Abstract
Diabetic kidney disease (DKD) remains a leading cause of end-stage renal disease (ESRD) and mortality in the Western world. Early DKD, including albuminuria and hyperfiltration, are common in adolescents with type 1 diabetes (T1D) and type 2 diabetes (T2D). Because DKD is characterized by a long clinically silent period without overt signs of disease, a major challenge in preventing DKD is the difficulty in identifying high-risk patients at an early stage when injury may be reversible and responsive to therapy.The relationship between insulin sensitivity and DKD is increasingly recognized in both T1D and T2D, but the underlying mechanisms remain unclear. In this review, we examine the literature on insulin sensitivity and renal health and focus on data in youth. We also summarize the potential pathways and mechanisms underlying the relationship between insulin sensitivity and DKD and how these may be exploited as therapeutic targets in the future.
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