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Adiponectin is Decreased in Insulin-treated Type 2 Diabetic Patients Compared to Those on Oral Hypoglycemic Drugs

Adiponectin (ApN) was studied in type 2 diabetic patients on oral hypoglycemic drugs (DM2) and insulin (DM3), and in type 1 patients (DM1). We determined ApN, C-reactive protein (CRP), fibrinogen (FIB), homocysteine (HCY), fasting plasma glucose (fPG), glycated hemoglobin (A1c), systolic (SBP) and diastolic (DBP) blood pressure, liver function tests, lipid values, uric acid (UA), and albumin/creatinine (A/C) ratio in 248 patients. DM3 group had been on insulin ≥2 years. A significant among-group difference was found in ApN (DM1 vs DM2 vs DM3 = 14.22±11.64 vs 8.23±5.55 vs 4.87±2.23 ; ANOVA: F=11.46, df=2, p<0.0001), CRP (DM1 vs DM2 vs DM3 = 2.04±2.52 vs 4.02±5.62 vs 2.07±2.12 ; F=7.17, df=2, p=0.027), high density lipoprotein (HDL) (DM1 vs DM2 vs DM3 = 1.69±0.31 vs 1.38±0.37 vs 1.59±0.24 ; F=13.93, df=2, p<0.001), UA (DM1 vs DM2 vs DM3 = 255.12±68.3 vs 336.4±87.1 vs 312.9±139.02 ; F=14.45, df=2, p<0.001) and BMI (DM1 vs DM2 vs DM3 = 24.20±3.06 vs 30.35±6.02 vs 28.81±4.18 ; F=11.91, df=2, p<0.0001), but not in FIB and HCY. Tukey post hoc test showed a significant difference (p<0.05) in ApN between DM1 and DM2, DM1 and DM3, and DM2 and DM3, but not in BMI (p=0.13), CRP (p=0.23), UA (p=0.38) and HDL (p=0.92) between DM2 and DM3. In DM1 the best model (R2=0.952) for ApN included FIB (R2=0.45, p<0.001), fPG (R2=0.38, p<0.01) and ALT (R2=0.11, p=0.03) ; in DM2 it included HDL (R2=0.55, p<0.0001) and ALT (R2=0.32, p<0.001), and in DM3 HDL (R2=0.65, p=0.002) and UA (R2=0.31, p=0.007). In DM1 ApN correlated significantly (p<0.05) with BMI (r=-0.40) and HDL (r=0.40), in DM2 (p<0.05) with HDL (r=0.57), ALT (-r=0.39) and A/C ratio (r=0.51), and in DM3 (p<0.05) with fPG (r=0.56), CRP (r=0.41), FIB (r=0.67) and HDL (r= 0.55). Duration of insulin therapy did not correlate with ApN in DM3 (p=0.84). ApN was decreased in DM3 compared to DM2, which could be due to a suppressive effect of insulin on ApN production in adipocytes. This suggests a possible increased risk of vascular disease in these patients. HDL was among the main predictors of ApN. In DM3 it was not decreased, while CRP was not increased, which could be beneficial in vascular protection.

adiponectin; insulin-therapy; type II diabetes; inflammatory markers

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