigilant in screening for EIAS and actively manage affected patients.

Key words: insulin autoimmune syndrome, urinary albumin-to-creatinine ratio, hyperinsulinemia, insulin resistance

CLC Number:

R587.3

Ruan Peng, Tayyaba Khan, Zhang Nenghan, Zhang Chunyan, Han Tuo, Wang Congxia. Association between exogenous insulin autoimmune syndrome and diabetic kidney disease[J]. Clinical Focus, 2025, 40(11): 999-1005.

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URL: https://www.lchc.cn/EN/10.3969/j.issn.1004-583X.2025.11.005

https://www.lchc.cn/EN/Y2025/V40/I11/999

Figures/Tables 5

Tab.1 Comparison of clinical characteristics between the EIAS group and the control group

变量	总体( $n$ =115)	对照组( $n$ =79)	EIAS组( $n$ =36)	$t$ /χ²值	$P$ 值
年龄(岁)	51.3±17.6	47.1±16.3	60.8±17.0	17.004	<0.01
性别[例(%)]
男性女性	66(57.4) 49(42.6)	49(62.0) 30(38.0)	17(47.2) 19(52.8)	2.216	0.137
BMI(kg/m²)	22.9±3.3	22.6±3.2	23.5±3.5	2.133	0.147
糖尿病类型[例(%)]
T1DM	11(9.6)	8(10.1)	3(8.3)
T2DM	92(80.0)	60(75.9)	32(88.9)		0.157
LADA	12(10.4)	11(13.9)	1(2.8)
病程(年)	10.0(2.0, 16.0)	6.0(1.0, 14.0)	12.5(7.8, 20.0)	7.876	0.005
胰岛素剂量(IU)	27.0(10.0, 42.0)	20.0(0.0, 38.0)	36.5(25.5, 49.2)	11.414	<0.01
吸烟史[例(%)]	43(37.4)	33(41.8)	10(27.8)	2.069	0.150
饮酒史[例(%)]	20(17.4)	17(21.5)	3(8.3)	2.993	0.084
血小板计数(×10⁹/L)	222.6±63.6	222.8±63.5	222.2±64.6	0.002	0.962
中性粒细胞计数(×10⁹/L)	4.0±1.5	3.9±1.6	4.3±1.3	1.216	0.272
单核细胞计数(×10⁹/L)	0.4±0.1	0.4±0.1	0.4±0.1	0.001	0.971
淋巴细胞计数(×10⁹/L)	1.7±0.7	1.7±0.7	1.6±0.7	0.451	0.503
谷丙转氨酶(IU/L)	18.5(13.2, 27.8)	17.0(13.0, 27.5)	20.0(15.0, 27.5)	0.474	0.491
谷草转氨酶(IU/L)	21.9±12.3	21.8±13.8	22.1±8.2	0.022	0.883
白蛋白(g/L)	44.6±3.7	44.7±3.3	44.2±4.5	0.486	0.487
血尿酸(μmol/L)	293.5±101.3	287.9±110.0	305.6±79.1	0.687	0.409
尿素氮(mmol/L)	5.5±2.1	5.5±2.1	5.6±2.1	0.107	0.744
血肌酐(mmol/L)	66.0±27.6	63.1±28.7	72.6±23.9	2.951	0.089
肾小球滤过率[ml/(min·1.73 m²)]	99.6±25.5	105.0±25.1	87.4±22.2	11.983	<0.01
总胆固醇(mmol/L)	4.6±1.6	4.8±1.7	4.3±1.3	1.960	0.164
甘油三酯(mmol/L)	1.4(1.0, 2.1)	1.4(1.0, 2.4)	1.4(0.9, 1.7)	0.946	0.331
低密度脂蛋白胆固醇(mmol/L)	1.3±0.3	1.3±0.3	1.3±0.3	0.029	0.865
高密度脂蛋白胆固醇(mmol/L)	2.7±1.0	2.8±1.0	2.5±1.0	1.275	0.261
空腹血糖(mmol/L)	11.5±5.3	12.4±5.9	9.6±3.0	7.616	0.007
空腹胰岛素(mU/L)	4.3(2.1, 14.7)	2.9(1.3, 6.2)	13.1(5.4, 35.0)	22.303	<0.01
空腹C肽(ng/ml)	0.9(0.6, 1.6)	0.8(0.6, 1.5)	1.1(0.7, 1.8)	3.463	0.063
餐后2 h血糖(mmol/L)	15.1±4.5	15.0±4.2	15.4±5.2	0.109	0.742
餐后2 h胰岛(mU/L)	10.5(4.5, 20.4)	8.2(3.6, 14.7)	19.5(10.8, 41.8)	14.863	<0.01
餐后2 h C肽(ng/ml)	1.8(1.2, 3.0)	1.8(0.9, 2.9)	2.1(1.5, 3.5)	2.546	0.111
糖化血红蛋白(%)	9.4±2.3	9.9±2.5	8.3±1.6	13.022	<0.01
HOMA-IR	2.3(0.9, 6.1)	1.8(0.7, 3.6)	6.1(2.3, 14.2)	17.133	<0.01
ACR(mg/g)	17.1(7.1, 83.5)	14.8(6.6, 53.9)	51.8(8.1, 114.6)	4.034	0.045
ACR分级[例(%)]
<30 mg/g	67(58.3)	52(65.8)	15(41.7)
[30, 300) mg/g	35(30.4)	20(25.3)	15(41.7)		0.051
≥300 mg/g	13(11.3)	7(8.9)	6(16.7)

Tab.1 Comparison of clinical characteristics between the EIAS group and the control group

变量	总体( $n$ =115)	对照组( $n$ =79)	EIAS组( $n$ =36)	$t$ /χ²值	$P$ 值
年龄(岁)	51.3±17.6	47.1±16.3	60.8±17.0	17.004	<0.01
性别[例(%)]
男性女性	66(57.4) 49(42.6)	49(62.0) 30(38.0)	17(47.2) 19(52.8)	2.216	0.137
BMI(kg/m²)	22.9±3.3	22.6±3.2	23.5±3.5	2.133	0.147
糖尿病类型[例(%)]
T1DM	11(9.6)	8(10.1)	3(8.3)
T2DM	92(80.0)	60(75.9)	32(88.9)		0.157
LADA	12(10.4)	11(13.9)	1(2.8)
病程(年)	10.0(2.0, 16.0)	6.0(1.0, 14.0)	12.5(7.8, 20.0)	7.876	0.005
胰岛素剂量(IU)	27.0(10.0, 42.0)	20.0(0.0, 38.0)	36.5(25.5, 49.2)	11.414	<0.01
吸烟史[例(%)]	43(37.4)	33(41.8)	10(27.8)	2.069	0.150
饮酒史[例(%)]	20(17.4)	17(21.5)	3(8.3)	2.993	0.084
血小板计数(×10⁹/L)	222.6±63.6	222.8±63.5	222.2±64.6	0.002	0.962
中性粒细胞计数(×10⁹/L)	4.0±1.5	3.9±1.6	4.3±1.3	1.216	0.272
单核细胞计数(×10⁹/L)	0.4±0.1	0.4±0.1	0.4±0.1	0.001	0.971
淋巴细胞计数(×10⁹/L)	1.7±0.7	1.7±0.7	1.6±0.7	0.451	0.503
谷丙转氨酶(IU/L)	18.5(13.2, 27.8)	17.0(13.0, 27.5)	20.0(15.0, 27.5)	0.474	0.491
谷草转氨酶(IU/L)	21.9±12.3	21.8±13.8	22.1±8.2	0.022	0.883
白蛋白(g/L)	44.6±3.7	44.7±3.3	44.2±4.5	0.486	0.487
血尿酸(μmol/L)	293.5±101.3	287.9±110.0	305.6±79.1	0.687	0.409
尿素氮(mmol/L)	5.5±2.1	5.5±2.1	5.6±2.1	0.107	0.744
血肌酐(mmol/L)	66.0±27.6	63.1±28.7	72.6±23.9	2.951	0.089
肾小球滤过率[ml/(min·1.73 m²)]	99.6±25.5	105.0±25.1	87.4±22.2	11.983	<0.01
总胆固醇(mmol/L)	4.6±1.6	4.8±1.7	4.3±1.3	1.960	0.164
甘油三酯(mmol/L)	1.4(1.0, 2.1)	1.4(1.0, 2.4)	1.4(0.9, 1.7)	0.946	0.331
低密度脂蛋白胆固醇(mmol/L)	1.3±0.3	1.3±0.3	1.3±0.3	0.029	0.865
高密度脂蛋白胆固醇(mmol/L)	2.7±1.0	2.8±1.0	2.5±1.0	1.275	0.261
空腹血糖(mmol/L)	11.5±5.3	12.4±5.9	9.6±3.0	7.616	0.007
空腹胰岛素(mU/L)	4.3(2.1, 14.7)	2.9(1.3, 6.2)	13.1(5.4, 35.0)	22.303	<0.01
空腹C肽(ng/ml)	0.9(0.6, 1.6)	0.8(0.6, 1.5)	1.1(0.7, 1.8)	3.463	0.063
餐后2 h血糖(mmol/L)	15.1±4.5	15.0±4.2	15.4±5.2	0.109	0.742
餐后2 h胰岛(mU/L)	10.5(4.5, 20.4)	8.2(3.6, 14.7)	19.5(10.8, 41.8)	14.863	<0.01
餐后2 h C肽(ng/ml)	1.8(1.2, 3.0)	1.8(0.9, 2.9)	2.1(1.5, 3.5)	2.546	0.111
糖化血红蛋白(%)	9.4±2.3	9.9±2.5	8.3±1.6	13.022	<0.01
HOMA-IR	2.3(0.9, 6.1)	1.8(0.7, 3.6)	6.1(2.3, 14.2)	17.133	<0.01
ACR(mg/g)	17.1(7.1, 83.5)	14.8(6.6, 53.9)	51.8(8.1, 114.6)	4.034	0.045
ACR分级[例(%)]
<30 mg/g	67(58.3)	52(65.8)	15(41.7)
[30, 300) mg/g	35(30.4)	20(25.3)	15(41.7)		0.051
≥300 mg/g	13(11.3)	7(8.9)	6(16.7)

Tab.2 Use of hypoglycemic drugs in the EIAS and control groups(n, %)

降糖药物	总体( $n$ =115)	对照组( $n$ =79)	EIAS组( $n$ = 36)	χ²值	$P$ 值
门冬胰岛素	57(49.6)	34(43)	23(63.9)	4.301	0.038
甘精胰岛素	46(40.0)	28(35.4)	18(50.0)	2.184	0.139
赖脯胰岛素	8(7.0)	6(7.6)	2(5.6)	-	0.999
地特胰岛素	13(11.3)	7(8.9)	6(16.7)	-	0.223
德古胰岛素	40(34.8)	31(39.2)	9(25.0)	2.211	0.137
预混人胰岛素	19(16.5)	9(11.4)	10(27.8)	4.814	0.028
二甲双胍	59(51.3)	43(54.4)	16(44.4)	0.987	0.320
α糖苷酶抑制剂	31(27.0)	21(26.6)	10(27.8)	0.018	0.893
钠-葡萄糖共转运蛋白2抑制剂	16(13.9)	10(12.7)	6(16.7)	0.332	0.565
二肽基肽酶4抑制剂	13(11.3)	9(11.4)	4(11.1)	-	1.000
磺脲类	5(4.3)	3(3.8)	2(5.6)	-	0.648
噻唑烷二酮类	5(4.3)	5(6.3)	0(0.0)	-	0.323
胰高血糖素样肽1受体激动剂	8(7.0)	5(6.3)	3(8.3)	-	0.704

Tab.2 Use of hypoglycemic drugs in the EIAS and control groups(n, %)

降糖药物	总体( $n$ =115)	对照组( $n$ =79)	EIAS组( $n$ = 36)	χ²值	$P$ 值
门冬胰岛素	57(49.6)	34(43)	23(63.9)	4.301	0.038
甘精胰岛素	46(40.0)	28(35.4)	18(50.0)	2.184	0.139
赖脯胰岛素	8(7.0)	6(7.6)	2(5.6)	-	0.999
地特胰岛素	13(11.3)	7(8.9)	6(16.7)	-	0.223
德古胰岛素	40(34.8)	31(39.2)	9(25.0)	2.211	0.137
预混人胰岛素	19(16.5)	9(11.4)	10(27.8)	4.814	0.028
二甲双胍	59(51.3)	43(54.4)	16(44.4)	0.987	0.320
α糖苷酶抑制剂	31(27.0)	21(26.6)	10(27.8)	0.018	0.893
钠-葡萄糖共转运蛋白2抑制剂	16(13.9)	10(12.7)	6(16.7)	0.332	0.565
二肽基肽酶4抑制剂	13(11.3)	9(11.4)	4(11.1)	-	1.000
磺脲类	5(4.3)	3(3.8)	2(5.6)	-	0.648
噻唑烷二酮类	5(4.3)	5(6.3)	0(0.0)	-	0.323
胰高血糖素样肽1受体激动剂	8(7.0)	5(6.3)	3(8.3)	-	0.704

Fig.1 Comparison of ACR levels and grades between the EIAS group and the control group

Tab.3 Comparison of clinical characteristics between different ACR subgroups

变量	总体( $n$ =115)	ACR<30 mg/g( $n$ =67)	ACR≥30 mg/g( $n$ =48)	$t$ /χ²值	$P$ 值
年龄(岁)	51.3±17.6	46.6±16.2	57.9±17.6	12.530	<0.01
性别[例(%)]
男性女性	66(57.4) 49(42.6)	37(55.2) 30(44.8)	29(60.4) 19(39.6)	0.308	0.579
BMI(kg/m²)	22.9±3.3	22.7±3.0	23.2±3.7	0.579	0.448
糖尿病类型[例(%)]
T1DM	11(9.6)	7(10.4)	4(8.3)
T2DM	92(80.0)	52(77.6)	40(83.3)		0.785
LADA	12(10.4)	8(11.9)	4(8.3)
病程(年)	10.0(2.0, 16.0)	7.0(1.0, 12.5)	10.5(5.0, 20.0)	7.025	0.008
胰岛素剂量(IU)	27.0(10.0, 42.0)	26.0(0.0, 40.5)	30.0(14.8, 46.2)	1.543	0.214
吸烟史[例(%)]	43(37.4)	23(34.3)	20(41.7)	0.643	0.423
饮酒史[例(%)]	20(17.4)	12(17.9)	8(16.7)	0.030	0.862
血小板计数(×10⁹/L)	222.6±63.6	224.3±68.2	220.1±57.0	0.122	0.728
中性粒细胞计数(×10⁹/L)	4.0±1.5	3.9±1.6	4.2±1.3	1.234	0.269
单核细胞计数(×10⁹/L)	0.4±0.1	0.4±0.1	0.4±0.1	3.659	0.058
淋巴细胞计数(×10⁹/L)	1.7±0.7	1.7±0.6	1.8±0.8	0.834	0.363
谷丙转氨酶(IU/L)	18.5(13.2, 27.8)	19.0(13.0, 26.5)	17.0(14.0, 28.0)	0.010	1.000
谷草转氨酶(IU/L)	21.9±12.3	20.2±7.7	24.3±16.7	3.055	0.083
白蛋白(g/L)	44.6±3.7	45.1±3.1	43.9±4.3	2.982	0.087
血尿酸(μmol/L)	293.5±101.3	280.7±96.4	311.2±106.3	2.337	0.129
尿素氮(mmol/L)	5.5±2.1	5.0±1.6	6.2±2.5	9.870	0.002
血肌酐(mmol/L)	66.0±27.6	60.9±17.0	73.3±36.9	5.847	0.017
肾小球滤过率[ml/(min·1.73 m²)]	99.6±25.5	105.4±23.0	91.6±26.9	8.073	0.005
总胆固醇(mmol/L)	4.6±1.6	4.3±1.1	5.0±2.0	5.989	0.016
甘油三酯(mmol/L)	1.4(1.0, 2.1)	1.4(0.9, 1.9)	1.5(1.1, 2.5)	1.196	0.274
低密度脂蛋白胆固醇(mmol/L)	1.3±0.3	1.2±0.3	1.3±0.3	0.511	0.476
高密度脂蛋白胆固醇(mmol/L)	2.7±1.0	2.6±0.9	2.9±1.1	2.612	0.109
空腹血糖(mmol/L)	11.5±5.3	11.6±5.5	11.5±5.2	0.006	0.938
空腹胰岛素(mU/L)	4.3(2.1, 14.7)	3.2(2.0, 8.4)	5.6(2.6, 31.9)	4.781	0.029
空腹C肽(ng/ml)	0.9(0.6, 1.6)	0.8(0.6, 1.5)	1.0(0.6, 1.7)	0.235	0.628
餐后2 h血糖(mmol/L)	15.1±4.5	15.6±5.1	14.4±3.3	1.731	0.191
餐后2 h胰岛(mU/L)	10.5(4.5, 20.4)	11.1(6.0, 20.1)	8.7(2.8, 21.2)	0.258	0.612
餐后2 h C肽(ng/ml)	1.8(1.2, 3.0)	2.0(1.3, 3.0)	1.6(1.0, 3.2)	0.932	0.334
糖化血红蛋白(%)	9.4±2.3	9.2±2.2	9.7±2.5	1.125	0.291
HOMA-IR	2.3(0.9, 6.1)	1.9(0.8, 4.2)	3.3(1.0, 12.6)	4.632	0.031
ACR(mg/g)	17.1(7.1, 83.5)	7.7(5.1, 13.1)	100.5(58.9, 444.1)	83.173	<0.01
EIAS[例(%)]	36(31.3)	15(22.4)	21(43.8)	5.934	0.015

Tab.3 Comparison of clinical characteristics between different ACR subgroups

变量	总体( $n$ =115)	ACR<30 mg/g( $n$ =67)	ACR≥30 mg/g( $n$ =48)	$t$ /χ²值	$P$ 值
年龄(岁)	51.3±17.6	46.6±16.2	57.9±17.6	12.530	<0.01
性别[例(%)]
男性女性	66(57.4) 49(42.6)	37(55.2) 30(44.8)	29(60.4) 19(39.6)	0.308	0.579
BMI(kg/m²)	22.9±3.3	22.7±3.0	23.2±3.7	0.579	0.448
糖尿病类型[例(%)]
T1DM	11(9.6)	7(10.4)	4(8.3)
T2DM	92(80.0)	52(77.6)	40(83.3)		0.785
LADA	12(10.4)	8(11.9)	4(8.3)
病程(年)	10.0(2.0, 16.0)	7.0(1.0, 12.5)	10.5(5.0, 20.0)	7.025	0.008
胰岛素剂量(IU)	27.0(10.0, 42.0)	26.0(0.0, 40.5)	30.0(14.8, 46.2)	1.543	0.214
吸烟史[例(%)]	43(37.4)	23(34.3)	20(41.7)	0.643	0.423
饮酒史[例(%)]	20(17.4)	12(17.9)	8(16.7)	0.030	0.862
血小板计数(×10⁹/L)	222.6±63.6	224.3±68.2	220.1±57.0	0.122	0.728
中性粒细胞计数(×10⁹/L)	4.0±1.5	3.9±1.6	4.2±1.3	1.234	0.269
单核细胞计数(×10⁹/L)	0.4±0.1	0.4±0.1	0.4±0.1	3.659	0.058
淋巴细胞计数(×10⁹/L)	1.7±0.7	1.7±0.6	1.8±0.8	0.834	0.363
谷丙转氨酶(IU/L)	18.5(13.2, 27.8)	19.0(13.0, 26.5)	17.0(14.0, 28.0)	0.010	1.000
谷草转氨酶(IU/L)	21.9±12.3	20.2±7.7	24.3±16.7	3.055	0.083
白蛋白(g/L)	44.6±3.7	45.1±3.1	43.9±4.3	2.982	0.087
血尿酸(μmol/L)	293.5±101.3	280.7±96.4	311.2±106.3	2.337	0.129
尿素氮(mmol/L)	5.5±2.1	5.0±1.6	6.2±2.5	9.870	0.002
血肌酐(mmol/L)	66.0±27.6	60.9±17.0	73.3±36.9	5.847	0.017
肾小球滤过率[ml/(min·1.73 m²)]	99.6±25.5	105.4±23.0	91.6±26.9	8.073	0.005
总胆固醇(mmol/L)	4.6±1.6	4.3±1.1	5.0±2.0	5.989	0.016
甘油三酯(mmol/L)	1.4(1.0, 2.1)	1.4(0.9, 1.9)	1.5(1.1, 2.5)	1.196	0.274
低密度脂蛋白胆固醇(mmol/L)	1.3±0.3	1.2±0.3	1.3±0.3	0.511	0.476
高密度脂蛋白胆固醇(mmol/L)	2.7±1.0	2.6±0.9	2.9±1.1	2.612	0.109
空腹血糖(mmol/L)	11.5±5.3	11.6±5.5	11.5±5.2	0.006	0.938
空腹胰岛素(mU/L)	4.3(2.1, 14.7)	3.2(2.0, 8.4)	5.6(2.6, 31.9)	4.781	0.029
空腹C肽(ng/ml)	0.9(0.6, 1.6)	0.8(0.6, 1.5)	1.0(0.6, 1.7)	0.235	0.628
餐后2 h血糖(mmol/L)	15.1±4.5	15.6±5.1	14.4±3.3	1.731	0.191
餐后2 h胰岛(mU/L)	10.5(4.5, 20.4)	11.1(6.0, 20.1)	8.7(2.8, 21.2)	0.258	0.612
餐后2 h C肽(ng/ml)	1.8(1.2, 3.0)	2.0(1.3, 3.0)	1.6(1.0, 3.2)	0.932	0.334
糖化血红蛋白(%)	9.4±2.3	9.2±2.2	9.7±2.5	1.125	0.291
HOMA-IR	2.3(0.9, 6.1)	1.9(0.8, 4.2)	3.3(1.0, 12.6)	4.632	0.031
ACR(mg/g)	17.1(7.1, 83.5)	7.7(5.1, 13.1)	100.5(58.9, 444.1)	83.173	<0.01
EIAS[例(%)]	36(31.3)	15(22.4)	21(43.8)	5.934	0.015

Tab.4 Univariate and multivariate logistic regression of ACR elevation

变量	单因素回归		多因素回归
变量	$O R$ (95% $C I$ )	$P$ 值	$O R$ (95% $C I$ )	$P$ 值
年龄	1.04(1.02~1.07)	0.001	1.04(0.99~1.09)	0.100
DM病程	1.07(1.02~1.12)	0.005	1.06(0.98~1.15)	0.171
胰岛素剂量	1.01(0.99~1.03)	0.253	1.00(0.98~1.02)	0.968
肾小球滤过率	0.98(0.96~0.99)	0.008	0.98(0.96~1.01)	0.179
空腹血糖	1.00(0.93~1.07)	0.937	1.04(0.92~1.16)	0.549
空腹胰岛素	1.01(1.00~1.03)	0.095	1.00(0.99~1.01)	0.923
糖化血红蛋白	1.09(0.93~1.28)	0.289	1.46(1.10~1.93)	0.008
EIAS	2.70(1.20~6.06)	0.016	2.89(0.95~8.79)	0.062

Tab.4 Univariate and multivariate logistic regression of ACR elevation

变量	单因素回归		多因素回归
变量	$O R$ (95% $C I$ )	$P$ 值	$O R$ (95% $C I$ )	$P$ 值
年龄	1.04(1.02~1.07)	0.001	1.04(0.99~1.09)	0.100
DM病程	1.07(1.02~1.12)	0.005	1.06(0.98~1.15)	0.171
胰岛素剂量	1.01(0.99~1.03)	0.253	1.00(0.98~1.02)	0.968
肾小球滤过率	0.98(0.96~0.99)	0.008	0.98(0.96~1.01)	0.179
空腹血糖	1.00(0.93~1.07)	0.937	1.04(0.92~1.16)	0.549
空腹胰岛素	1.01(1.00~1.03)	0.095	1.00(0.99~1.01)	0.923
糖化血红蛋白	1.09(0.93~1.28)	0.289	1.46(1.10~1.93)	0.008
EIAS	2.70(1.20~6.06)	0.016	2.89(0.95~8.79)	0.062

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