engleski

Adiponectin is differently associated with nephropathy in type 1 and type 2 diabetes

Background and aims: The aim of this study was to compare the relation between adiponectin and nephropathy in type 1 and type 2 diabetes. Materials and methods: ApN, C-reactive protein (CRP), fibrinogen (FIB), homocysteine (HCY), lipoprotein(a) [Lp(a)], creatinine clearance (CrCl), creatinine, fasting (fPG) and postprandial plasma glucose (ppPG), glycated haemoglobin (A1c), blood pressure (BP), liver function, lipids, ferritin, uric acid (UA), creatine phosphokinase and leucocyte count (WBC) were determined in 164 patients with type 1 (DM1) and type 2 diabetes (DM2). The patients were assigned to subgroups based on their 24-h albumin excretion rate (AER) [<30 (NA), 30-300 (MI), >300 (MA)] and CrCl (normal >0.83 mL/sec for women and >1.17 mL/sec for men (CrCl1)). Differences between types of DM were tested using Student t test or Mann Whitney test if assumption of homogeneity of variance was not met. Differences between ApN according to AER and CrCl were tested using factorial analysis of variance. Results: Statistically significant differences were found among ApN values according to AER (F=8, 45, df=2, p<0.001) in DM1 (NA=12.37±6.62, MI=21.38±7.98 and MA=31.85±18.05) and DM2 (NA=9.05±5.63, MI=7.46±4.58 and MA=5.26±3.3). A statistically significant difference in ApN between the types of DM (F=73.402, df=1 ; p<0.001), and an interaction between DM type and AER (F=18.12, df=2 ; p<0.001) were also observed. DM1 had significantly higher ApN than DM2. Significant within-group differences for ApN were found in DM1 between the NA and MI, and the NA and MA subgroups using Tukey post hoc test, while between-group differences in ApN were found in the MI and MA subgroups of DM1 and DM2. In a model for ApN as a dependent variable and the type of DM, CrCl and interaction DM type and CrCl as factors, a statistically significant difference was found for all analysed factors. ApN was found to be higher in CrCl2 than in CrCl1 (F=12.7, df=1, p<0.001) in both types of diabetes (DM1: CrCl1=13.9±7.93 vs. CrCL2=23±12.8 and DM2: CrCl1=7.63±4.76 vs. CrCl2=9.86±6.25). Post hoc test showed that ApN was significantly increased in both CrCl subgroups of DM1 as compared to DM2. In a model for Lp(a) as a dependent variable and the type of DM (F=0.82 ; df=1 ; p=0.37), AER (F=0.21, df=2, p=0.81) and interaction between DM type and AER (F=0.06 ; df=2 ; p=0.93) as factors, there were no statistically significant differences. After stepwise regression in DM1 for ApN, the best model (R2=0.9002) included CrCl, BMI, LDL, WBC, CRP and age, whereas in DM2 the best model (R2=0.2882) included ppPG, LDL, and UA. In DM1 ApN correlated significantly (p<0.05) with HCY (r=0.57), CrCL (r=-0.61), AER (r=0.61) and creatinine (r=0.40), and in DM2 with HCY (r=0.25), CrCl (r=-0.22), creatinine (r=0.20) and diastolic BP (r=-0.19). ApN and HDL were significantly increased (p<0.001) in DM1, whereas CRP (p=0.04), FIB (p<0.001), HCY (p<0.001) and gamma-glutamyl-transpeptidase (p<0.05) were significantly increased in DM2. Conclusion: ApN was increased in both DM1 and DM2 in the subgroups with decreased CrCl, but with a different albuminuria-related behaviour, showing an increase with a progression of albuminuria in DM1, and a decrease with a progression of albuminuria in DM2. Other inflammatory markers were decreased in DM1. The interaction between renal insufficiency and albumin loss appears to significantly affect ApN level, which is consistent with different courses of nephropathy in DM1 and DM2.

adiponectin; diabetes mellitus; nephropathy; albuminuria

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