engleski

Adipocytokines and obesity are associated with endothelial dysfunction and retinopathy development in type 1 diabetes

Purpose. To investigate the relationship between adipocytokines, obesity and endothelial function, and their association with diabetic retinopathy (DR) in patients with type 1 diabetes. Methods. This cross- sectional study included 189 type 1 diabetic patients (109M/80F) with median age 46 years and median diabetes duration 13 years. Glycated hemoglobin (HbA1c), total cholesterol, HDL and LDL cholesterol, triglycerides (TG) and serum creatinine were determined using routine laboratory methods. Urinary albumin excretion rate (UAE) was measured from a 24- hr urine sample. Adiponectin, leptin and resistin were determined by ELISA method. Anthropometric parameters assessed were body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR). Central augmentation index (cAIx) and pulse wave velocity (PWV) were obtained using SphygmoCor device. Ophthalmologic examination included color fundus photography according to the EURODIAB methodology. Patients with severe nonproliferative DR (NPDR) or proliferative DR were not included in the study. Results. Patients were divided into two groups: group 1 (no retinopathy ; n=157) and group 2 (mild/moderate NPDR ; n=32). The groups did not differ in the values of metabolic markers, serum creatinine, UAE and adiponectin. Group 2 had longer diabetes duration (p<0.001), marginally higher leptin (p=0.058) and resistin (p=0.051), and higher BMI (p=0.002), WC (p<0.001), WHR (p=0.001), cAIx (p=0.007) and PWV (p<0.001) than group 1. Adiponectin was negatively correlated with leptin (p=0.041), resistin (p=0.052), BMI, WC and WHR (p<0.001), while leptin was positively correlated with BMI (p<0.001) and WHR (p=0.002). cAIx was positively related to diabetes duration (p=0.001), leptin (p<0.001), WHR (p=0.049) and DR (p<0.007), and negatively to adiponectin (p<0.001). PWV was positively related to diabetes duration (p<0.001), leptin (p=0.007), resistin (p=0.051), BMI, WC and DR (p<0.001). Logistic regression analyses showed that diabetes duration (OR=1.11, p<0.001) was the main predictor of DR in patients with type 1 diabetes. However, after adjustment for diabetes duration, adiponectin (OR=0.93, p=0.055), leptin (OR=1.03, p=0.050), resistin (OR=1.23, p=0.045), BMI (OR=1.16, p=0.004) and WC (OR=1.05, p=0.004) also showed increased risk for DR in these patients. Conclusions. This study showed that the association between adipocytokines and obesity plays an important role in endothelial impairment involved in the pathogenesis of retinopathy in type 1 diabetes.

diabetic retinopathy, type 1 diabetes, adipocytokines, obesity

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