Endocrine Abstracts

Introduction: Patients with diabetes (DM) are at increased risk for cardiovacular disease (CVD). Possible effects of insulin therapy on development of atherosclerosis and CVD were studied.

Patients and methods: Relevant metabolic parameters were determined in 348 patients assigned into groups with DM2 on oral hypoglycemic drugs (DM2-OH) and insulin (DM2-INS), and with DM1.

Results: A significant among-group difference was found in adiponectin (ApN) (DM1 vs DM2 vs DM3=15.23±11.54 vs 7.93±5.75 vs 4.47±2.14; ANOVA: F=11.56, df=2, P<0.0001), C-reactive protein (CRP) (DM1 vs DM-OH vs DM-INS =2.14±2.42 vs 4.15±5.13 vs 2.16±2.32; F=7.27, df=2, P=0.026), high density lipoprotein (HDL) (DM1 vs DM-OH vs DM-INS =1.71±0.21 vs 1.37±0.35 vs 1.52±0.31; F=14.01, df=2, P<0.001), uric acid (UA) (DM1 vs DM-OH vs DM-INS =249.12±71.3 vs 351.4±88.1 vs 321.9±137.13; F=14.23, df=2, P<0.001) and body mass index (BMI) (DM1 vs DM-OH vs DM-INS =24.35±4.01 vs 30.45±7.17 vs 28.51±5.17; F=12.01, df=2, P<0.0001), between tested groups. Tukey post hoc test showed a significant difference (P<0.05) in ApN between DM1 and DM-OH, DM1 and DM-INS, and DM-OH and DM-INS, but not in BMI (P=0.12), CRP (P=0.21), UA (P=0.41) and HDL (P=0.89) between DM-OH and DM-INS. In DM-INS the best model (R²=0.942) for ApN included HDL (R²=0.66, P=0.002) and UA (R²=0.35, P=0.007). In DM-INS ApN correlated significantly (P<0.05) with HDL (r=0.55), FPG (r=0.42), CRP (r=0.49), and fibrinogen (FIB) (r=0.69). Duration of insulin therapy did not correlate with ApN in DM-INS (P=0.82).

Conclusions: ApN was decreased in DM-INS compared to DM-OH, which could be explained with an effect of insulin on adipocytes and C-peptide, consequently on ApN level. Decreased ApN suggests increased risk of vascular disease in insulin treated patients. HDL was among the main predictors of ApN. In DM-INS HDL was not decreased, while CRP was not increased, which could be beneficial in CVD protection.